Request for alternate base period 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your personal information clearly. Enter your last name, first name, middle initial, address, city, state, and ZIP code. Ensure accuracy as this information is crucial for processing.
3. Next, provide your claim effective/start date and the last four digits of your Social Security number. This step is essential for verifying your identity.
4. In Step 1 of the form, indicate the last completed calendar quarter prior to your claim effective/start date. This helps establish the timeframe for your wage assessment.
5. Proceed to Step 2 where you will enter wage information from up to three employers. Include their names, addresses, and quarterly gross wages. If necessary, attach additional pages for more employers.
6. In Step 3, certify that all provided information is accurate by signing and dating the form. Remember that false statements can lead to penalties.
7. Finally, follow the return instructions carefully. Ensure that all documents are sent within ten calendar days as specified in the important notice at the top of the form.

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