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Decision of Eligibility For Unemployment Insurance Benefits

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UTAH DEPT OF WORKFORCE SERVICES

UI DIVISION
Utah Department of Workforce Services
140 EAST 300 SOUTH Unemployment Insurance
PO BOX 45266
SALT LAKE CITY, UT 84145-0266 Decision of Eligibility for
Unemployment Insurance Benefits

ELECTRONIC: 4/7/2021 MDSN

PERRY JOHNSTON SSN: xxx-xx-9481


1 S MAIN ST EMPLOYER: N/A
SAINT GEORGE, UT 84770-3415

Notice: This decision is made on your claim for benefits:

You indicated you earned at least $5,000 net income in self employment in the most recent taxable year prior to your regular
unemployment compensation claim. You did not provide documentation or the documentation you provided did not verify this.
Therefore it is determined that you are not eligible for an additional $100 per week in supplemental benefits according to Section
2104(b) of the CARES Act (15 U.S.C. 9023(b)(1)).

RIGHT TO APPEAL: You may appeal if you believe this decision is incorrect. Your written appeal must be submitted online, faxed,
postmarked (or otherwise delivered) on or before 4/22/2021. An appeal submitted after the deadline may be considered if you can
show good cause for filing late. A copy of your appeal will be sent to other interested parties. For more information about the
appeals process go to jobs.utah.gov/appeals. Your written appeal must be signed by you or your legal representative and include
1) your name and current mailing address, 2) your Social Security number, 3) the date 4) your statement of appeal. It is important
to continue filing your weekly claims while the appeal process is pending. You will not be paid for any week not filed timely, unless
you can show good cause for filing late.

Appeal online: Appeal by fax: Appeal by mail:


jobs.utah.gov/appeals (801) 526-9242 Appeals Unit, PO Box 45244, Salt Lake City, UT, 84145-0244

UI CLAIMS CENTER PHONE NUMBERS: S.L.: 801-526-4400, Ogden: 801-612-0877, Provo: 801-375-4067, Out of Area:
888-848-0688. APPEALS PHONE NUMBER: S.L.: 801-526-9300, Toll Free: 877-800-0671.

REPR.: J Williams EMP.#: 1000000

Doc ID: 32414158 PID: 021-277-295 DO NOT WRITE BELOW THIS LINE DWS-UI Form 615J - Rev 1/18

**32414158**

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