Form UB-106-A-FF at a glance
What it is: Form UB-106-A-FF is the Weekly Claim for Unemployment Insurance (UI) Benefits of the Arizona Department of Economic Security.
Who signs: The claimant signs at Claimant's Signature, claiming benefits for the calendar week that ended on Saturday midnight.
To receive UI Benefits, you must file a weekly claim each week. A determination on your eligibility will not be made until you file a weekly claim. All weekly claims are for a calendar week which starts at 12:01 a.m. Sunday and ends at 12:00 midnight on the following Saturday. Weekly claims cannot be filed until after the calendar week has ended. Pages 1-3 are instructions. Complete, sign and return pages 4-5 only.
Your weekly certification cannot be processed unless both pages are returned.
A filled-in Form UB-106-A-FF example: a part-time worker files a weekly claim
How to fill out Form UB-106-A-FF, box by box
Name, Claimant ID Number and week dates
Enter your Name and Claimant ID Number, then the Week Beginning Date (Must be a Sunday) and the Week Ending Date (Must be a Saturday).
Your Claimant ID number can be found at the top of any document the Department has sent to you.
1. Physically and mentally able to work
Yes - I was physically and mentally able to look for and/or accept work each workday during the week.
No - I was not physically and/or mentally able to look for and/or accept work each workday during the week. If No, check all the reasons that apply: Illness or Injury, Disability, Physical Limitations, Pregnancy, Mental Limitations.
2. Available for work
Yes - I was available to look for and/or accept work each workday during the week.
No - I was not available to look for and/or accept work each workday during the week. If No, check all the reasons that apply: Lack of Transportation, Lack of Childcare, Domestic Responsibility, llness of Family Member, Leave of Absence, Jury Duty/Other Public Service, Caring for Family Member, Military Obligations, Out of Area, or Other Reasons Explain.
3. Incarcerated in a correctional facility or detention center
Yes - I was incarcerated for more than 24 hours during the week. No - I was not incarcerated, or I was incarcerated for less than 24 hours during the week.
4. Did you start school or training
Yes - I started school or training, or my class schedule changed during the week. No - I did not start school or training and my current class schedule did not change during the week.
5. Did you look for work
5. Did you look for work during the week? (If No, you must answer 5a.) (You must report your work search efforts; 4 job contacts or reemployment activities on 4 different days are required.) To be considered as actively seeking work you must make at least 4 job contacts or reemployment activities on 4 different days of the week. Not meeting the work search requirements will result in a disqualification from receiving unemployment benefits and you may have to pay back any benefits you have received.
Yes - I completed 4 job contacts and/or reemployment activities on 4 different days. (You can attach supporting documentation with this weekly claim.)
No - I did not complete 4 job contacts/reemployment activities on 4 different days.
If you did not look for work or meet the required contacts, you will be disqualified until you are reemployed and earn 8 times your weekly benefit amount.
5a. Skip filing for the week
5a. If No, do you choose to skip filing for the week because you did not meet the work search requirements?
Yes - I did not look for work or meet the required contacts. I want to skip filing. (If you choose to skip filing for the week, you do not need to answer the remaining questions. Go to the bottom of page 5 and sign and date.)
No - I did look for work or meet the required contacts. I want to continue filing.
Work search efforts
If you do not choose to skip filing for the week, you must report your work search efforts. Contact Details (Email, Phone Number, Contact Person, etc.) Name of Employer/Company/ Union and Address (City, State and ZIP Code) Method (Email, Website, Phone, In Person, Fax) Job Title or Type of Work Action Taken on the Date of Contact Date.
Include the employer's name and address or website URL (www.example.com).
6. Refused job offers or referrals to work
6. Did you refuse any job offers or referrals to work during the week? (If Yes, you must answer 6a. and 6a1.)
Yes - I refused a job offer or a referral to work during the week.
No - I did not refuse a job offer or a referral to work during the week.
6a. Refusal reason and name and phone number of the company
6a. Check the refusal reason appropriate for your situation: Refused a Job Offer or Refused a Referral to Work. (You must answer 6a1. as well) 6a1. Name and phone number of the company:
7. Work or earn any money
7. During this week, did you work or earn any money, including part-time work? (If yes, you must answer 7a. and 7b.)
Any work you performed and all wages you earned before deductions must be reported when you file your weekly claim, even if you have not been paid at the time you file.
Yes - I worked or earned money during the week. No - I did not work or earn any money during the week.
7a. Gross earnings and employer information
7a. Enter your gross earnings (before taxes and/or deductions) and employer information. Amount Earned (Before Deductions) Name and Address of Employer (City, State and ZIP Code) Method (Email, Website, Phone, In Person, Fax) Contact Details (Email, Phone Number, Contact Person, etc.) Job Title or Type of Work.
7b. Are you still working?
7b. Are you still working? (Answer Yes if you are still working with any of the employers. If No, check the reason for separation, and answer 7b1. and 7b2.)
Yes - You are still working with any employer. (If Yes, move on to question 8.)
No - Your employment ended for one of the reasons. (You will also need to answer 7b1. and 7b2.) Reasons: Laid Off/Lack of Work, Quit/Resigned, Fired/Discharged, Union Strike/Labor Dispute, Leave of Absence, Suspended from Work.
7b1. Name of employer and 7b2. last day of work
7b1. Name of employer you separated from: Provide the name and address of the employer as it is shown on your paystub.
7b2. What was your last day of work? Provide the last day you physically performed work for this employer.
8. Returned to full-time work
8. Have you returned to full-time work which will not require you to file any further weekly claims at this time? If you fail to report earnings or otherwise make false statements about your eligibility, you could be disqualified from receiving future benefit payments, have to pay back your previous payments plus penalties, and may face criminal prosecution.
Yes - You have returned to full time work and will no longer need to continue filing weekly claims.
No - You are still unemployed and wish to continue filing weekly claims.
Claimant's Signature and the certification
By signing you certify that you were registered for work and unemployed, that the statements are true and correct to the best of your knowledge, and that you have reported all changes in writing. The law provides penalties for false statements made in connection with this claim and if any issues arise from your answers, the department will contact you.
Each false statement or representation or failure to disclose a material fact will be a separate offense.
Common questions about Form UB-106-A-FF
Where do I file it?
When completed, fax to: 602-364-1210 or 602-364-1211 (Phoenix) 520-770-3357 or 520-770-3358 (Tucson). You may also mail to: Arizona Department of Economic Security Unemployment Insurance Benefits P.O. Box 29225 MD 5895 Phoenix, AZ 85038-9225.
Is there a penalty?
Any person who knowingly makes a false statement or knowingly withholds information to get UI benefits commits a criminal offense and may be subject to a fine, imprisonment, restitution, and loss of future benefits. It is a felony to misrepresent or fail to disclose facts or to make false statements in order to obtain or increase benefits.
Sources
[1] Form UB-106-A-FF (12/25), Weekly Claim for Unemployment Insurance (UI) Benefits, Arizona Department of Economic Security (the Official source link on this page).
