To be comple

Agency:Contact Name

TAKE THIS FORM WITH YOU IF YOU GO TO FILE A CLAIM

UNEMPLOYMENT COMPENSATION FOR FEDERAL EMPLOYEES (UCFE) PROGRA

NOTICE TO FEDERAL EMPLOYEE ABOUT UNEMPLOYMENT INSURANCE

This form has been given to you because (1) you have been separated from your job, or (2) you were placed in a nonpay status, or (3) yourrecords have been transferred to a different payroll office.

Unemployment insurance (UI) for Federal workers. When unemployed, Federal workers may be entitled to UI benefits

similar to those of workers in private industry. If you become unemployed or are in a nonpay status and want to FILE A

CLAIM, go to the nearest LOCAL PUBLIC EMPLOYMENT SERVICE OFFICE of the STATE EMPLOYMENT SECURITY

AGENCY to register for work and file your claim for UI. Your ELIGIBILITY for UI CANNOT be determined until AFTERyou file a claim. DO NOT DELAY filing a UI claim; if you wait, your unemployment benefits may be reduced or you may not

qualify for any benefits.

To help EXPEDITE your claim, take THIS FORM with you, your SOCIAL SECURITY ACCOUNT NUMBER CARD, the OFFICIAL NOTICE 

SEPARATION or of your present NONPAY status (Standard Form 50 if available), EARNINGS and LEAVE statements, or similar documents temloyed by a Federal agency.FEDERAL AGENCY will insert

in the box:1st line - Parent Federal AgencyName and 3 digit code number2nd line - Major Component (ifany)3rd and 4th line - completeaddress to which all formspertaining to a claim should besent (ES-931, 931A, 934, 936, andnotices of appeal, hearings, anddeterminations)

CODE NO.

3 Digit

Identification

FEDERAL AGENCY

Telephone No

KEEP THIS FORM and TAKE IT WITH YOU if you file a UCFE/UI claim for unemployed Federal workers provided by Federal law

(U.S. CODE, Title 5, Chapter 85). For more information about UCFE/UI, read the REVERSE SIDE of this form.

161

673UH
UNEMPLOYMENT COMPENSATION FOR FEDERAL EMPLOYEES (UCFE) PROGRA

UNEMPLOYMENT INSURANCE (UI) FOR FEDERAL WORKERS

TAKE THIS FORM WITH YOU IF YOU GO TO FILE A CLAIM

GENERAL INFORMATION:1. WHO WILL PAY UNEMPLOYMENT BENEFITS?If you are eligible, you will be paid by a State employment security agency under the provisions of its unemployment insurance (UI) law. Tweekly benefits and the period for which benefits will be paid will generally be determined by the law of the State in which you had your last Duty Station will be printed on your final "Notification of Personnel Action", SF-50. If you have received all the regular benefits for which under certain circumstances, became eligible for additional weeks of extended benefits; check with a State local office official. If your last d

United States, you will not be eligible until you return to the United States, including the District of Columbia, Puerto Rico, and Virgin Island

then be determined under the law of your State of residence.UCFE/UI for unemployed Federal workers is paid from U.S. Government funds. No deductions were taken from your pay to finance these benefi2. UNDER WHAT CONDITIONS WILL I BE ELIGIBLE?All State UI laws require that:a. You must be unemployed, able to work, and available for suitable work; (In some cases, you may be eligible if you are employed less than fub. You must register for work and file a claim at a local public employment service/UI claim office;

c. You must continue to report to the office as directed; andd. You must have had a certain amount of employment/wages within a base period of 1 year specified in the State law and have been separated 

your own.

All State UI laws will deny you benefits for such reasons as:

a. Quitting your job voluntarily without good cause or being discharged for misconduct connected with work; or b. Refusing an offer of a suitable job without good cause.Some State UI laws deny or reduce UI benefits for certain types of payments you may receive (retirement, severance, and/or lump-sum amount 

leave).3. DO I HAVE THE RIGHT OF APPEAL?Yes. If a determination is made denying you benefits, you have the right to appeal as provided in the applicable State law.

4. ARE THERE ANY PENALTIES?Yes. If you willfully make a false (fraudulent) claim, you may be fined, imprisoned, or both. If you make a mistake in giving information when 

the local UI claim office as soon as you discover the mistake: prompt notification may avoid a penalty.

(The above statements are issued for general information; they do not have the effect of law, regulation, or ruling).

IF YOU BECOME REEMPLOYED and have been collection UCFE/UI benefit payments, it is your RESPONSIBILITY to notify the local officepaying benefits now that you are employed. Failure to do so may result in a penalty such as a fine, imprisonment, or both.

67$1'$