Form Uia 1538 PDF Details

Form UIA 1538 is a document used to help marriage equality supporters provide information to their elected officials in order to show the impact of the proposed legislation on their lives and on society as a whole. The goal of this form is to show how legalizing same-sex marriage would improve the economy, benefit children, and strengthen families. This form can be downloaded and filled out online, making it easy for individuals to have their voices heard. marriage equality supporters everywhere are encouraged to use this form to make their voices heard and help make change happen!

Form NameForm Uia 1538
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namesUIA, LARA, 2011, accrues

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UIA 1538

State of Michigan

Authorized by

(Rev. 11-11)

Department of Licensing and Regulatory Affairs

MCL 421.1, et seq.


Unemployment Insurance Agency


What You Need To File An Unemployment Claim


If you have become unemployed or have had your hours of work reduced, you may ile a claim for unemployment beneits. You may ile your claim by telephone toll-free at 1-866-500-0017 (TTY customers use 1-866-366-0004), or ile via the Internet

at under the heading, “Filing Unemployment Claims Online.” Completing the information on

this sheet irst will save you time when you ile your claim for unemployment beneits.



Social Security Number:

Driver license number or state ID number:

Mailing address (where you want information about your unemployment claim sent):

Telephone number (If you do not have a phone, give a

number where a message can be left in case UIA staff need to contact you):

Method of Payment: You will be asked to choose if you want your beneit payments issued by direct deposit to

your bank or credit union account or by debit card:

If you are not a citizen or national of the United States, give your Alien Registration Number and the expiration date shown on your alien ID or documents:

_______ Direct Deposit ______ Debit Card

You will need the names and payroll addresses for all the employers you have worked for in the 18 months prior to iling your

claim. You will also need the date you started work and ended work with each of these employers. If any of the employers provided you with Form UIA 1711, Unemployment Compensation Notice to Employee, have the form(s) available. You may

be asked to provide the UIA with some of the information contained on the form. It would also be helpful to have available

any W-2 forms you have received from employers you have worked for in the past 18 months, as the form contains the employer’s Federal Employer Identiication Number (FEIN).


Your Most Recent Employer #1

(Separating Employer):

Street Address (use the payroll address if known):

City, State and Zip Code

Dates of employment and earnings (report your gross earnings for your most recent period of continuous employment with this employer):

Beginning Date: _______________

Ending Date: _______________

Earnings: _______________

LARA is an equal opportunity employer/program.

UIA 1538 (Rev. 11-11) Reverse Side

List all other employers you have worked for in the past 18 months giving the payroll address if known (use additional paper if necessary):



Payroll Address:

City, State and Zip Code: Dates of Employment:

Beginning Date: _______________

Ending Date: _______________



Payroll Address:

City, State and Zip Code: Dates of Employment:

Beginning Date: _______________

Ending Date: _______________


When entering dates, either on the web or the telephone, you must enter two digits for the month, two digits for the day, and four digits for the year. Example: October 3, 2011 should be entered as 10/03/2011 on the web or 10032011 on the phone.


Your beneit entitlement will be based on gross wages paid in the irst four of the last ive completed calendar quarters immediately preceding the Sunday of the week in which you ile your claim. If there are insuficient wages in those quarters, the wages in the last four completed quarters will be used. For example, if you iled for beneits on Wednesday, November 12, 2011, the wages paid during the calendar quarters below would be used to compute your beneit entitlement.

July 1, 2011 through September 30, 2011

April 1, 2011 through June 30, 2011

January 1, 2011 through March 31, 2011

October 1, 2010 through December 31, 2010

July 1, 2010 through September 30, 2010

You may be asked to provide quarterly wages if they were not reported by your employer(s). You should have the information available before iling your claim.

INTEREST: Interest accrues at the rate of 1% per month (computed on a daily basis) as provided in Act No. 14 of the Public

Acts of 2011 and Section 15(a) of the MES Act.

If you have any questions about this form, call the UIA at 1-866-500-0017 (TTY customers use 1-866-366-0004).