Form ES161.5 "The Self-employment Assistance Program (Seap) Withdrawal Form" - New York

What Is Form ES161.5?

This is a legal form that was released by the New York State Department of Labor - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2019;
  • The latest edition provided by the New York State Department of Labor;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form ES161.5 by clicking the link below or browse more documents and templates provided by the New York State Department of Labor.

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Download Form ES161.5 "The Self-employment Assistance Program (Seap) Withdrawal Form" - New York

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Self-Employment Assistance Program Unit
Harriman State Office Campus
Building 12, Room 222
Albany, NY 12240-0001
The Self-Employment Assistance Program (SEAP)
Withdrawal Form
Instructions: Submit your SEAP Withdrawal Form online, by mail to the address above or fax it to (518) 402-
6586. If you fax it, do not mail the original. If you need more space, attach additional sheets. Keep claiming
weekly benefits until a SEAP staff member contacts you. You must report any days you work in employment or
self-employment when you claim weekly benefits.
To submit your SEAP withdrawal form online, go to: www.labor.ny.gov/signin.
1.
Log in to your online services account.
2.
Click on the envelope icon in the upper right to begin a new message.
Select “SEAP – Submit Withdrawal Form" as the subject line for your message.
3.
Name:
Last four digits of Social Security Number:
Telephone Number:
1.
Why do you want to withdraw from the SEAP?
Lack of money for business
Enrolled in training/school
Did not earn enough
Became employed
Other
2. Did you start the business start-up process?
Yes – Answer questions 3 through 14
No – Skip questions 3 through 14
3. What was the name of your business?
4. Was the business located in your home?
Yes
No
If no, did the business own or rent the property where it was located?
Own
Rent
5. What kind of business did you start?
6. Did you get a Federal Identification Number (FEIN) for your business?
Yes
No
If yes, what is the number?
7. Do you have a business checking account?
Yes
No
8. Do you have any accounts receivable?
Yes
No
If yes, how will these accounts be collected?
ES 161.5 (02/19)
Page 1 of 2
Self-Employment Assistance Program Unit
Harriman State Office Campus
Building 12, Room 222
Albany, NY 12240-0001
The Self-Employment Assistance Program (SEAP)
Withdrawal Form
Instructions: Submit your SEAP Withdrawal Form online, by mail to the address above or fax it to (518) 402-
6586. If you fax it, do not mail the original. If you need more space, attach additional sheets. Keep claiming
weekly benefits until a SEAP staff member contacts you. You must report any days you work in employment or
self-employment when you claim weekly benefits.
To submit your SEAP withdrawal form online, go to: www.labor.ny.gov/signin.
1.
Log in to your online services account.
2.
Click on the envelope icon in the upper right to begin a new message.
Select “SEAP – Submit Withdrawal Form" as the subject line for your message.
3.
Name:
Last four digits of Social Security Number:
Telephone Number:
1.
Why do you want to withdraw from the SEAP?
Lack of money for business
Enrolled in training/school
Did not earn enough
Became employed
Other
2. Did you start the business start-up process?
Yes – Answer questions 3 through 14
No – Skip questions 3 through 14
3. What was the name of your business?
4. Was the business located in your home?
Yes
No
If no, did the business own or rent the property where it was located?
Own
Rent
5. What kind of business did you start?
6. Did you get a Federal Identification Number (FEIN) for your business?
Yes
No
If yes, what is the number?
7. Do you have a business checking account?
Yes
No
8. Do you have any accounts receivable?
Yes
No
If yes, how will these accounts be collected?
ES 161.5 (02/19)
Page 1 of 2
9. Do you have any inventory?
Yes
No
If yes, what are your plans for this inventory?
10. Do you have any outstanding business debts?
Yes
No
If yes, please explain.
11. Do you have any other business obligations?
Yes
No
If yes, please explain.
12. Do you have any equipment that you bought for your business?
Yes
No
If yes, what are your plans for this equipment?
13. Did you promote your business?
Yes
No
If yes, please explain.
14. Are you still performing any activity for your business?
Yes
No
If no, on what date did you stop activity?
If yes, please explain.
15. Do you have any comments about the SEAP program?
_____________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
I certify that the above is true and correct. I understand that I must report any activity I perform related to
self-employment when I certify for weekly benefits, even if I did not earn any income. I understand that I
must actively look for work and keep a record of my job search efforts.
Signature
Date
ES 161.5 (02/19)
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