Keep This Form
Please ensure that you read both sides of this form prior to ling a claim for unemployment benets. If
you become unemployed, this information may help to determine your unemployment benet entitlement.
When to le a claim for unemployment benets:
A claim for unemployment benets begins the week it is led. Therefore, you should le your claim for
benets during your rst week of unemployment.
To receive unemployment benets, you must both be eligible and qualied. You must:
• File a claim, and report for benets as directed by Unemployment Insurance (UI).
• Register for work each time a new, additional or re-opened claim is led as directed by UI.
• Have sufcient earnings in the past 18 months.
• Be able to work.
• Be available for work. You must immediately inform UI of any changes to your contact information
(mailing address and telephone number).
• If directed by UI, appear at a specied location provided in a mailed notice for an evaluation of your
eligibility for unemployment benets.
• If requested by UI, provide a statement of wages (wage afdavit) for purposes of calculating your
unemployment benets as state law requires that you produce evidence of those wages (pay stubs,
W-2, employer payroll records, etc.).
• Be actively engaged in seeking work.
• Conduct a systematic and sustained work search effort and provide proof of those efforts by submitting
your work search efforts as directed by UI.
To le a claim for benets, you will need the following:
1. This form and any similar forms you received from any employer in the past 18 months, or pay
stubs with employer name, employer payroll record, or W-2 Form.
2. Your Social Security number, complete mailing address (zip code), telephone number, and county
of residence.
3. Your driver’s license or state identication card.
4. Your Alien Registration Number and the expiration date of your work authorization if you are not a
citizen or national of the United States.
5. Name(s) of employer(s), date(s) of employment, and reason for separation from each employer
you worked for in the past 18 months.
6. Information from your nancial institution if you choose to have your benets directly deposited
into your checking or savings account.
UNEMPLOYMENT COMPENSATION NOTICE TO EMPLOYEE
STATE OF MICHIGAN
RICK SNYDER DEPARTMENT OF TALENT AND ECONOMIC DEVELOPMENT ROGER CURTIS
GOVERNOR TALENT INVESTMENT AGENCY DIRECTOR
UNEMPLOYMENT INSURANCE WANDA M. STOKES
DIRECTOR
UIA 1711
(Rev. 05-18)
Authorized by
MCL 421.1 et seq.
TED is an equal opportunity employer/program.
Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.
