UIA 1583EUC |
State of Michigan |
Authorized by |
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(3-12) |
Department of Licensing And Regulatory Affairs |
MCL 421.1, et seq. |
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UNEMPLOYMENT INSURANCE AGENCY |
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www.michigan.gov/uia |
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Bi-Weekly Emergency Unemployment Compensation
(EUC) Record of Work Search
Federal law requires that you engage in an active work search for each week you are claiming Emergency Unemployment Compensation (EUC) beneits. You must contact a
minimum of two employers per week, and report the details and results of each work search effort on this form. Complete and submit this form BEFORE contacting MARVIN or using MARVIN Online during your scheduled appointment to certify/report for beneits. You can report your EUC work search efforts online through the Claimant Web Account Manager (CWAM) by visiting www.michigan.gov/uia and selecting “Online Services for Unemployed Workers.” If you do not complete and submit this form timely, a determination will be made on your eligibility for those week(s) you were paid but did not submit an EUC work search form. This may have an effect on your eligibility for future payments and/or you may be required to pay back the beneits you were paid for these week(s) in question, plus any applicable interest and penalties. If you have any questions about this form or EUC work search requirements, call 1-866-500-0017 (TTY customers use 1-866-366-0004) between 8:00 AM and 4:30 PM (Eastern Time) Monday through Friday. Detailed instructions on reverse side.
Date Mailed/Faxed: ______________
Name:
(Please print clearly and use black ink)
Enter your Social Security number
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Name and Title of |
Method of |
Type of Work |
Person Contacted |
Contact |
Applied for |
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Result
(Application submit- ted, interview, hiring, not hiring, etc.)
First Week Ending Date: __________________
Second Week Ending Date: __________________
Your Certiication: By signing this form, I am reporting my work searches for the week(s) shown above. The information reported on this form is true and correct to the best of my knowledge and belief. Under 18 U.S.C. Section 1001, knowingly and willfully concealing a material fact by any trick, scheme, or device or knowingly making a false statement in connection with this claim is a federal offense, punishable by a ine of not more than $10,000 or imprisonment for not more than ive years, or both.
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Signature:_________________________________________________________________Date:_____________________ |
*015831203* |
For UIA Use Only |
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User I.D.: _____________________ Date: ______________ |
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LARA is an equal opportunity employer/program. |
UIA 1583EUC
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Instructions for Completing the EUC Work Search
The following information must be completed on the Work Search form in order to continue to receive EUC payments.
•Week Ending Dates – these dates are for the previous two weeks. The dates start on Sunday and end on Saturday. Write the Saturday date for each week.
•Date of Contact – the dates of your work search must fall within the week ending (Sunday thru Saturday) date for each week.
•Name of Employer – write the name, if known, or the online job search site, or employment service or agency that was contacted. If the employer is not known or not identiied, indicate “not known or not identiied.”
•Employer Address – enter the employer address, or city/state, website address, general location, or indicate “not known”.
•Name and Title of Person Contacted – enter the name and title, if known of the person contacted, or the area contacted (e.g., human resources department, website address), or indicate not known.”
•Method of Contact – enter how contact was made, (e.g., in person, phone, mail, fax, email, online, by resume, response to job ad, etc.)
•Type of Work Applied for - enter the type of work applied for, (e.g., factory worker, retail sales,wait staff, truck driver, etc.)
•Results – enter results of work search, (e.g., submitted resume and/or application, not accepting applications, not hiring, scheduled for interview, etc.)
IMPORTANT NOTE ABOUT NUMBER OF WORK SEARCHES PER WEEK
You must list at least two employers each week. The third employer contact is optional, but only two employer contacts per week are required.
SUBMITTING YOUR WORK SEARCH: You must submit your completed EUC work search online by logging into your CWAM account, which can be located on the UIA home page at www.michigan.gov/uia, or by mailing or faxing your completed EUC work search to:
Unemployment Insurance Agency
P.O. Box 169
Grand Rapids, MI 49501-0169
Fax Number: 1-517-636-0427
If you have questions regarding the EUC work search, call our toll free telephone Inquiry Line at
1-866-500-0017 and press option 3 to speak with an agent.
