Form Ib10-A2 - Eligibility Review Notice

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Employment Security
COMMERCE
Eligibility Review Notice
Employment Security
COMMERCE
ATTACH PHOTO ID HERE
SSN: _______________________
Failure to respond to this request and provide the information requested within 14 days of the date that this form originally was mailed to
you can result in a denial of benefits.
The purpose of this review is to monitor your continued eligibility for benefits. To be considered timely this form must be received
within 14 days of the date that it originally was mailed to you. If you have returned to full-time work, it is not necessary to complete
items 1-4.
The date you returned to work:
_______
_______
________
Month
Day
Year
Employer name and address:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
1.
Are you currently attending school or a training program approved under one of the following:
( ) Trade Adjustment Assistance (TAA)
( ) Workforce Investment Act (WIOA)
If you answered yes to either of these, proceed to line 5 and return the form. You do not need to complete the remainder of this notice.
2.
What is the distance (one way) you are willing to commute to work? __________________________ miles
3.
What means of transportation will you use to look for work? ___________________________________
4.
Is there anything (health problem, dependent care, transportation, school attendance, training (other than
indicated in item 1), etc. that would prevent you from immediately accepting full-time work?
NO ( )
YES ( )
If YES explain _______________________________________________________________________________________________________
___________________________________________________________________________________________________________
5.
Attach a copy of photo ID: Acceptable forms to photo identification include a driver’s license, passport, or other government-
issued identification. Please send this completed form including work search and photo ID to the Division of Employment
Security, Intrastate Claims Unit at: Post Office Box 27967 Raleigh, NC 27611; fax to 919.733.1370; or scan and e-mail to
. Please e-mail
or call 919.707.1237 with any questions
you may have.
6.
Work Search Requirements: The Employment Security Law, G.S. 96-14.9(e), requires you to be registered for work with the
Workforce/Employment Service office in the state where you live and actively seeking work with a minimum of five contacts
with potential employers for each week you claim. You must keep a detailed record of your work search activities, which are
subject to audit by DES. You should maintain these records for at least five (5) years after you stop filing and return to full-time
work. Failure to maintain an adequate and verifiable work search record for any week claimed may result in a denial, delayed
payment, and/or overpayment (requiring repayment) of benefits.
IB10-A2 Rev (04/2016)

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