Form Tra-858a-E - Weekly Request Form For Allowances By Participant In Approved Training

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State of Wisconsin

Division of Employment & Training

Department of Workforce Development

Division of Unemployment Insurance

TRA Weekly Request for Allowances by Participant in Approved

Asset PIN _____________________________

Training under the Trade Act of 1974, As Amended

P.O. _________________________________

Personal information you provide may be used for secondary purposes [Privacy Law, s.

Invoice No. ____________________________

15.04(1)(m), Wisconsin Statutes]. Provision of your Social Security Number (SSN) is

mandatory per the federal Social Security Act. Your SSN is used to verify your identity. If

you do not provide it, we cannot take your claim.

Name (last, first, middle)

Social Security Number

Telephone Number

Email Address

Street Address

City

State

Zip Code

Training Institution

Training Program

For Week Beginning Sunday, _________________________ and Ending Saturday, ______________________________

A. Training Attendance

Did you attend all scheduled training approved under the Trade Act Program this week?........................................

YES

If “NO,” explain why you didn’t attend all scheduled training.

_________________________________________________________________________________________________________

If there was a break in training scheduled by the school, list the from and through dates of the entire break period.

Training break scheduled from ______________________________ to ___________________________________

Training Representative Signature __________________________________________________ Date Signed _________________

Instructor or Training Institution Representative signatures are required for verification for each enrolled class, on a weekly basis.

mail, and fax it with this form.

Online classes must obtain attendance verification from your instructor on a weekly basis in writing, via

Enter this week’s attendance record below by indicating P for Present and A for Absent. Remedial students must enter the number

of hours that you attended remedial training each day.

Name of Class

Instructor Signature

B. Transportation and Subsistence Allowances

If you have been approved by your TAA Coordinator to receive mileage reimbursement for travel outside the normal commuting

distance, enter your travel information here: Number of Days ___________ Round Trip Mileage per day _____________________

If you have been approved by your TAA Coordinator to reside away from home to attend training, complete the following:

Days resided away _________ Number of One-way trips ______________ Miles per Day ______________________________

Total Lodging Cost ________________ Total Meal Cost ______________

Note: Meal and Lodging receipts must be attached.

C. Participant Certification

I certify the above information is complete and correct. If I add or drop classes or change my training plan in any way I have informed my

TAA Coordinator. I understand penalties (including loss of TRA/TAA benefits and prosecution) are provided for willful misrepresentation

made to obtain TRA Allowances and/or TAA assistance.

Participant Signature _____________________________________________________ Date Signed __________________________

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APPROVALS – FOR LOCAL USE ONLY

Transportation/Travel

Subsistence

Reimbursements

ATAA

RTAA

Rate/Mile

No. of Days

Actual Cost

No. of Days

Total

TAA Coordinator Signature