(English) Retroactive PUA – Fact-finding content
Form intro content plus all 19 eligibility questions, each accompanied by legally compliant helper text optimized to increase readability, comprehension, and accuracy of responses.
View all Retroactive PUA Eligibility materials as Google Documents and download in your preferred format.
Form Intro Content
Issue: [INSERT ISSUE NAME]
Slug: PUA Expanded Eligibility (2020)
Title: Background
We are reaching out to you because we recognize you as someone who was previously denied PUA eligibility in our records, but may be now eligible for payments based on expanded eligibility provisions for PUA in the past year.
These provisions apply retroactively to the beginning of the PUA program. As a result, you must respond to the following questions to establish eligibility even if you answered them in the past. You will also recognize previous questions found on weekly claim forms. Certify for all weeks and make sure to answer questions 17 to19 related to the newest eligibility provisions covering:
Individuals who refuse to return to work that is unsafe or to accept an offer of new work that is unsafe;
Certain individuals providing services to educational institutions or educational service agencies;
Individuals experiencing a reduction of hours, or a temporary or permanent layoff.
Note: individuals who did not file an initial PUA claim on or before December 27, 2020 are limited to weeks of unemployment beginning on or after December 6, 2020.
Unless you absolutely need to, please do not call us with questions. Most questions are answered on our website. You should be able to complete this form on your own.
Form Questions 1-19 + Helper Text
1. Did your place of employment close as a direct result of the COVID-19 public health emergency?
Answer yes if:
your place of employment closed due to the COVID-19 public health emergency
you cannot return to regular hours of work due to the COVID-19 emergency declaration or social distancing protocols
Answer no if:
your place of employment did not close at any time during the COVID-19 public health emergency
your place of employment closed but you can return to regular hours of work this week
your place of business closed for reasons not related to the COVID-19 emergency declaration or social distancing protocols
2. Are you an independent contractor or self-employed individual, and has the COVID-19 public health emergency severely limited your ability to do your customary work activities?
Answer yes if:
you are an independent contractor or self-employed individual AND had a reduction in your usual work to the point you were forced to suspend activities during this week
Answer no if:
you are not an independent contractor or self-employed individual
you are an independent contractor or self-employed individual, and you have been able to work your regular number of hours this week
you are an independent contractor or self-employed individual, and you can perform your customary work activities (business is not significantly slower than normal)
3. Are you unable to work from home or anywhere because you are the main caregiver to a child or household member who needs your constant and ongoing care; and they cannot attend school, daycare or other facility that is closed as a direct result of the COVID-19 public health emergency?
Answer yes if:
you cannot work because you need to provide ongoing and constant care to a child or household
you do not receive paid leave benefits under the Families First Coronavirus Responses Act (FFCRA)
the school, daycare or other facility is closed due to the COVID-19 public health emergency (school is considered closed when it is fully online and does not provide in-person classes, or it offers a mixture of online and in-person classes with students attending some days remotely)
Answer no if:
you can work from home while being the main caregiver to a child or household member
the school, daycare or other facility is open
you chose to allow the child to attend class remotely (school is considered open when it requires students to be physically present or when students have the option to stay home and attend online classes or school in-person full time)
4. Are you unable to reach your place of employment because of a quarantine imposed by a state or municipal order restricting travel as a result of the COVID-19 public health emergency?
Answer yes if:
your county is restricting travel and therefore you are not able to work
Answer no if:
your county is not in a phase where travel is restricted
5. Are you unable to reach your place of work because you have been advised by a healthcare provider to self-quarantine due to concerns related to COVID-19?
Answer yes if:
you were advised to self-quarantine during this week due to COVID-19
Answer no if:
you have not been advised to self-quarantine this week due to COVID-19
6. Were you scheduled to start a job in Washington state but no longer have the job or are unable to reach the job as a direct result of the COVID-19 public health emergency?
Answer yes if:
you were hired and scheduled to start a job, but no longer have or cannot reach that job due to the COVID-19 public health emergency
Answer no if:
you were not hired and scheduled to start a job
you are employed and can reach your job
7. Did you have to quit as a direct result of COVID-19?
Answer yes if:
you quit your job as a direct result of COVID-19
Answer no if:
you did not have to quit your job due to COVID-19
you quit your job due to COVID-19 but can return to work this week
8. Were you diagnosed with COVID-19?
Answer yes if:
you were diagnosed with COVID-19 and are still unable to return to work (a qualifying diagnosis does not require a positive test. Any diagnosis from a qualified medical professional, including one made via phone or telehealth, is sufficient.)
Answer no if:
you were diagnosed with COVID-19 but were able to return to work this week
you were not diagnosed with COVID-19
9. Do you have symptoms of COVID-19 and are seeking a medical diagnosis?
Answer yes if:
you had COVID-19 symptoms, were seeking a medical diagnosis, and were unable to return to work for this reason
Answer no if:
you did not have COVID-19 symptoms
you had COVID-19 symptoms but did not seek a medical diagnosis
you had COVID-19 symptoms, sought a medical diagnosis, and were able to return to work because your diagnosis was negative
10. Has an individual in your household been diagnosed with COVID-19?
Answer yes if:
someone in your household has been diagnosed with COVID-19 and you are unable to return to work this week for this reason
Answer no if:
no one in your household has been diagnosed with COVID-19
11. Are you providing constant and ongoing care for a family member or household member who has been diagnosed with COVID-19?
Answer yes if:
you provide constant and ongoing care for a family or household member who has COVID-19
Answer no if:
you do not provide constant and ongoing care to a family or household member who has COVID-19
12. Did you become the breadwinner or major support for a household because the head of household died as a direct result of COVID-19?
Answer yes if:
you became a major source of income for your household and are unable to find work
Answer no if:
you became a major source of income due and are employed this week
you did not become a major source of income after the head of household died
13. Were you offered the option to telework (work remotely or from home) for your usual number of hours with pay during the COVID-19 public health emergency?
Answer yes if:
you received the option to telework and you can do so this week for your usual number of hours with pay
Answer no if:
you did not receive the option to telework by your usual employer
14. Can you telework (work remotely or from home) this week for your usual number of hours with pay during the COVID-19 public health emergency?
Answer yes if:
you can telework your usual number of hours with pay this week
Answer no if:
you cannot telework your usual number of hours with pay this week
you cannot telework because you are providing constant and ongoing care for your children while schools or daycares are closed
you cannot telework due to the nature of your job (for example, if you work in construction or at a restaurant)
you cannot telework due to domestic violence, sexual violence, or stalking
15. Did you apply for or receive any private income protection insurance or supplemental unemployment benefits?
Answer yes if:
you received private income protection insurance from sources such as Aflac, MetLife, The Standard, or Guardian
you received supplemental unemployment benefits, where the employer often pays the premiums when unemployment is due to illness, injury, or a reduction in the workforce
Answer no if:
none of the above applies
16. Have you applied for or received unemployment benefits from another state or the U.S. Railroad Retirement Board in the last 12 months?
Answer yes if:
you received unemployment benefits, including extensions from any state or the Railroad Retirement Board
Answer no if:
you did not receive unemployment benefits, including extensions from any state or the Railroad Retirement Board
17. Have you been denied continued unemployment benefits because you refused to return to work or accept an offer of work at a worksite that is not in compliance with local, state, or national health and safety standards directly related to COVID-19? This includes, but is not limited to, those related to facial mask wearing, physical distancing measures, or the provision of personal protective equipment consistent with public health guidelines.
Answer yes if:
your unemployment benefits stopped because you refused to go back to a worksite that was non-compliant
your unemployment benefits stopped because you would not accept a new job opportunity at a worksite that was non-compliant
Answer no if:
you continued to receive unemployment benefits
your unemployment benefits stopped for reasons other than the above
18. Did you provide services to an educational institution or educational service agency, and you are unemployed or partially unemployed because of volatility in the work schedule directly caused by the COVID-19 public health emergency? This includes, but is not limited to, changes in schedules and partial closures.
Answer yes if:
you provided services to the above, including K-12 schools, private and public colleges; AND
you are unemployed or partially unemployed because of changes in your work schedule as a direct result of the COVID-19 public health emergency (the state considers whether you are claiming a week that is between or within academic terms and, if you are, whether you have a contract or a job is available for you to return to in the following academic year or term.)
Answer no if:
you provided services to the above but are still working or partially employed
you did not provide services to any of the above employers
19. Are you an employee and your hours have been reduced, or you were laid off as a direct result of the COVID-19 public health emergency?
Answer yes if:
your hours were reduced due to the COVID-19 public health emergency
you were laid off as a direct result of the COVID-19 public health emergency
you were laid off but could not claim regular unemployment benefits because you did not make enough to qualify, were previously disqualified, or exhausted all other benefits available to you
Answer no if:
your hours were not reduced due to the COVID-19 public health emergency
you were not laid off
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