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How to use or fill out backdate request with our platform
- Click ‘Get Form’ to open the backdate request in the editor.
- Begin by filling out the Applicant Information section. Enter your first name, middle name, last name, mailing address, and the last four digits of your Social Security Number. Ensure all details are accurate for a smooth processing.
- In the Applicant’s Request section, check all applicable boxes. Specify if you are requesting an effective date change or payments for previous weeks. If requesting payments, remember to attach a PUA Weekly Certification Form (DOL-5158PUA) for each week.
- Provide a brief explanation for your request in the designated area. This helps clarify your situation to the Georgia Department of Labor.
- Finally, sign and date the form electronically. Your electronic signature holds the same validity as a handwritten one, confirming that all information is true and correct.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2020 | 4.8 Satisfied (123 Votes) |
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