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A new application with a copy of the out-of-state workers' compensation insurance certificate is needed for each calendar year you request supplemental reports. Complete the Application for Out-of-State Supplemental Reporting.Complete the UF Supplement. This includes a few additional short-answer questions so that we can learn more about you when reviewing your application. To apply for State Supplementary Assistance, go to the Human Services benefits portal and complete the HHS application. The employee should complete Form A-4 electing their withholding percentage and return it to the employer. Out-of-State Resident Working for an Arizona Business. Do not cross fiscal year or quarter dates when completing the form. Include your employer code, employer name and reason for the supplement. How can I report an address change (or other change to my case)?