Request for Waiver

The Continued Assistance Act (CAA) now allows us to offer you an opportunity to request a waiver on any benefits paid to you that you were not eligible for. That means you may NOT have to pay them back to the Oregon Employment Department. This waiver applies to the following programs:

• Pandemic Emergency Unemployment Compensation (PEUC)
• Federal Pandemic Unemployment Compensation (FPUC)
• Pandemic Unemployment Assistance (PUA) and
• Lost Wages Assistance (LWA).

In normal times, if we find that a person was not eligible for benefits they received, we say they have an “overpayment” which they have to pay back.

The CAA allows us to let you NOT repay these benefits if we find that payment of these benefits was NOT caused by any error made by you AND such repayment would be contrary to equity and good conscience. By “contrary to equity and good conscience,” we mean that it is against equity and good conscience to collect an overpayment that was not the claimant’s fault during a pandemic.

We will look at the information you provide on this form and decide whether federal law allows you NOT to repay the overpayment (also known as “waiving repayment”).

Please use this form to request a waiver so you do NOT have to repay the amount you owe.

Examples of reasons you could be eligible to waive repayment of an overpayment include:

1. The Employment Department made a mistake in processing your claim, which is why you received an overpayment and you are currently out of work or your work hours were reduced due to the pandemic
2. You received benefits on the incorrect claim due to an error of the Employment Department and you are currently out of work or your work hours were reduced due to the pandemic.

First Name*

Last Name*

Social Security Number (SSN)*

Customer Identification Number

Phone Number*

What is your customary occupation?*

Are you now employed?*

Additional information you would like us to consider in deciding whether you are eligible to waive repayment of an overpayment.

Federal law requires that you answer these two questions or you will NOT be eligible for the waiver.

Please tell us how this overpayment was not your fault or how you did not make any errors.*

Tell us how it would not be fair or right for us to have you repay these benefits.*

It may take 2‐3 weeks from the date of receipt for a decision to be issued.

If you need help completing this form, please call 503.947.1995.

The above information is furnished voluntarily and I hereby apply for waiver of repayment established by the State of Oregon. I certify the information provided is true and correct to the best of my knowledge*