STATE OF MICHIGAN
GRETCHEN WHITMER DEPARTMENT OF LABOR AND ECONOMIC OPPORTUNITY JEFF DONOFRIO
GOVERNOR UNEMPLOYMENT INSURANCE AGENCY DIRECTOR
Authorized by
MCL 421.1 et seq.
UIA 1733
(Rev. 06-19)
UIA is an equal opportunity employer/program.
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*017061906*
Appeal of a Redetermination
(This is an Appeal form. If you want to protest a Determination, please use other side.)
Right of Appeal
If you disagree with this redetermination you have the right to appeal requesting a hearing before an administrative
law judge. If your appeal is led after the deadline, you must include the reason your appeal is late in your
statement. You can also attach copies of any documents that support your appeal.
You can submit your appeal online at www.michigan.gov/uia sign into MILogin to access your MiWAM and upload
documents. If you wish to appeal in writing, complete Form UIA 1733, Appeal of a Redetermination. Include your
name, case number and social security number or Michigan Identication Number (MIN) on documents submitted
with your appeal. Fax the completed form UIA 1733 and any supporting documents to 1-616-356-0739 or mail to
Unemployment Insurance, P.O. Box 124, Grand Rapids, MI 49501-0124. If you fax or mail your appeal, it must be
signed.
Check box
if appealing
If Applicable: I did not appeal within 30 calendar days of when the redetermination was mailed because:
Certication: 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, I may be required to pay damages and
could be subject to criminal prosecution.
__________________________________ ____________
Signature Date
1. Do you have information that you did not provided prior to the redetermination? Yes No
If yes, provide it now.
2. Date redetermination was issued:________________
Date on Redetermination
I appeal for the following reasons:
Important Advocacy Information
An Advocate may be able to assist you at the hearing. This service is free. Some restrictions may apply. After you
receive your Notice of Hearing, call the Advocacy Program at 1-800-638-3994 to request an advocate. Provide
the Appeal Number from your Notice of Hearing form. If the administrative law judge (ALJ) nds that you have
committed an intentional misrepresentation you must pay the cost of the advocacy fees.
MIN:
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