ETA-935 STATE AGENCY IDENTIFICATION CLAIMANT S AFFIDAVIT OF FEDERAL CIVILIAN SERVICE WAGES AND REASON FOR SEPARATION ETA-935 1. State Agency Address 2. Claimant s Name and Mailing Address 3. Local Office/Call Center ID 4. Date of Request 5. Effective Date of Claim 7. Federal Agency Name and Address 6. Separation Date 8. Social Security Number Instructions Complete and Return Immediately 9. Affidavit of Federal Wage and Separation Information/Documentary Evidence a* Enter the location of your Official Duty Station City State b. Enter your wages with the above named employer below. Show wages by quarter starting with the wages that you earned after base period begin date up to the date you separated from this employer. Under Documentary Evidence enter the source of the information provided and attach a copy. If additional space is needed to explain reason for separation attach your signed explanation* Quarter Ending Year Gross Wages Documentary Evidence c* Severance Pay. Did you receive ....
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How to fill out the ETA-935 online
Filling out the ETA-935 form is a crucial step for individuals seeking benefits related to federal civilian service. This guide provides clear, step-by-step instructions to help users complete the form accurately and effectively.
Follow the steps to successfully fill out the ETA-935 form.
- Click ‘Get Form’ button to access the ETA-935 form and open it in your preferred editor.
- In the first field, enter the state agency address. This should reflect the location relevant to your claim.
- Provide your name and mailing address in the designated section. Ensure this is accurate so that you receive any correspondence regarding your claim.
- Input your local office or call center ID to assist with the processing of your claims.
- Record the date of your request in the specified field. This is essential for processing timelines.
- Fill in the effective date of your claim as it pertains to your specific situation.
- Enter the name and address of the federal agency associated with your claim.
- Fill in your separation date from the federal job.
- Input your Social Security number in the designated area. Ensure this is entered correctly to avoid issues with your claim.
- Complete the affidavit of federal wage and separation information. Begin by entering the location of your Official Duty Station (City, State).
- Report your wages in a quarterly format starting from the base period beginning date up to your separation date. Provide the gross wages for each quarter and attach any documentary evidence as necessary.
- Indicate if you have received or are entitled to severance pay by selecting ‘Yes’ or ‘No.’ If ‘Yes,’ provide the total entitlement and the severance pay period dates.
- Answer whether you are entitled to receive a pension from any branch of the federal government. If applicable, record your gross monthly pension.
- Explain your reason for separation in detail. If necessary, attach a signed explanation on a separate sheet.
- Sign and date the form as the claimant, affirming that all statements are true to the best of your knowledge.
- Once completed, save your changes, download the document, print it if needed, or share it according to your requirements.
Complete your ETA-935 form online today to ensure your claims process runs smoothly.
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