LA Works Main Logo UNEMPLOYMENT INSURANCE Appeals Form  

(*) Entry Required
  1. * Are you a Claimant or an Employer?

    Claimant
    Employer

  2. * Name and contact information for person filing the appeal.


    Character Count: (Max 200, remaining 200.)

  3. * What is the claimant's Social Security Number?


  4. What is the name of the employer?

  5. What are the Determination Number(s)?


    Character Count: (Max 200, remaining 200.)

  6. What is the Determination Mailing Date?

  7. What is your Statement of Appeal?


    Character Count: (Max 200, remaining 200.)

  8. What is your e-mail address?

  9. What is your phone number?