This government document is issued by Labor & Industry for use in Pennsylvania
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https://www.google.com/url?client=internal-element-cse&cx=007572080359491747877:1wdjf9sxttm&q=https://www.dli.pa.gov/Businesses/Workforce-Development/Documents/Current-Directives/Guidance-on-Digital-Intake-Form-Use.pdf&sa=U&ved=2ahUKEwjjwYvV0-mFAxVH8QIHHehaAKU4KBAWegQIBhAB&usg=AOvVaw0Dp5haFoJmmqfW-iIWHaj0