Time Work Interpreter

Fax Appeal Form (Sep ****)

Unemployment Benefits Fax Appeal Form

Indicate which type of document you are appealing. Include this form and a copy of the document you are appealing when faxing. Keep the fax confirmation as proof of transmission. For information on the appeal process, go to www.texasworkforce.org/uiappeal. Select the type of document you are appealing Where to send appeal Appeal Fax Number Determination on Payment of Unemployment Benefits

Example: Appeal Tribunal 512-***-****

DETERMINATION ON PAYMENT OF UNEMPLOYMENT BENEFITS

Date Mailed: August 8, 2016

Appeal Tribunal Decision

Example:

Texas Workforce Commission

Appeal Tribunal Commission Appeals 512-***-****

TWC Building

Austin, Texas 78778

06-Date 15-Mailed 2016

Commission Appeals Decision

Example:

TEXAS WORKFORCE COMMISSION

Austin, Texas Commission Appeals 512-***-****

FINDINGS AND DECISIONS OF COMMISSION

UPON REVIEW OF CLAIM FOR BENEFITS

Jun 23 2016

Date Mailed

Other—Your examples. document does not match any of the Appeal Tribunal 512-***-**** Print form and complete all information before faxing. Attach a copy of the decision you are appealing, if available. Number of pages: (including this cover sheet)

I am appealing on behalf of the CLAIMANT EMPLOYER (mark one) My name is

Last four digits of the Claimant’s Social Security Number Claimant’s First Name MI L ast N ame

Mail Date of the letter I am appealing (MM/DD/YYYY) If appealing an Appeal Tribunal or Commission Appeal decision, what is the Appeal Number? Reason for Appeal

Date(s)/Time(s) I am not available to participate in a hearing: I will need an interpreter. (mark one) Yes No Language: TWC will use the date we receive the fax to determine whether your appeal is timely. If unable to fax, mail your appeal on or before the deadline or appeal online by going to www.texasworkforce.org/uiappeal and selecting the Unemployment Benefits Appeal Form. You must appeal each determination separately. Keep your confirmation as proof of transmission. Caution: If you submit an appeal before the mail date of the determination or decision, it will not be accepted. Continue to request payment every two weeks while waiting on your appeal, unless you return to full-time work. To change or verify your address, log on to ui.texasworkforce.org and select Contact information.

Contact this candidate