OHIO DEPARTMENT OF JOB AND FAMILY SERVICES

OFFICE OF UNEMPLOYMENT INSURANCE OPERATIONS

NEW CLAIM INSTRUCTION SHEET
JFS-80010 11/01/2017
Claimant's Name Claimant Id Confirmation Number
DENNIS BURDSAL 215581666 CA310103203734243924
Claimant's Telephone Number Selected Method Of Contact Date Issued Social Security Number
(937)-392-1598 E-MAIL 02/08/2021 221-76-2866
ODJFS Office

Toledo UI Delivery Center

PO Box 182212
DENNIS BURDSAL Columbus, OH 43218-2212
605 N 2ND ST
RIPLEY, OH 45167-1010 Phone: (800) 589-2799
Fax: (614) 466-7449

IMPORTANT INFORMATION - READ AND FOLLOW INSTRUCTIONS CAREFULLY

Your application for unemployment benefits has been received. You are now responsible for
reading and following the instructions below:

REVIEW INFORMATION
■ If your contact information above is incorrect, call the ODJFS office listed above immediately.
■ Read the Worker's Guide to Unemployment Compensation available at:
http://www.odjfs.state.oh.us/forms/findform.asp?formnum=55213
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FILE WEEKLY CLAIMS

■ Start claiming weeks right away, even if you are awaiting a decision. You will not be paid for weeks
not claimed.
Your first scheduled filing date is 02/07/2021
■ File weeks online at https://unemployment.ohio.gov
■ Login with your user name (Social Security number) and PIN.
■ Weekly claims cannot be filed until after the week is over. Weeks begin on Sunday and end
on Saturday.
■ Weeks must be filed timely (within three weeks of the end of the week) to be considered for
payment.

WORK SEARCH REQUIREMENTS

■ You are required to complete at least two work search activities per week.
■ You are required to provide the details regarding the activities for each week claimed. Keep a
record of your work search activities for three years, in the event of an audit.
■ You are required to register with our agency for job placement assistance.
■ If you receive notification about a possible job, you are required to respond by following the
instructions provided.

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DSN: 059357 THIS SPACE FOR OFFICIAL USE ONLY PSN: 059357
Page 1 of 5 CORRESPONDENCE ID: 000000492960925 CLAIMANT ID: 000000215581666 NOTICE: JI03N1
 RESPOND TO ADDITIONAL INFORMATION REQUESTS
■ Respond to notices via US Mail or login to your account at https://unemployment.ohio.gov
■ Respond to wage information requested below (Claimant's Monetary Affidavit) and include proof or
any corrections.

■ Failure to respond to notices in a timely manner could result in a denial of benefits.

RECEIVE PAYMENT
■ Payments are made electronically as a direct deposit to your personal bank account, or to a US
Bank debit established if your benefits are approved (US Bank debit card contact:1-855-254-9198).

QUESTIONS OR ADDITIONAL INFORMATION

■ Call the ODJFS office listed at the top of this form, Monday-Friday, 8:00 am to 5:00 pm,
excluding holidays.
■ Visit http://www.jfs.ohio.gov/unemp_comp_faq/index.stm for unemployment compensation frequently
asked questions

OVERPAYMENT, PENALTY WEEKS or CHILD SUPPORT ORDER

■ If you have an outstanding overpayment or penalty week balance, payment will be withheld
until the overpayment as has been repaid and penalty week(s) have been served.
■ If an active child support order is on file, money will be withheld from weekly benefits and
submitted in accordance with the court order.
A1002D038E0593574018G

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DSN: 059357 THIS SPACE FOR OFFICIAL USE ONLY PSN: 059357
Page 2 of 5 CORRESPONDENCE ID: 000000492960925 CLAIMANT ID: 000000215581666 NOTICE: JI03N1
 REEMPLOYMENT ACTIVITIES REQUIREMENTS

Ohio is committed to assisting you in getting back to work. To accomplish this, we have created a username
and temporary password in OhioMeansJobs.com for you. These have been mailed to you in two separate
mailings for your security and are independent from your unemployment claim.

Required Reemployment Activities:

To receive unemployment compensation payments, you must complete these reemployment activities in
OhioMeansJobs.com each benefit year:
■ Create a resume by 04/03/2021
■ You must mark your resume “active” and it must remain in active status to continue to receive
benefits.
■ You can upload an existing resume or use our “resume builder” to assist you with creating a
resume.
■ Complete a career profile assessment by 06/26/2021

Log in to OhioMeansJobs.com
Once you have received your username and temporary password:
■ Go to OhioMeansJobs.com
■ Under “Individuals”, select “Get Started”
■ Click the “Unemployment Compensation Claimants” icon
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OhioMeansJobs Unemployment Guide

This will detail what is required during specified weeks of your claim.
■ Select “Sign In Now”
■ Enter the OhioMeansJobs Username and Temporary Password provided in a separate
correspondence from the Office of Unemployment Insurance Operations

If you need hands-on assistance or a computer to use, you can find the nearest OhioMeansJobs center by
clicking on the icon or call: 1-888-296-7541 and select option 5.

Tips and suggestions when using OhioMeansJobs.com:

■ For help videos or step-by-step instructions to complete these requirements go to:
https://unemployment.ohio.gov
■ To explore other careers, we strongly encourage you to complete the WorkKeys practice assessments
to discover your skill levels and how they relate to other occupations.

If you are legally prohibited from using a computer, have a physical or visual impairment that prevents you
from using a computer, or have a limited ability to read, write, speak, or understand English, you must contact
your local OhioMeansJobs Center to be scheduled for an in-person appointment to get assistance in
completing the same or similar activities.

IMPORTANT: Failure to complete reemployment activities by the deadlines shown above may deny
your unemployment benefits until the activity is completed. If you do not claim during weeks where
an activity is due, you will be required to complete it the week you reopen your claim. Complete them
early or all at once.

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DSN: 059357 THIS SPACE FOR OFFICIAL USE ONLY PSN: 059357
Page 3 of 5 CORRESPONDENCE ID: 000000492960925 CLAIMANT ID: 000000215581666 NOTICE: JI03N1
 OHIO DEPARTMENT OF JOB AND FAMILY SERVICES
OFFICE OF UNEMPLOYMENT INSURANCE OPERATIONS
CLAIMANT'S MONETARY AFFIDAVIT
JFS-80010 11/01/2017
Claimant's Name Claimant Id Benefit Year Ending Date Social Security Number
DENNIS BURDSAL 215581666 01/29/2022 221-76-2866
Claimant's Telephone Number Date Issued Application Date
(937)-392-1598 02/08/2021 02/04/2021
ODJFS Office

Toledo UI Delivery Center

DENNIS BURDSAL PO Box 182212
605 N 2ND ST Columbus, OH 43218-2212
RIPLEY, OH 45167-1010
Phone: (800) 589-2799
Fax: (614) 466-7449

CLAIMANT: REPORT ANY ADDITIONS OR CORRECTIONS OF YOUR EMPLOYMENT NO LATER THAN

02/16/2021

INSTRUCTIONS: Carefully read this agency's record of your employment for the specified time period (see Item 1,
below). Complete the remainder of this form if:
- any of your employment is incorrect or missing;
- you worked for a federal civilian employer(s);
Report any changes by returning this form by mail or fax to the office identified above.

Do NOT return this form if you have no additions or corrections to the employment listed in Item 1.
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1. The following is a record of the weeks worked and wages earned as reported by your employer(s) during the
following time period:
10/01/2019 to 12/31/2020
This record includes only Ohio employment, and possibly military service or federal employment reported for
a prior unemployment claim. ODJFS will request out-of-state, military, and federal wages from the
appropriate state and/or agency.

10/01/2019 to 01/01/2020 to 04/01/2020 to 07/01/2020 to 10/01/2020 to

12/31/2019 03/31/2020 06/30/2020 09/30/2020 12/31/2020
EMPLOYER NAME WEEKS WAGES WEEKS WAGES WEEKS WAGES WEEKS WAGES WEEKS WAGES

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Page 4 of 5 CORRESPONDENCE ID: 000000492960925 CLAIMANT ID: 000000215581666 NOTICE: JI03N1
 Claimant's Name Social Security Number Benefit Year Ending Date
DENNIS BURDSAL 215581666 221-76-2866 01/29/2022
2. For the time period specified in Item 1, furnish the details (weeks worked, wages earned, or employers)
of all missing or incorrect Ohio employment or employment for a federal civilian employer. Make certain
to enter the number of weeks and wages in the correct time period.
EMPLOYER NAME, ADDRESS, 10/01/2019 to 01/01/2020 to 04/01/2020 to 07/01/2020 to 10/01/2020 to
TELEPHONE NUMBER, AND 12/31/2019 03/31/2020 06/30/2020 09/30/2020 12/31/2020
FEDERAL TAX ID NUMBER (FEIN) WEEKS WAGES WEEKS WAGES WEEKS WAGES WEEKS WAGES WEEKS WAGES

( )
FEIN:

( )
FEIN:

( )
FEIN:

( )
FEIN:
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* If you entered missing weeks, wages, or employers in the spaces above, or

if you corrected the weeks or wages reported in Item 1, you must attach
proof of your employment (such as pay stubs, W-2, or SF-50 forms).
3. Complete this section only if you worked for a federal civilian employer.
A. Did you receive terminal leave pay? Yes No

If yes, enter the following:

Gross Amount of Terminal Leave Pay: $_______________
Date of Receipt: _______________, Days: _______________, Hours: _______________
B. Did you receive/are you entitled to receive severance pay?
Yes No
If yes, enter the following:
Total Entitlement: $_______________
Severance pay period beginning date: ______________
Severance pay period ending date: _______________

4. CERTIFICATION: I certify that the statements made above are true and correct. If I receive benefits to
which I am not entitled, I will be required to make repayment. I understand that Ohio law provides
penalties for false statements.
Signature of Claimant Date

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