Dws Ui Form 617 B PDF Details

Earlier this month, the Department of Workforce Services (DWS) released UI form 617B. This form is for individuals who have lost their jobs and are now collecting unemployment benefits. The form is used to report any wages you may earn while receiving unemployment benefits. In this blog post, we will go over how to fill out UI form 617B, what information is required, and what happens if you report wages that exceed your benefit amount. Stay tuned!

Form NameDws Ui Form 617 B
Form Length3 pages
Fillable fields0
Avg. time to fill out45 sec
Other names new york state department of labor unemployment insurance division claim service subsection 2016-2019 form

Form Preview Example

DWS-UI 617B Rev. 11/2016

State of Utah

Department of Workforce Services

Appeals Unit



Claimant’s Name:



Claimant’s SS Number:


Date(s) of Hearing:



Appeal Case Number:


Date Retained:




Date Representation Ended:


Total Amount of Expenses/Fees PAID by Claimant to date: $

Total Fee (including any pre-paid amount) Requested: $



(i.e. research, preparation of appeal, attendance at hearing)



I certify that the above information and the information provided in response to the questions on the second and third pages of this form is true and correct to the best of my knowledge.

Printed Name of Representative

Signature of Representative

Representative Telephone Number

Representative’s email address

Street Address or P.O. Box

City, State, Zip Code

Make sure all pages of this form are completed and provided to the administrative law judge. Return the completed form to the Appeals Unit by mailing it to PO Box 45244, Salt Lake City, UT 84145-0244, by FAX to 801-526-9242, or by email to dwsappeals@utah.gov. Department rule R- 994-508-202 requires that prior to the administrative law judge approving the fee, a copy of this petition must be mailed to the claimant and the claimant is allowed ten days from the date of mailing to object to the fee.

The approval or disapproval of a fee rests solely with the administrative law judge. Department rule R994-508-201(2) generally prohibits the approval of fees in excess of 25% of the Claimant’s

maximum unemployment entitlement. The fee decision will become final unless within ten days from the date of issuance of the approved fee letter, further written appeal is made to the Appeals Board, P.O. Box 45244, Salt Lake City, UT 84145-0244, setting forth grounds upon which the appeal of the fee is made.

Section 35A-4-103(3) . . . Any individual claiming benefits in any proceeding before the department or its representatives or a court may be represented by counsel or any other duly authorized agent; but no counsel or agent shall either charge or receive for his services more than an amount approved by the department. Any person who violates any provision of this subsection shall, for each offense, be fined not less than $50 nor more than $500 or imprisoned for not more than six months, or both.

Before the petition for fees will be considered, the following questions must be answered:

1.In your opinion, why was representation advisable or necessary at the hearing: (Include, e.g., any complexity or novelty of facts of issues.)

2.Was the alternative of self-representation explained to the Claimant?

Why was this option rejected?

3.What fee, if any, was agreed to for your services?

4.On what basis was the agreed fee, if any, calculated?

5.What fee is customarily charged in your locality for representation and what is the basis for that fee?

6. What is the amount and nature of your experience:

In unemployment insurance appeals?

In other administrative appeals?

7.Is the fee sought reasonable and equitable given the Claimant’s circumstances and, if so, why?

Equal Opportunity Employer Program

Auxiliary aids and services are available upon request to individuals with disabilities by calling (801) 526-9240. Individuals

with speech and/or hearing impairments may call Relay Utah by dialing 711. Spanish Relay Utah: 1-888-346-3162.

How to Edit Dws Ui Form 617 B Online for Free

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With regards to the blank fields of this specific form, this is what you want to do:

1. It is crucial to complete the Dws Ui Form 617 B correctly, hence be careful when working with the sections including these particular blanks:

Dws Ui Form 617 B conclusion process described (stage 1)

2. Right after this selection of fields is done, proceed to type in the suitable information in these: I certify that the above, Printed Name of Representative, Representatives email address, Street Address or PO Box, City State Zip Code, Make sure all pages of this form, and The approval or disapproval of a.

Filling in section 2 in Dws Ui Form 617 B

3. Completing complexity or novelty of facts of, Was the alternative of, Why was this option rejected, and What fee if any was agreed to for is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Ways to fill in Dws Ui Form 617 B part 3

Always be really attentive when filling out What fee if any was agreed to for and Was the alternative of, because this is where a lot of people make mistakes.

4. Now fill out this next form section! Here you'll get all of these What fee if any was agreed to for, and fee blank fields to complete.

The best way to fill out Dws Ui Form 617 B part 4

5. And finally, the following final part is what you'll have to wrap up prior to submitting the form. The blank fields at issue include the next: What is the amount and nature of, In unemployment insurance appeals, In other administrative appeals, and Is the fee sought reasonable and.

Ways to complete Dws Ui Form 617 B stage 5

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