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Reemployment Assistance (RA)
Forms
RA Benefits Forms
The RA Benefits forms available below are in Adobe PDF format.
Employee/Claimant Benefit Forms |
| Claimant Change of Name and Address Form Name and address may also be updated online at RAClaims.sd.gov or by calling 605.626.2452. |
| Direct Deposit Form |
| Employer Contacts Form (Job Search Tracking Sheet) This form also in the back of the Facts About Reemployment Assistance (PAM247) booklet |
| Medical Statement of Ability to Work |
| Overpayments and Appeals forms |
| Weekly Request for Payment The preferred and faster methods for submitting weekly requests are online at RAClaims.sd.gov or through the automated phone system at 605.626.3212. however you may contact the Customer Service Center at 605.626.2452 if you need a printed form. You may use this form for backdate and late payment requests as well. Complete one form for each week you are requesting back pay. The RA Division will review to determine eligibility. Back date and late payment requests cannot be done online or through the automated phone system. |
Employer Forms |
| Employee Recall Date Form Employers who have furloughed employees and will be recalling them, please provide recall dates if you have not already done so. You may also call 605.626.2452 with this information. |
| Employer Reporting Refusal of Work When Recalled Report employees who have been placed on temporary layoff but refuse to return to work or quit without good cause. See Refusal to Work page for more information. (Open this form in an Adobe reader program to complete. Changes made in your internet browser will not save.) |
| Employer Reporting No Shows or Refusal of Work/Interviews Report individuals who refuse to interview or to accept a suitable job offer, do not show up for work, etc. See Refusal to Work page for more information. (Open this form in an Adobe reader program to complete. Changes made in your internet browser will not save.) |
RA Tax Forms
You can complete most RA Tax forms online, then print and mail or fax.
Overpayments Forms
See Appeals and Waiver section to request an appeal of an overpayment determination or if you've been determined not at fault and wish to request a financial waiver.
| Credit Card Authorization Form (Adobe PDF — Print and mail or fax) |
Appeals and Waiver Forms
Open forms in an Adobe reader program to complete. Changes made in your internet browser may not save. Then print, sign, and mail, fax or drop off at your Job Service office. We cannot accept appeals or waiver requests over the phone or by email.
| Appeal Request (Adobe PDF — Print and mail or fax) Complete this form if you disagree with a determination made by the Division and are requesting a hearing or have an overpayment determination that puts you at fault, and you would like to request a review of that determination. You may also request a financial waiver. |
| Request for Financial Waiver of Overpayment (Adobe PDF — Print and mail or fax)
Complete this form if you have an overpayment and it has been determined you are not at fault, and you would like to request a financial waiver. View Family Income Table for Overpayment Waiver Provision |