Follow the steps to successfully complete the Dol 5158pua form online.

1. Click ‘Get Form’ button to access the Dol 5158pua form and open it for editing.
2. Begin with section A for applicant information. Enter your first name, middle name, last name, last four digits of your Social Security Number, and complete your mailing address, including street, city, apartment/unit (if applicable), state, and zip code.
3. In section B, answer the questions regarding your work status. Indicate whether you were able, available, and actively seeking work during the specified week. If your answer is 'No', provide an explanation.
4. Respond to whether you refused any work offered that week and if applicable, include an explanation.
5. Indicate if you worked or earned wages in any employment or self-employment. If yes, provide the name of your employer, gross earnings, and your current employment status with that employer.
6. Answer whether you applied for and received any type of unemployment compensation during the week. If yes, fill in the type of payment received and the amount.
7. Address whether you received any payments for loss of wages due to illness or disability. If yes, specify the payment type and amount received.
8. Indicate any payments you received from a private income protection insurance plan, along with the payment type and amount.
9. Provide information regarding any payments received from a supplemental unemployment benefit (SUB) plan, including the payment type and amount.
10. Lastly, respond to whether you received payments from any retirement, pension, or annuity, giving details of the payment type and amount.
11. In section C, certify your status for requesting assistance by selecting the applicable reasons related to COVID-19 and provide a reason for your payment request.
12. Finally, sign and date the form to certify that the information you provided is accurate. Review all sections before saving, downloading, printing, or sharing the completed form.

Complete your Dol 5158pua form online today to ensure you receive the support you need.