Alternate Base Period Claimant Affidavit

The alternate base period includes wages paid between 01/01/2025 and 03/31/2025 that are not yet reported to us by your employer. The wage information must be as accurate as possible. When the employer submits the wage information, the wages reported on the affidavit will be replaced and your benefit amount will be adjusted if employer wage information differs from the affidavit amount. You are responsible for any overpayment that occurs due to wage amounts not matching.

ALL FIELDS ARE REQUIRED

1. First Name

2. Last Name

3. Social Security Number

4. Employer Name

5. Employer Address

Enter your wages using the form below. CLICK in the date box and choose the date you were paid. Then enter the GROSS amount of the paycheck in the box next to the date. Be sure to include all paychecks paid during the time frame.

Date	Amount
		Remove
TOTAL: $
	This is the amount you wish to submit as earnings paid to you
	from 01/01/2025 to 03/31/2025

6. Enter year to date (YTD) gross wages from the last paystub with a PAID date on or before 03/31/2025 (use the date of actual payment shown on the paystub. DO NOT use pay period ending dates)

7. Enter the total **** wages found on your monetary determination for the employer listed above. The same amount is also listed on the Notice to Complete Online Affidavit. If you have not received your monetary determination or the notice, call 208-332-8942 for this amount.

Total gross wages paid for the alternate base period.

This is the amount you wish to submit as earnings paid to you from 01/01/2025 to 03/31/2025

Attach the paystubs you used to determine the amount above here. If you are not able to attach the supporting documents, you may fax them to: 208-334-6400.

NOTE: If you do not provide proper documentation supporting the amount above, your affidavit total will not be processed.

You may attach up to five supporting documents. NOTE: Each file must be less than 5 MB in size. Only the following file types are allowed: pdf,bmp,jpg,jpeg,png,gif

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If it is determined from the documentation that the total on the affidavit needs to be adjusted to prevent a potential overpayment, a specialist will be contacting you. Please provide the easiest and fastest way to reach you.

I agree that by submitting this form I understand the Department will determine my eligibility based on the information and documents I provide in this affidavit. If the Department determines subsequently that I am not entitled to the benefits I received because my statements here were not accurate or complete I will be required to repay any benefits I received to which I am not entitled. I further understand that if I make a false statement or fail to report a material fact that in addition to repaying any benefits I received, I will be subject to civil penalties and possible criminal prosecution.

I Accept

Only click on "Submit Form" once. Allow up to 30 seconds for the form to submit. A new page will display indicating successful submission of the affidavit.

Idaho Department of Labor
Brad Little, Governor
Jani Revier, Director
Labor.Idaho.gov
Idaho.gov
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An Equal Opportunity Employer and Service Provider