Oregon Employment Department Updated Gross Earnings Form

All information collected through this form is securely encrypted. This form can be used for PUA and Regular UI claims. You can amend earnings for weeks you already reported and either increased or decreased your weekly earnings. No additional documentation is needed.








Enter numbers only, no spaces or hyphens. Example: 123456789


Required for email status updates


Example: 555-555-5555



Enter your past calendar month’s updated “gross earnings” for each week you need to change. Leave blank the weeks you don’t need to update.


Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts minus 25% of the past calendar month's expenses or the amount of a PPP loan used for personal expense that you need to report. If you're unsure about what PPP funds to report, see the PPP FAQ (linked below).




Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



Claim weeks always end on a Saturday. Only select a Saturday.




This week's gross receipts (total amount that came into the business) minus 25% of the past calendar month’s expenses



I understand that making the certification is under penalty of perjury and that intentional misrepresentation in order to obtain payments to which I am not entitled to receive may be subject to criminal prosecution.



I certify by submitting the information I have given on this form is correct, and that I have supplied the information voluntarily, in order to obtain PANDEMIC UNEMPLOYMENT ASSISTANCE. I know that Federal funds are provided and that penalties are prescribed by law for willful misrepresentation or concealment of material facts in order to obtain assistance payments to which I am not entitled to receive under the ACT. The information gathered by the Employment Department may be used by other state and federal agencies for verification of eligibility for other programs. Therefore, I AUTHORIZE the Employment Department to release the information TO ANY SOURCE for purposes authorized under Employment Department law.


Anything else you would like us to know about your updated “gross earnings”?




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