Request UC Assistance

**PLEASE NOTE: This form is only applicable for people who live in 161st District. To find out in which district you live and how to reach out to your state representative, please click here.

Under certain circumstances, our office can send a Legislative Inquiry to the Department of Labor and Industry so that your UC claim can be reviewed by a UC investigator.

** If your claim is under review, appeal, or adjudication do not fill out this form, our office cannot submit a legislative inquiry. Please visit: Appeals ( **

Before you complete the form, check this list of issues and links to resolve them:

If your claim issue is not listed above, please complete and submit this form:

Alternate phone:

Address on claim if different from current address. (Please include City, State, and ZIP Code)

New address (if change is needed) Street, City, State and Zip

Last Four Digits of SSN: *

Please reenter last 4 digits of SSN to verify *

Did you receive a Financial Determination Letter? *

Were you found financially eligible for benefits?

If you were found ineligible for benefits, and you disagree, did you file an appeal?

If you filed an appeal, on what date (MM/DD/YYYY)?

Have you successfully filed your first weekly claim? *

If you have successfully filed a weekly claim, are you still awaiting payment after 7 business days?

If yes, list the date(s) of the week(s) you filed but did not receive payment and, if you worked during any of those weeks, your earnings for each week. If you have not yet filed a weekly claim, enter “NONE.” *

Did you work in a state other than Pennsylvania? For more information on Interstate, Commuter or Combined Wage claims: *

Have you reached out to another office for help with your unemployment? *

If yes, whose office and date contacted?

Is your claim under review, appeal or adjudication? If yes, do not submit this form. *