Request alternate base period 2016 form-2026

1. Click ‘Get Form’ to open the request alternate base period 2016 form in the editor.
2. Begin by filling in your personal information, including your last name, first name, middle initial, address, city, state, zip code, claim effective/start date, and the last four digits of your Social Security number. Ensure all entries are clear and legible.
3. In Step 1 of the form, provide details about your last completed calendar quarter prior to your claim effective/start date. Enter the start and end dates clearly.
4. For Step 2, list your employers and their corresponding quarterly gross wages. If you have more than three employers, attach an additional page with this information. Make sure to include proof of wages as specified.
5. In Step 3, certify that the information provided is accurate by signing and dating the form. Include your area code and telephone number for contact purposes.
6. Finally, follow the return instructions carefully. You can fax or mail your completed form along with any attachments within ten calendar days from the date mailed of your last Monetary Benefit Determination.

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