State of Illinois
Department of Employment Security
www.ides.illinois.gov
Request for Reconsideration of Claims Adjudicator’s Determination and,
if applicable, Appeal to the Referee
ADJ024F Page 1 of 1 BEN-523 Rev. (09/2011)
Claimant Information:
Last Name: First Name: MI:
ID or SSN:
(Este es un documento importante. Si usted necesita un intérprete, póngase en contacto con su oficina local.)
The reconsideration process is governed by section 703 of the Illinois Unemployment Insurance Act and 56 Ill. Adm. Code
2720.160 Reconsidered Finding or Determination. If your Request for Reconsideration becomes an Appeal as a result of the
reconsideration process, your case will be forwarded to the appeals unit.
If you need additional space, please use the other side of this document, if appropriate, or attach a separate sheet of paper.
Ap
pellant: (Check One) Claimant Employer (Employer, please provide Company Name and Account #)
Name: Account #:
Section A: Reason for Request for Reconsideration
I disagree with the claims adjudicator’s determination dated , regarding
because: (Give all your reasons and facts)
* Note to claimant: You must continue to certify for benefits by Tele-Serve or Online for each two week period that you are
unemployed during the appeal process.
Section B: Signature
Signature: Date:
Name (Printed or Typed): Telephone Number:
