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SAMPLE, this page for reference only.
You are not eligible to receive benefits as explained below:
DE 1080MON Rev. 4 (10-22) (INTERNET)
If you believe that this decision is not correct, you may file an appeal to the field office shown at the top of this form. In your appeal letter, explain why you do not agree with this decision. Any appeal from this notice, to be timely, must be filed on or before MM/DD/YYYY.
While an appeal is pending, you must continue to submit claim forms for each week you wish to be paid. If the final decision holds you eligible, you will only be paid for those weeks for which you have filed claim forms and have met all eligibility requirements.