Reemployment Assistance Appeal Withdrawal

Appeal Withdrawal

A claimant or employer who filed a Reemployment Assistance appeal may withdraw the appeal by submitting a written request. Use the form below to submit your withdrawal request. After the request is submitted, the hearing officer assigned to your case will review the withdrawal for approval. If approved, the appeal will be dismissed.

Claimant ID:

Appeal Docket Number:

Your docket number can be located on the top right of the Notice of Hearing. If your appeal hearing has not been scheduled, enter the Issue ID on your Determination. If the withdrawal request is for a monetary appeal and your hearing has not been scheduled, enter the 8 digit number located beneath the bar code at the top of the Notice of Monetary Determination.

Name of Individual Requesting Withdrawal:

Phone Number:

Phone Number of Individual Requesting Withdrawal

Reason for Withdrawal:

With my signature below I attest to the following:

I understand that upon approval of my withdrawal request the appeal will be withdrawn and the determination, including any disqualification, ineligibility, charges, or overpayment, will remain in effect.

I understand that a withdrawn appeal will be reopened only upon an allegation that the withdrawal request was made as a result of misinformation from or coercion by the appellee or an employee of the Department, which will be a threshold issue to be decided by an Appeals Referee.

Signature:

Type your name into the signature box to affix your electronic signature on this form.

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Date:

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If you need to speak with a representative, please call

1-833-FLAPPLY
(1-833-352-7759)

People who need assistance filing a claim online because of legal reasons, computer illiteracy, language barriers, or disabilities may call: 1-833-FL-APPLY (1-833-352-7759).

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