This government document is issued by Department of Labor for use in Georgia
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https://www.google.com/url?client=internal-element-cse&cx=450907bf5042c4844&q=https://dol.georgia.gov/document/unemployment-benefits/ui-weekly-certification-form-dol-421/download&sa=U&ved=2ahUKEwjCyK_AjpeHAxVZg_0HHXGCA544HhAWegQICBAB&usg=AOvVaw0twzdcMkMk9gjJ7p7hmnv7&fexp=72519171,72519168