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Click here or scroll down to respond to this candidateDIRECTORStreet Address YORK STCandidate's Name
Street Address YORK STINKSTER MI Street Address -2820UIA Street Address C/E(Rev. 02-21)GRETCHEN WHITMERGOVERNORSTATE OF MICHIGANDEPARTMENT OF LABOR AND ECONOMIC OPPORTUNITYUNEMPLOYMENT INSURANCE AGENCYAuthorized ByMCL 421.1 et seq.SUSAN R. CORBIN lMail Date:Letter ID:March 7, 2024LPHONE NUMBER AVAILABLECB6205790Candidate's Name
CLM:Name:Request for InformationA question of eligibility and/or qualification has been raised on a claim in which you are an interested party. Respond to the questions on the reverse side of this form and keep a copy for your records. Return the completed form to Unemployment Insurance (UI) by March 18, 2024. Failure to respond to this request for information will result in a determination based on available information. U S PARK9420December 31, 2023 Case Number: 46232496Employer Name:Social Security Number:Benefit Year Begin:How to RespondSubmit copies (not the originals) of any records which you believe support your position, such as pay stubs, layoff slip, federal income tax form, W-2, etc. If you require additional space, attach additional pages(s). Include your name, Claim ID and Letter ID as shown above, on all documents that you submit. You can respond online, by mail or fax. To submit your response through your MiWAM account, go to www.michigan.gov/uia and select "Additional fact finding is required for your claim." If you do not have an existing MiWAM account, you can create an account by selecting "Register as a New User", and follow the prompts. To respond by mail, return the completed form along with a copy of any additional documents to Unemployment Insurance Agency, P.O. Box 169, Grand Rapids, MI 49501-0169 or fax to PHONE NUMBER AVAILABLE PenaltiesIt is against state law to intentionally make false statements or conceal material information to gain or avoid the payment of benefits. You may have to repay up to 1.5 times the amount of benefits received. Benefits will be stopped, and any remaining benefits will be lost. You may also be subject to criminal prosecution. If prosecuted, you may be required to pay court costs and fines, face jail time, perform community service or any combination of these.If your address changes it is important to update it with Unemployment Insurance. If you have questions, contact UIA Customer Service at PHONE NUMBER AVAILABLE TTY customers use PHONE NUMBER AVAILABLE EAN: PHONE NUMBER AVAILABLEl1 UIA is an Equal Opportunity Employer/Program.Auxiliary aids, services and other reasonableaccommodations are available upon request toindividuals with disabilities.Page 1 of 4 0000585UIA 1713 C/E Letter ID: LPHONE NUMBER AVAILABLE(Rev. 02-21)Additional information is necessary regarding Personal Reasons. FalseWhat was your last day worked?Did you give notice to the employer that you were leaving? Yes NoWhat date did you tell the employer would be your last day of work?What was the personal reason you voluntarily quit work? Attending School/TrainingChild CareLoss of TransportationOther Personal ReasonsRelocationRelocation of Military SpouseRequest for Leave DeniedWas your military spouse reassigned to a new geographic location? Yes NoDid you relocate to the new location with your military spouse? If yes, submit documentation which verifies relocation with spouse.Yes NoCertification: I certify that the information I have reported is true and correct. I understand that if I intentionally make a false statement, misrepresent facts or conceal material information to reduce or prevent benefits, I may be required to repay benefits, charged damages and could be subject to criminal prosecution. Signature Date Telephone NumberPrint Name TitleUIA is an Equal Opportunity Employer/Program.Auxiliary aids, services and other reasonableaccommodations are available upon request tol individuals with disabilities.1Page 2 of 4 0000586UIA 1713 C/E Letter ID: LPHONE NUMBER AVAILABLE(Rev. 02-21)l1 UIA is an Equal Opportunity Employer/Program.Auxiliary aids, services and other reasonableaccommodations are available upon request toindividuals with disabilities.Page 3 of 4 0000587UIA 1713 C/E Letter ID: LPHONE NUMBER AVAILABLE(Rev. 02-21)EnglishIMPORTANT! This document(s) contains important information about your unemployment compensation rights, responsibilities and/or benefits. It is critical that you understand the information in this document. IMMEDIATELY: If needed, call PHONE NUMBER AVAILABLE for assistance in the translation and understanding of the information in the document(s) you have received.SpanishIMPORTANTE! Este documento (s) contiene informacin importante sobre sus derechos, responsabilidades y / o beneficios de compensacin de desempleo. Es fundamental que comprenda la informacin de este documento. INMEDIATAMENTE: Si es necesario, llame al PHONE NUMBER AVAILABLE para obtener ayuda en la traduccin y comprensin de la informacin en el (los) documento (s) que ha recibido. ArabicAlbanian E RNDSISHME! Ky dokument prmban informacione t rndsishme pr t drejtat, prgjegjsit dhe / ose prfitimet e kompensimit t papunsis. sht e rndsishme q ju t kuptoni informacionin n kt dokument. MENJHER: Nse sht e nevojshme, telefononi PHONE NUMBER AVAILABLE pr ndihm n prkthimin dhe kuptimin e informacionit n dokumentet q keni marr.Page 4 of 4 0000588 |
