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Click ‘Get Form’ to open the Request to File a Late Initial Claim for Unemployment Insurance Benefits in the editor.
Begin by filling out your Claimant Information. Enter your first name, last name, middle initial, and either your Claimant Identification Number or the last four digits of your Social Security Number.
Provide your email address and telephone number to ensure the Department can contact you regarding your claim.
Specify the effective date you are requesting for backdating. Remember, this must be a Sunday date.
Select a reason for filing a late initial claim from the provided list. If applicable, attach any supporting information that could aid in your request.
Review the certification section carefully. Ensure all information is accurate before signing and dating the form.
Once completed, save your document and email it to Specialclaims@dwd.in.gov as instructed.

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