Forff 2026

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4.8 out of 5

60 votes

The document is a confidential financial statement required by the Arizona Department of Economic Security for individuals applying for a waiver of recoupment of overpaid Unemployment Insurance Benefits. It collects detailed personal and financial information from the claimant, including household members, income sources, monthly expenses, bank accounts, vehicles, and other assets. The document also includes legal disclaimers regarding equal opportunity and non-discrimination policies.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Claimant Information section. Enter your name, date of birth, social security number, and driver's license number. Ensure accuracy as this information is crucial for verification.
Next, provide details about your partner or spouse if applicable. Include their name, date of birth, social security number, and driver's license number.
Complete the Residential Address section with your current address. If your mailing address differs, fill that in as well.
List all household members along with their relationships and dates of birth in the designated area.
Document all sources of earned income by entering the names of individuals working, their gross monthly amounts, and employer details.
Proceed to list unearned income sources such as Social Security benefits or child support along with the monthly amounts received.
Detail your monthly expenses including housing costs, utilities, medical expenses, and any other bills you may have.
Finally, review all entries for accuracy before signing at the bottom of the form to confirm that all information provided is true.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (60 Votes)

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