Fax Appeal Form (Sep 2016)
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:
A
ppeal Tribunal 512-475-1135
DETERMINATION ON PAYMENT OF UNEMPLOYMENT BENEFITS
Date Mailed: August 8, 2016
Appeal Tribunal Decision
Example:
Texas Workforce Commission
Appeal Tribunal
Commission Appeals 512-475-2044
TWC Building
Austin, Texas 78778
06-15-2016
Date Mailed
Commission Appeals Decision
Example:
TEXAS WORKFORCE COMMISSION
Austin, Texas
Commission Appeals 512-475-2044
FINDINGS AND DECISIONS OF COMMISSION
UPON REVIEW OF CLAIM FOR BENEFITS
Jun 23 2016
Date Mailed
Other—Your document does not match any of the
Appeal Tribunal 512-475-1135
examples.
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 ame ast N
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.
