Unemployment Insurance
|TAA-6 (Rev. 7/2014) |
|Trade Adjustment Assistance (TAA) |
|UI/TRA Income Projection and Statement of Support |
|Name SSN Petition # |
|Unemployment |Current UI benefit year ends: | | |
|Insurance (UI) | | | |
| |Subsequent benefit year eligibility, if anticipated, is based on employment at | | |
| |If the worker’s petition # is between 70000 & 84999: If eligibility for another UI benefit year is based on part-time or short-term |
| |employment that follows the worker’s most recent total separation from adversely affected employment AND the UI rate on the subsequent |
| |claim is lower than the weekly TRA amount, the worker may opt to receive TRA over UI. This option would be given after the new claim is|
| |established. |
|Additional Trade |If the worker’s petition number is less than 70000 or greater than 85000, was a bona fide application for training (JS-52) signed by the|
|Readjustment Allowances |worker and a TAA counselor on or before the “210” date? Yes No |
|(TRA) |If no, additional TRA may not be paid. |
|Remedial/ |Number of weeks of remedial education included in worker’s TAA retraining plan, if any: | |
|prerequisite | | |
|training | | |
| |If the worker’s petition number is between 70000 and 79999, number of weeks of | |
| |prerequisite education needed to participate in occupational skills training, if any. | |
| |
|UI/TRA |UI |UI |Basic TRA |
| |Current |Subsequent |26 weeks |
| |Claim |Claim | |
|Week ending date of first | | | | | |
|eligible week | | | | | |
|Week ending date of last | | | | | |
|eligible week | | | | | |
|Number of weeks ineligible for TRA due to a break in training longer than 30 | | | |
|days | | | |
|Does not qualify (X) | | | | | |
| | | | |
|Final week of UI/TRA income support | |Training ends | |
| | | | |
|If UI/TRA income support is not available during the entire training program, worker must complete and sign section below. |
|Signature of TAA Counselor | |Date | |
| | | | |
|Worker’s Certification of Income Support |
| |
|I understand that my unemployment compensation and TRA benefits are projected to end prior to the end of my training and/or I am ineligible to receive TRA |
|during breaks in training that are longer than 30 days. I have the following financial resources to pay living expenses in order to complete training: |
|_______________________________________________________________________________________ |
|_______________________________________________________________________________________________ |
|Continue on reverse side if necessary. If relying on another individual for financial support, the person offering to support you must provide a signed |
|statement acknowledging the duration of time he or she will provide you with financial support. |
| |
|I understand this information is requested to assist the state workforce agency determine whether I am qualified to undertake and complete training, pursuant |
|to federal Trade Act regulations requiring an evaluation of my personal qualifications that includes financial resources. I understand that I may be found |
|liable for an overpayment of Trade Act benefits, including training costs, in the event I fail to begin, participate in or complete training without |
|justifiable cause. |
|*The UI/TRA benefits listed above are projections only and subject to change based on individual circumstances or other factors. |
|Signature | |Date | |
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