Fillable UNEMPLOYMENT COMPENSATION NOTICE TO EMPLOYEE (Henry Ford College)

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UNEMPLOYMENT COMPENSATION NOTICE TO EMPLOYEE (Henry Ford College)

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UNEMPLOYMENT COMPENSATION NOTICE TO EMPLOYEE
Keep This Form
Please ensure that you read both sides of this form prior to ling a claim for unemployment benets. If
you become unemployed, this information may help to determine your unemployment benet entitlement.
When to le a claim for unemployment benets:
A claim for unemployment benets begins the week it is led. Therefore, you should le your claim for benets during your rst
week of unemployment.
To receive unemployment benets, you must both be eligible and qualied. You must:
• File a claim, and report for benets as directed by the Unemployment Insurance Agency (UIA).
• Register for work each time a new, additional or re-opened claim is led as directed by the UIA.
• Have sufcient earnings in the past 18 months.
• Be able to work.
• Be available for work. You must immediately inform the UIA and all base period employers of any changes to your contact
information (mailing address and telephone number) and respond to all UIA requests to update your contact information.
• If directed by the UIA, appear at a specied location provided in a mailed notice for an evaluation of your eligibility for
unemployment benets.
• If requested by the UIA, provide a statement of wages (wage afdavit) for purposes of calculating your unemployment
benets 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 the UIA.
To le a claim for benets, 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 identication 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 benets directly deposited into your checking or
savings account.
Filing Claims by Telephone
Day and Time to File Claims by Telephone
If the last two digits of your Social Security Number are:
00 through 15 Monday 8:00 a.m. - 12:30 p.m., ET
16 through 33 Monday 12:30 p.m. - 4:30 p.m., ET
34 through 48 Tuesday 8:00 a.m. - 12:30 p.m., ET
49 through 66 Tuesday 12:30 p.m. - 4:30 p.m., ET
67 through 81 Wednesday 8:00 a.m. - 12:30 p.m., ET
82 through 99 Wednesday 12:30 p.m. - 4:30 p.m., ET
If you miss your assigned day and time, claims are accepted on Thursday or Friday from 8:00 a.m. - 4:30 p.m. ET.
UIA 1711 Authorized by
(Rev. 03-17) MCL 421.1, et seq.
Bruce Noll
Unemployment Insurance
Acting Director
State of Michigan
TALENT INVESTMENT AGENCY
Unemployment Insurance
3024 W. Grand Blvd., Detroit, MI 48202
www.michigan.gov/uia
Rick Snyder
State of Michigan
Governor
UIA 1711
(Rev. 03-17)
Reverse Side
To Be Completed by the Employer
Rule R 421.204 of the Michigan Administrative Rules requires that a completed copy of this form, or an equivalent
written notice, be given to each employee before, or when he/she is separated from your employ. A $10.00 penalty
for non-compliance with this rule may be imposed by the UIA. Please complete the following information in the
spaces below.
Your 10-digit UIA Account Number:
Your 9-digit Federal Identication Number:
Employer’s Name with Doing Business As (DBA), and complete mailing address where wage and separation
information is available for the worker listed on this form.
__________________________________________ _______________________________________
Name DBA
__________________________________________ _______________________________________
Address for Employment City, State, Zip Code
__________________________________________ _______________________________________
Name of Contact Person Telephone Number
_____________________________________________________________________________________
Reason for Separation
Employers with questions may contact the Ofce of Employer Ombudsman (OEO) at 1-855-484-2636,
or OEO@michigan.gov.
Filing Claims on the Internet
You may le your new, additional, or reopened claim on the UIA website at www.michigan.gov/uia. Select “Michigan Web
Account Manager (MiWAM)” logo to sign up for a web account with UIA. You do not have to have a MiWAM account to le
a claim. However, if you do have a MiWAM account, rst login, click on the “Claimant Services” tab and select the “File a
claim” link under the ling options. You may le your claim through the Internet if ALL of the following requirements are met:
• You have worked under only one Social Security number.
• You have not led a claim for unemployment benets against another state during the past 12 months.
Before ling online, ensure you have the information from Items 1 through 6 (listed above), a pen or pencil, and paper to
make notes of information you will receive from the UIA. You can write the information you need on this form so that it is
available when you le your claim.
The Internet Filed Claim system is available 24 hours a day, 7 days a week, regardless of the last two digits of your Social
Security number.
If you have a problem or question about your claim, you can call the UIA at 1-866-500-0017 (TTY customers use 1-866-
366-0004). UIA staff is available to assist you from 8:00 a.m. to 4:30 p.m., ET, Monday through Friday.
TIA is an Equal Opportunity Employer/Program.
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UNEMPLOYMENT COMPENSATION NOTICE TO EMPLOYEE (Henry Ford College)

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Completed 26 July 2020

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