UI / DE 6316WGS

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NOTICE REGARDING BENEFITS PAID PENDING VERIFICATION OF WAGES OR EARNINGS

Name
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For Office Use Only
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Date
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On
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, an immediate recomputation of your Disaster Unemployment Assistance (DUA) claim was completed based on your statement of wages/earnings as recorded below. The Base Period of your DUA claim is based on your most recently completed tax year prior to your becoming unemployed due to the disaster. The Base Period of your DUA claim is
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QTR 1 Begins (Date)
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Ends (Date)
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Amount
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QTR 2 Begins (Date)
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Ends (Date)
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Amount
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QTR 3 Begins (Date)
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Ends (Date)
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Amount
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QTR 4 Begins (Date)
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Ends (Date)
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Amount
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Pursuant to 20 Code of Federal Regulations 625.6 (e)(1), you have twenty-one (21) days from
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to submit documentation to substantiate your statement of wages and/or earnings, as shown above, used to establish your DUA claim. Documentation must be from the tax year shown above. If you are an employee, acceptable documentation includes, but is not limited to: check stubs, W-2, IRS 1040. If you are self-employed, acceptable documentation is: IRS 1040, or IRS 1040, Schedule C.

Please include your Social Security Number on all documentation and mail legible copies in the self-addressed envelope provided.

Failure to submit documentation to substantiate your statement of wages and/or earnings used to establish your DUA benefit award will result in a claim recomputation to the minimum entitlement under 20 Code of Federal Regulations 625.6(e)(3). In addition, an overpayment will be established under 20 Code of Federal Regulations 625.6(e)(3), to recover any excess benefits paid.

Interviewer Signature
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Office Stamp

DE 6316WGS Rev. 2 (10-21) (INTRANET)