BAP Availability and Overpayment Declaration

Declaration of (Name)
I am the (check one)

Please answer all of the questions. Some of the questions may have been asked during the Employment Security Department’s investigation.  Please answer the questions here, even if you answered them before.


The following questions are about the period you were unemployed or partially unemployed (in other words, the period you are requesting benefits for).  

1. Did you suffer from any sicknesses or injuries which kept you from working full time?
2. Did you have adequate transportation to look for and get to work?
3. Do you care for anyone else (minor child, sick spouse, elder parent) that would keep you from performing full time work?
4. Were you a full time student during this period?
5. Did you perform at least the minimum required work searches for each of the weeks you have been requesting benefits, starting the week of July 4, 2021?
If requested, could you provide a list of those job searches?
6. If you did not look for work, do you have a job offer with a definite start date?
7. Were there any other reasons you were not able or available for full time work?
1. Did the Employment Security Department (“ESD”) give you notice that any of the benefits listed in the appealed Determination Letter were paid conditionally?
2. Did you provide all the information requested by the ESD in its investigation about the issue which caused the overpayment?
3. Was the information you provided completely accurate?
4. Did you provide any information to ESD about which you were not entirely sure or didn’t fully know the answer at the time?
5. Did you leave out any information that was requested by ESD when you filed your claim for benefits?
6. Did you later discover, or did ESD bring to your attention later, that you had not provided accurate or complete information?
7. Was there a difference in what you told ESD during the investigation and what you stated in your appeal, or during a hearing. For example, you told ESD you were not available for full time work, but stated in your appeal that you were available for full time work?
8. Is there any additional information you would like the judge to consider regarding whether you are at fault for the overpayment?
I declare under penalty of perjury under the laws of the state of Washington that the facts I have provided on this form are true.