How to Fill Out the New York SEAP Individual Services Verification Form (ES161.4)

Form ES161.4 is the one-page Individual Services Verification Form that New York’s Department of Labor uses to confirm Self-Employment Assistance Program (SEAP) participants attended the workshops and classes on their Individual Services Plan. You complete it after each qualifying session, get the instructor’s signature, and send it to the SEAP Unit by the due date assigned to you. If the form arrives late or incomplete, your weekly SEAP allowance is suspended from the due date until the Unit receives an acceptable version, with no back pay for the gap.¹

You can download the current form from forms.labor.ny.gov or get a copy from your SEAP coordinator.²

What to Enter in Each Field

The form is short, but every field has to be accurate for the SEAP Unit to accept it.

Your name and the last four digits of your Social Security number. The form does not ask for the full SSN.
The school or agency name and phone number, including area code. Use the organization’s full legal name.
The workshop or class title exactly as it appears in the course listing or your Individual Services Plan.
The specific dates you attended, in month/day/year format.
The total number of hours you spent in that workshop or class.
The instructor’s printed name, title, and signature. An authorized representative of the training provider can sign in the instructor’s place.
Your signature and the date, certifying that you attended the workshop or class listed.

Both signatures are required. Without the instructor’s signature and your own certification, the form counts as incomplete and the SEAP Unit will not accept it.²

When the Instructor Cannot Sign

Some training providers won’t have anyone available to sign the form on the spot. The DOL allows two substitutes. You can submit a certificate of completion in place of the instructor’s signature, as long as it shows the school or agency name, the class title, the date you took it, and the number of hours.³

If the provider doesn’t issue certificates either, your assigned business counselor can sign the ES161.4, but only if they can independently verify that you took the class.¹ Check the verification process before you enroll. Finding out after the fact that no one can confirm your attendance is a problem that’s easy to avoid up front.

How to Submit the Form

You have three options, all printed on the form itself.²

Online. Sign in to your NY.gov account at labor.ny.gov/signin, scan the completed form, and upload it. You can also go to Messages, select Compose New, use “SEAP” as the first subject line and “Submit SEAP Benchmark Forms” as the second, and attach the scanned form.³
Fax to (518) 402-6586.
Mail to the Self-Employment Assistance Program Unit, 1220 Washington Ave., Building 12, Room 222, Albany, NY 12226.

Online submission is the fastest. If you mail the form, build in delivery time, because what counts is the date the SEAP Unit receives it, not the date you drop it in the mail.

Due Dates and the Cost of a Late Form

Your due dates are set when you’re accepted into the program, based on your individual progress plan. There is no single universal schedule.³

If the form is late, your SEAP benefits are suspended from the date it was due through the date the DOL receives and accepts a complete version. Those suspended weeks are not paid out later as a lump sum. Benefits resume only from the date the completed form arrives.¹ A form received on time but missing a signature does not count as received until the corrected version arrives, which is where most participants lose money unnecessarily. Review every field, confirm both signatures, and keep an eye on the clock between the class date and your deadline.

Keep Your Own Copies

Make copies of every ES161.4 you send in, along with any certificates of completion and notes from your business counselor meetings. If the SEAP Unit later questions whether you completed a particular requirement, your own records let you respond right away instead of trying to track down a training provider months after the fact. The IRS generally recommends keeping records of business-related expenses for at least three years, and your SEAP training documentation fits that category once you start deducting startup costs on your tax return.⁴

1
New York State Department of Labor. Self-Employment Assistance Program (SEAP) Participant Q&As
2
New York State Department of Labor. New York SEAP Individual Services Verification Form (ES161.4)
3
New York State Department of Labor. SEAP Benchmark and Training Frequently Asked Questions
4
Internal Revenue Service. Taking Care of Business: Recordkeeping for Small Businesses