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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