Third Party Certification Filing Initial Unemployment



Third Party Certification for filing initial Applications AND WEEKLY CERTIFICATIONS WITH THE Oregon Employment DepartmentCertificationThe Oregon Department of Human Services Office of Developmental Disabilities (ODDS) agrees to send this signed form to the Oregon Employment Department. This certification process is only to be used during the COVID-19 pandemic. The Oregon Employment Department will notify ODDS when this certification process ends.Please read and sign the following certification prior to submitting any Unemployment Insurance (UI), Pandemic Unemployment Assistance (PUA), or Pandemic Emergency Unemployment Compensation (PEUC) initial claim applications or weekly certification on behalf of any individuals enrolled in ODDS programs.I understand that I may be liable for overpaid benefits if I knowingly submit false information in order to obtain benefits that any individual is not entitled to receive.I understand and will ensure that Individuals understand that they have certified under penalty of perjury that they are either citizens of the United States or are legally authorized to work in the United States.To the best of my knowledge that individuals understand the questions they have been asked.The answers they provide are true to the best of their knowledge.The information provided on any application forms by individuals is correct to the best of my knowledge and that individuals supplied the information voluntarily.Individuals understand the law provides penalties for making false statements in order to obtain unemployment insurance benefits.Individuals understand their application will serve as a registration for work and as a request for an initial determination of benefits potentially payable.Individuals will accept the responsibility for the security of their personal identification number (PIN) when claiming unemployment insurance benefits online, or by touch-tone telephone.Individuals are aware they can reset their UI PIN online at but can also notify the Employment Department if they need to have their PIN changed for any reason.Individuals understand by submitting an application for UI, PUA, or PEUC benefits, they are authorizing the Employment Department to use their information to administer their UI, PUA, or PEUC benefits and provide them with employment services.Their failure to meet the eligibility requirements via weekly claim certification will result in a denial of benefits. You can go to unemployment. for more information. Individuals understand certifications provided on their application are under penalty of perjury and that willful misrepresentation in order to obtain benefits to which they are not entitled to receive may subject them to criminal prosecution.Signature ______________________________________ Date (Month/Day/Year) ___________________________ Printed Name_______________________________ ................
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