DEPARTMENT OF LABOR & INDUSTRY UNEMPLOYMENT COMPENSATION BOARD OF REVIEW
IMPORTANT! — READ THE INFORMATION ON THE REVERSE OF THIS FORM BEFORE FILING AN APPEAL.
EXPRESS APPEAL FILING INFORMATION IS INCLUDED.
Ｌｉ＃｜ｒｘ＃ｚｄｑｗ＃ｗｒ＃ｄｓｓｈｄｏ＃ｄ＃ｑｒｗｌｆｈ＃ｒｉ＃ｇｈｗｈｕｐｌｑｄｗｌｒｑ／＃｜ｒｘ＃ｐｘｖｗ＃ｏｈ＃ｅ｜＃ｗｋｈ＃ｏｄｖｗ＃ｇｄｗｈ＃ｗｒ＃ｄｓｓｈｄｏ＃ｄｖ＃ｌｑｇｌｆｄｗｈｇ＃ｒｑ＃ｗｋｈ＃ｇｈｗｈｕｐｌｑｄｗｌｒｑ１＃Ｗｒ＃ｈｑｖｘｕｈ＃ｓｕｒｐｓｗ＃ｏｌｑｊ／＃ use the express link www.uc.pa.gov/appeals／＃ｆｒｐｓｏｈｗｈ＃ｗｋｈ＃ＸＦ０７９Ｅ／＃Ｓｈｗｌｗｌｒｑ＃ｉｒｕ＃Ｄｓｓｈｄｏ／＃ｄｑｇ＃ｏｈ＃ｇｌｕｈｆｗｏ｜＃ｗｒ＃ｗｋｈ＃ｈｏｈｆｗｕｒｑｌｆ＃ｕｈｖｒｘｕｆｈ＃ｄｆｆｒｘｑｗ＃ｒｉ＃ ｗｋｈ＃ＸＦ＃Ｖｈｕｙｌｆｈ＃Ｆｈｑｗｈｕ＃ｏｌｖｗｈｇ＃ｒｑ＃｜ｒｘｕ＃ｇｈｗｈｕｐｌｑｄｗｌｒｑ１＃＼ｒｘ＃ｐｄ｜＃ｄｏｖｒ＃ｏｈ＃ｗｋｈ＃ｄｓｓｈｄｏ＃ｅ｜＃ｉｄ｛＃ｒｕ＃ｐｄｌｏ＃ｅ｜＃ｆｒｐｓｏｈｗｌｑｊ＃Ｖｈｆｗｌｒｑ＃Ｌ＃ｅｈｏｒｚ＃ｄｑｇ＃ｕｈｗｘｕｑｌｑｊ＃ｗｋｌｖ＃
form in accordance with the appeal instructions on the notice of determination.
FOLLOW THE APPEAL INSTRUCTIONS CAREFULLY.
SECTION I: TO BE COMPLETED BY PERSON FILING APPEAL
CLAIMANT’S NAME AND ADDRESS: |
DATE OF DETERMINATION BEING APPEALED |
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CLAIMANT’S SOCIAL SECURITY NO. |
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CLAIMANT’S TELEPHONE NO. ( |
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EMPLOYER’S NAME AND ADDRESS WHERE THE CLAIMANT LAST WORKED:
EMPLOYER’S TELEPHONE NO. ( |
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REASON(S) FOR DISAGREEING WITH THE DETERMINATION AND FILING THIS APPEAL ARE: |
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I certify that all information I have provided in this document is correct and complete. I acknowledge that false statements in this ｇｒｆｘｐｈｑｗ＃ｄｕｈ＃ｓｘｑｌｖｋｄｅｏｈ＃ｓｘｕｖｘｄｑｗ＃ｗｒ＃４；＃Ｓｄ１Ｆ１Ｖ１＃ﾆ＃７＜３７／＃ｕｈｏｄｗｌｑｊ＃ｗｒ＃ｘｑｖｚｒｕｑ＃ｉｄｏｖｌｆｄｗｌｒｑ＃ｗｒ＃ｄｘｗｋｒｕｌｗｌｈｖ１＃
NAME OF PERSON FILING APPEAL
SECTION II: TO BE COMPLETED ONLY BY THE UC SERVICE CENTER
APPEAL FILED ON |
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REFEREE OFFICE |
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APPEAL NO. |
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APPEAL FILED BY: |
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CLAIMANT |
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EMPLOYER |
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EMPLOYMENT SECURITY |
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PA CAREERLINK® |
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APPEAL RECEIVED BY: UCSC |
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PERSONALLY DELIVERED |
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POSTMARKED |
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FAXED |
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OTHER |
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TYPE CLAIM: UC |
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UCX |
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TRA |
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TRADE ACT PETITION NO. |
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OTHER |
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NAFTA PETITION NO. |
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APPELLANT REQUIRES ASSISTANCE BECAUSE OF DISABILITY WITH: |
HEARING |
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SPEECH |
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VISION |
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FOR THE FOLLOWING SPOKEN LANGUAGE |
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OTHER |
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ELIGIBLE SECTION(S) |
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INELIGIBLE SECTION(S) |
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APPLICATION FOR BENEFITS DATE |
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CLAIM WEEK(S) RULED ON |
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UC SERVICE CENTER |
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SIGNATURE OF APPEAL CLERK |
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NAME AND ADDRESS OF EMPLOYER(S) AND ANY OTHER PARTY INVOLVED IN THE CLAIMANT’S ELIGIBILITY |
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EMPLOYER’S ADDRESS |
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EMPLOYER’S REPRESENTATIVE (IF ANY) |
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UC-46B REV 04-14 (PAGE 1)
INFORMATION ABOUT THIS FORM AND THE APPEAL PROCESS
What is the purpose of this form?
This is an appeal form. If you decide to appeal, please read your UC Service Center determination for information ｒｑ＃ｚｋｈｕｈ＃ｗｒ＃ｏｈ＃｜ｒｘｕ＃ｄｓｓｈｄｏ. You may complete this form online at www.uc.pa.gov/appeals. Follow the instructions ｗｒ＃ｏｈ＃ｗｋｈ＃ｄｓｓｈｄｏ＃ｅ｜＃ｆｏｌｆｎｌｑｊ＃ｗｋｈ＃ＸＦ＃Ｖｈｕｙｌｆｈ＃Ｆｈｑｗｈｕ＃ｑｒｗｈｇ＃ｒｑ＃｜ｒｘｕ＃ｇｈｗｈｕｐｌｑｄｗｌｒｑ＃ｗｒ＃ｆｒｐｓｏｈｗｈ＃ｄｑ＃ｒｑｏｌｑｈ＃ＸＦ０７９Ｅ／＃Ｓｈｗｌｗｌｒｑ＃ｉｒｕ＃ Ｄｓｓｈｄｏ１＃Ｌｉ＃｜ｒｘ＃ｚｌｖｋ＃ｗｒ＃ｏｈ＃ｅ｜＃ｉｄ｛＃ｒｕ＃ｐｄｌｏ／＃｜ｒｘ＃ｐｄ｜＃ｘｖｈ＃this＃ｉｒｕｐ＃ｗｒ＃ｄｓｓｈｄｏ＃ｗｋｈ＃ｈｑｆｏｒｖｈｇ＃ｑｒｗｌｆｈ＃ｒｉ＃ｇｈｗｈｕｐｌｑｄｗｌｒｑ１＃Ｌｉ＃｜ｒｘ＃ｏｈ＃ｄｑ＃
appeal, a copy of the completed form will be sent to all parties.
Ｇｒ＃Ｌ＃ｔｘｄｏｌｉ｜＃ｗｒ＃ｏｈ＃ｄｑ＃ｄｓｓｈｄｏＢ＃
Ｌｉ＃｜ｒｘ＃ｄｕｈ＃ｗｋｈ＃ｆｏｄｌｐｄｑｗ／＃｜ｒｘ＃ｐｄ｜＃ｄｓｓｈｄｏ＃ｌｉ＃ｗｋｈ＃ｇｈｗｈｕｐｌｑｄｗｌｒｑ＃ｇｈｑｌｈｖ＃ＸＦ＃ｅｈｑｈｗｖ＃ｄｑｇ＃｜ｒｘ＃ｗｋｌｑｎ＃｜ｒｘ＃ｖｋｒｘｏｇ＃ｅｈ＃ｈｏｌｊｌｅｏｈ＃ｉｒｕ＃ ｅｈｑｈｗｖ１＃Ｌｉ＃｜ｒｘ＃ｄｕｈ＃ｗｋｈ＃ｈｐｓｏｒ｜ｈｕ／＃｜ｒｘ＃ｐｄ｜＃ｄｓｓｈｄｏ＃ｌｉ＃ｗｋｈ＃ｇｈｗｈｕｐｌｑｄｗｌｒｑ＃ｊｕｄｑｗｖ＃ｅｈｑｈｗｖ＃ｄｑｇ＃｜ｒｘ＃ｗｋｌｑｎ＃ｗｋｈ＃ｆｏｄｌｐｄｑｗ＃ｖｋｒｘｏｇ＃ ｅｈ＃ｌｑｈｏｌｊｌｅｏｈ＃ｒｕ＃ｈｏｌｊｌｅｏｈ＃ｉｒｕ＃ｉｈｚｈｕ＃ｅｈｑｈｗｖ１＃＼ｒｘ＃ｐｘｖｗ＃ｌｑｇｌｆｄｗｈ＃｜ｒｘｕ＃ｕｈｄｖｒｑ＃ｉｒｕ＃ｏｌｑｊ＃ｄｑ＃ｄｓｓｈｄｏ１＃
What do I do if I have questions?
Ｇｒ＃ｑｒｗ＃ｘｖｈ＃ｗｋｌｖ＃ｉｒｕｐ＃ｗｒ＃ｄｖｎ＃ｔｘｈｖｗｌｒｑｖ＃ｄｅｒｘｗ＃ｗｋｈ＃ｈｑｆｏｒｖｈｇ＃ｇｈｗｈｕｐｌｑｄｗｌｒｑ＃ｒｕ＃ＸＦ＃ｅｈｑｈｗｖ１＃Ｗｋｌｖ＃ｉｒｕｐ＃ｖｋｒｘｏｇ＃ｅｈ＃ ｘｖｈｇ＃ｒｑｏ｜＃ｗｒ＃ｏｈ＃ｄｑ＃ｄｓｓｈｄｏ１＃If you have any questions about UC, call the UC Service Center listed on the determination.
Ｌｉ＃｜ｒｘ＃ｚｒｘｏｇ＃ｏｌｎｈ＃ｗｒ＃ｄｖｎ＃ｄ＃ｔｘｈｖｗｌｒｑ＃ｅｈｉｒｕｈ＃｜ｒｘ＃ｇｈｆｌｇｈ＃ｚｋｈｗｋｈｕ＃ｗｒ＃ｄｓｓｈｄｏ／＃ｆｄｏｏ＃ｓｕｒｐｓｗｏ｜＃ｅｈｆｄｘｖｈ＃ｄｑ＃ｄｓｓｈｄｏ＃ｐｘｖｗ＃ｅｈ＃ｏｈｇ＃
within 15 days after the determination is issued.
Ｚｋｄｗ＃ｋｄｓｓｈｑｖ＃ｌｉ＃Ｌ＃ｏｈ＃ｄｑ＃ｄｓｓｈｄｏＢ＃
Ｄｉｗｈｕ＃｜ｒｘｕ＃ｄｓｓｈｄｏ＃ｌｖ＃ｕｈｆｈｌｙｈｇ＃ｄｑｇ＃ｓｕｒｆｈｖｖｈｇ／＃ｗｋｈ＃ｉｕｒｑｗ＃ｒｉ＃ｗｋｌｖ＃ｉｒｕｐ＃ｚｌｏｏ＃ｅｈ＃ｆｒｐｓｏｈｗｈｇ＃ｄｑｇ＃ｕｈｗｘｕｑｈｇ＃ｗｒ＃｜ｒｘ＃ｄｖ＃ｑｒｗｌｆｄｗｌｒｑ＃ ｗｋｄｗ＃ｌｗ＃ｋｄｖ＃ｅｈｈｑ＃ｓｕｒｆｈｖｖｈｇ１＃＼ｒｘ＃ｐｄ｜＃ｄｏｖｒ＃ｕｈｆｈｌｙｈ＃ｄ＃ｆｒｓ｜＃ｒｉ＃ｗｋｌｖ＃ｄｓｓｈｄｏ＃ｌｉ＃ｗｋｈ＃ｄｊｊｕｌｈｙｈｇ＃ｓｄｕｗ｜＃ｋｄｖ＃ｏｈｇ＃ｄｑ＃ｄｓｓｈｄｏ１＃
Ｌｉ＃ｄｑ＃ｄｓｓｈｄｏ＃ｌｖ＃ｏｈｇ／＃ｄ＃ＸＦ＃ｕｈｉｈｕｈｈ＃ｚｌｏｏ＃ｆｒｑｇｘｆｗ＃ｄ＃ｋｈｄｕｌｑｊ＃ｚｋｈｕｈ＃ｗｋｈ＃ｓｄｕｗｌｈｖ＃ｄｑｇ＃ｗｋｈｌｕ＃ｚｌｗｑｈｖｖｈｖ＃ｆｄｑ＃ｊｌｙｈ＃ｗｈｖｗｌｐｒｑ｜＃ｘｑｇｈｕ＃ oath. The parties may arrange for witnesses with ｕｖｗｋｄｑｇ＃knowledge of the facts to participate in the hearing. Firsthand
knowledge refers to something which the witness actually saw or heard, as distinguished from something learned from some other person or source. Information learned secondhand might not, depending on the circumstances, be considered at the hearing.
If the hearing concerns the claimant’s separation from employment, and the claimant quit his or her job, the claimant ｚｌｏｏ＃ｅｈ＃ｌｑｈｏｌｊｌｅｏｈ＃ｉｒｕ＃ｅｈｑｈｗｖ＃ｘｑｏｈｖｖ＃ｗｋｈ＃ｆｏｄｌｐｄｑｗ＃ｓｕｒｙｈｖ＃ｗｋｄｗ＃ｗｋｈｕｈ＃ｚｄｖ＃ｄ＃ｑｈｆｈｖｖｌｗｒｘｖ＃ｄｑｇ＃ｆｒｐｓｈｏｏｌｑｊ＃ｕｈｄｖｒｑ＃ｗｒ＃ｙｒｏｘｑｗｄｕｌｏ｜＃
leave work. If the employer discharged the claimant, the claimant’s separation will not be disqualifying unless the employer proves that the claimant was dismissed for willful misconduct or the claimant’s unemployment is his or her fault.
At the hearing, the referee will try to obtain testimony about all of the facts relevant to the appeal. The referee will issue a decision after the hearing and mail a copy to the parties.
May I have legal representation?
Ｚｋｈｗｋｈｕ＃｜ｒｘ＃ｄｕｈ＃ｗｋｈ＃ｆｏｄｌｐｄｑｗ＃ｒｕ＃ｗｋｈ＃ｈｐｓｏｒ｜ｈｕ／＃｜ｒｘ＃ｐｄ｜＃ｏｈ＃｜ｒｘｕ＃ｒｚｑ＃ｄｓｓｈｄｏ＃ｄｑｇ＃ｕｈｓｕｈｖｈｑｗ＃｜ｒｘｕｖｈｏｉ＃ｗｋｕｒｘｊｋｒｘｗ＃ｗｋｈ＃
appeal process, or you may have an attorney or any other advocate represent you. If you are the claimant and you qualify, free legal assistance may be available from the legal services organization serving your area, your local bar association, or a law school clinic.
Ｖｋｒｘｏｇ＃Ｌ＃ｏｈ＃ｆｏｄｌｐｖ＃ｚｋｌｏｈ＃ｄｑ＃ｄｓｓｈｄｏ＃ｌｖ＃ｓｈｑｇｌｑｊＢ＃
＼ｈｖ１＃Ｌｉ＃ｗｋｈ＃ｈｐｓｏｒ｜ｈｕ＃ｄｓｓｈｄｏｖ＃ｄ＃ｇｈｗｈｕｐｌｑｄｗｌｒｑ＃ｊｕｄｑｗｌｑｊ＃｜ｒｘ＃ｅｈｑｈｗｖ／＃｜ｒｘ＃ｆｄｑ＃ｕｈｆｈｌｙｈ＃ｅｈｑｈｗｖ＃ｚｋｌｏｈ＃ｗｋｈ＃ｄｓｓｈｄｏ＃ｌｖ＃ｓｈｑｇｌｑｊ１＃ Ｌｉ＃｜ｒｘ＃ｄｓｓｈｄｏ＃ｄ＃ｇｈｗｈｕｐｌｑｄｗｌｒｑ＃ｇｈｑ｜ｌｑｊ＃ｅｈｑｈｗｖ＃ｄｑｇ＃ｗｋｈ＃ｄｓｓｈｄｏ＃ｌｖ＃ｇｈｆｌｇｈｇ＃ｌｑ＃｜ｒｘｕ＃ｉｄｙｒｕ／＃ｒｑｏ｜＃ｅｈｑｈｗｖ＃ｉｒｕ＃ｚｈｈｎｖ＃ｗｋｄｗ＃
you claimed while the appeal was pending can be paid. Therefore, if you remain partially or fully unemployed while an appeal concerning your eligibility is pending, ｆｒｑｗｌｑｘｈ＃ｗｒ＃ｏｈ＃ｆｏｄｌｐｖ＃ｉｒｕ＃ｅｈｑｈｗｖ１＃ＸＦ＃Ｆｏｄｌｐｖ＃ｆｄｑ＃ｅｈ＃ｏｈｇ＃ｅ｜＃ｆｄｏｏｌｑｊ＃
Pennsylvania Teleclaims System (PAT) or by Internet at www.uc.pa.gov. Your UC Service Center can assist you if you ｄｕｈ＃ｘｑｄｅｏｈ＃ｗｒ＃ｏｈ１＃
Auxiliary aids and services are available upon request to individuals with disabilities.
Equal Opportunity Employer/Program
UC-46B REV 04-14 (PAGE 2)
