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NOTICE OF DETERMINATION OF INVALID CLAIM, SECTION 1277

In order to have a valid claim, Section 1277 requires that you were paid or earned at least $1,300 as an employee in one quarter during the period from Blank line________ to Blank line________ and performed some work; or that you were paid or earned at least $900 as an employee in the quarter of your highest earnings and earned at least 1.25 times your high quarter earnings during the above period and performed some work. You may also qualify if you were not paid Unemployment Insurance benefits on your last claim but were disabled and received Disability Insurance benefits or Workers’ Compensation benefits during the above period. Disability or Workers’ Compensation benefits that you received in the above period may be considered as wages toward meeting the monetary requirement of Section 1277, if you performed some work during this same period.

Your claim is invalid under Section 1277 for the reason(s) checked below:

THIS DETERMINATION DOES NOT AFFECT YOUR CLAIM FOR EXTENDED BENEFITS.

If you believe this determination to be contrary to law or the facts, you may file an appeal within thirty (30) days from the date of mailing or service of this notice. An appeal may be filed on the enclosed form DE 1000M. The grounds or reasons for the appeal must be stated on that form.

Any Unemployment Insurance claim you file will be invalid under Section 1277 until Blank line________, at which time this test will no longer apply.

Date this notice was issued to you: Blank line________ .

DE 429L Rev. 20 (12-21) (INTRANET)