Fillable Form DS-7665 UNEMPLOYMENT INSURANCE BENEFITS

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Form DS-7665 UNEMPLOYMENT INSURANCE BENEFITS

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Country of origin: US
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The US Department of State (DOS) or the State Department, is the government official division that advises the President and performs international relations. Equivalent to the outside service of different nations, it was built up in 1789 as the country's first official department.

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If you have applied for or have been receiving unemployment insurance benefits payments, it is
your responsibility (under penalty of law) to notify the appropriate local office in writing to
discontinue the issuance of unemployment insurance checks once you are employed. Failure to
notify the state agency can result in a penalty, such as a fine, imprisonment, or both.
U.S. Department of State
UNEMPLOYMENT INSURANCE BENEFITS
DS-7665
05-2015
Employee's Signature Date (mm-dd-yyyy)
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Form DS-7665 UNEMPLOYMENT INSURANCE BENEFITS

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Completed 22 February 2020

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