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Unemployment Claimants GDOL Service Request
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Email *
Date Submitted to GA DOL* *
MM
/
DD
/
YYYY
Claimant's Last Name* *
Claimant's First Name* *
CLAIMANT'S SSN* (Last 4 digits) **(It is important to only include the last four digits to protect your security.) *
Claimant's County* *
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Claimant's Phone Number* *
Claimant's Issue* *
"Other" Explanation
Benefits Program (If the claimant knows, in which program are they enrolled?)
CLAIM TYPE (This can help us direct this inquire to the most appropriate staff to address. All claims are either: 1) Employer Filed (Often referred to as "Partials"), or 2) Individually filed.)
GDOL Tracking (Do not fill-in this section as it is used to track and ensure your submission is addressed)
GDOL Staff Notes (Do not fill-in this section as it is used to track and ensure your submission is addressed)
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