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SAMPLE, this page for reference only

WEEKLY REQUEST FOR ALLOWANCES BY WORKER IN TRAINING

Trade Act Of 1974, as Amended

Worker’s Name (Last, First, Middle)Blank space

Social Security Number ‎‎XXX-XX- Blank space

Petition NumberBlank space

Mailing Address (No, Street, City or County, State, Zip Code)Blank space

Trade Readjustment Allowance (To be completed by worker)

1st Week Ends

2nd Week Ends

Did you work or have self-employment in that week?

Blank Line__________

Name and Address of Employer
(If self-employed, write

"self"

)Blank space

How much did you earn before deductions that week, whether you were paid or not?

Blank Line__________

Include ALL earnings from all sources. If you had no earnings that week, write "none"

Did you attend training each day during that week as scheduled?

Blank Line__________

If no, complete Items A and B.

Dates of Absences Blank line
Reason for Absences Blank line
Blank line

Have you applied for or received any training or education allowance for that week?

Blank Line__________

Name of Program Blank space

Amount Received

Blank Line__________

Date Received

Blank Line__________

Have you filed (or do you intend to file) a claim, or have you received unemployment insurance under a State or Federal law for that week or any part of that week?

Blank Line__________

Amount Received

Blank Line__________

Are you receiving a pension?

Blank Line__________

If yes, has there been any change in the amount since you last reported it?Blank Line______________________________

If there has been a change, enter the new gross amount and explain the reason for the change.

If you want federal income tax withheld for the week(s) shown above, mark this box

(If you mark the box and are certifying for two weeks, federal income tax will be withheld from both weeks. Federal income tax is not withheld from subsistence/relocation allowances.)

Worker Certification: I AUTHORIZE deduction for advances made to me, if appropriate. I GIVE this information to support my request for allowances. The information contained in this request is correct to the best of my knowledge. I UNDERSTAND that penalties are provided for willful misrepresentation made to obtain allowances to which I am not entitled.

Blank line

Signature of Worker

Blank line

Date (Month, Day, Year)

Progress And Attendance In Training (To be completed by Training Facility)

From the beginning of training and through training week(s) shown above, has this worker made satisfactory progress in training? If no, give reason for unsatisfactory progress:Blank space

Yes

Did good cause exist for worker's unsatisfactory progress in training? Explain:Blank space

Yes

Date TerminatedBlank space

Last Hour and Date AttendedBlank space

Did you provide lodging and meals to this worker during the training week(s) shown above?

If Yes, Charge per Day
$Blank space

No. Days ProvidedBlank space

Attendance Record:

Enter "P" and date the worker attended or was absent WITH good cause. Enter "A" and date the worker was absent WITHOUT good cause. Please explain reason for absence in space under question C1.

Caption
Question	Answer
	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	No Days Training Scheduled
1st Week	Blank space	Blank space	Blank space	Blank space	Blank space	Blank space	Blank space	Blank space
2nd Week	Blank space	Blank space	Blank space	Blank space	Blank space	Blank space	Blank space	Blank space

The answers in Part C are in accordance with our records. Statements made by the worker appear to be complete and correct to the best of my knowledge.

Blank line

Name of Training Facility

Blank line

Signature of Training Official

Blank line

Date

-Determination and Appeal Rights on Reverse-

DE 8322 Rev. 6 (5-22) (INTRANET)

SAMPLE, this page for reference only

Mail Original Of This Form To:

Blank space

Determination

Amount Authorized

Payment Denied

Trade Readjustment Allowance

$__________Blank line

(Type __________)

Subsistence Allowance

$__________Blank line

(Number Days __________)

Transportation Allowance

$__________Blank line

Initial

Terminal

Daily (Number Days __________)

Reason for Denial:Blank space

INTERVIEWER /

Blank line

Initials

Blank line

Date Signed

Appeal Rights (Please Read Carefully)

You have the right to file an appeal if you do not agree with all or part of this decision. To appeal, you must write a letter stating that you want to appeal. Explain why you do not agree with the decision. Write your Social Security number on your letter. (Title 22, California Code of Regulations (CCR),Section 5022.) Mail your letter to the address shown on the front of this form. (Title 22, California Code of Regulations (CCR), Section 5023 and ‎20 CFR ,Section 617.51.) File your appeal within 30 days of the mail date of this notice or not later than Blank Line__________.

When your appeal is received, your case will be reviewed. If the decision is still the same, we will send your appeal to the Office of Appeals. If you appeal after 30 days, you must show good cause for the delay or the Administrative Law Judge (ALJ) may dismiss your appeal.

The Office of Appeals will send you a letter with the date, place, and time of your hearing. At the hearing, the Administrative Law Judge (ALJ) will listen to you, examine the facts, and make a decision. You may bring a representative or someone to help you. For more information or help with your appeal, please call the EDD Special Claims Office at ‎888-697-1760.

When an appeal is pending, you must continue to complete and mail Weekly Request for Allowances by Worker in Training claim forms. If you do not receive any response, a hearing letter or claim forms, contact the EDD Special Claims Office at ‎888-697-1760. If the judge decides you can be paid, we can only pay if claim forms were received.

DE 8322 Rev. 6 (5-22) (INTRANET)

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UI / DE 8322

WEEKLY REQUEST FOR ALLOWANCES BY WORKER IN TRAINING

-Determination and Appeal Rights on Reverse-