Uia 1734 Inquiry Form

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UIA 1734
Authorized by
(Rev. 11-11)
MCL 421.1, et seq.
Reset Form
State of Michigan
Department of Licensing and Regulatory Affairs
Unemployment Insurance Agency
INQUIRY
This form is used to request general claims information (e.g., question regarding your entitlement, 10 or more days have passed
and your benefit payment has not been received, etc.). Do not use this form to protest a (re)determination. Use Protest of a (Re)
Determination (Form UIA 1733) for this purpose, and read “Your Protest and Appeal Rights” found in the claims information booklet
you received.
USE THIS FORM ONLY IF YOU HAVE FAILED TO GET YOUR REQUESTED INFORMATION THROUGH THE MARVIN SYSTEM,
OR BY CALLING THE UIA INQUIRY LINE. IF YOU ARE INQUIRING ABOUT A PAYMENT DELAY, USE THIS FORM ONLY IF YOU
BE SURE TO SIGN THIS FORM
HAVE NOT RECEIVED A SCHEDULED PAYMENT AFTER 10 OR MORE DAYS.
(PLEASE PRINT)
Social Security Number: _____________________
Check this box if this is a new address
Telephone Number: ______________________
Name: __________________________________________________________________________________________________________________
Address: ________________________________________________________________________________________________________________
City & State:_____________________________________________________________________
Zip Code _____________________________
COMPLETE THE ITEM THAT CORRESPONDS TO YOUR INQUIRY
1. I filed a new claim on __________________________ and have not received a determination.
2. I filed a reopened claim on __________________________ and have not received a determination.
3. I filed for extended benefits on __________________________ and have not received a determination.
4. I called MARVIN or sent form(s) for payment for week(s) ending __________________________ and/through
__________________________ and have not received my payment(s).
5. I requested a redetermination on __________________________ concerning the determination dated
__________________________ and have not received the redetermination.
6. I filed an appeal to the Administrative Law Judge (by mail/ fax/other) on _________________________ concerning the
redetermination dated __________________________ . I have not been scheduled for a hearing OR have not received a
decision from my Administrative Law Judge hearing.
7. I submitted a replacement check affidavit on __________________________ for week(s) ending ______________________
and/through __________________________ and have not received my payment(s) or information.
8. I requested the following information:
Your Signature: _______________________________________________
Date: ___________________
(Over)
*017341111*

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