ETA-861 (Rev - State of Connecticut Department of Labor



|TAA-861 (Rev. 01/21) |

|Connecticut Department of Labor |

|Request for Job Search Allowance |

|Trade Act of 1974, as amended |

|Name (Last, First, Middle) |Social Security No. |Job Center |Date |

|      |      |      |      |

|Address |Petition No. |Company |Liable State      |

|      |      |      | |

|Date of total separation from adversely affected employment       |Is this your first request for job search |

| |allowance? Yes No |

| |

|Section A. Worker Request |

|Purpose: A job search allowance shall be granted to cover expenses incurred by adversely affected job seekers traveling outside their commuting areas for |

|prearranged job activities. An application may be submitted to a state agency by an individual who has been totally or partially separated and only after the |

|certification covering the individual has been made. In addition, an application must be submitted to the state agency before the job search begins for the job |

|search allowance to be granted. Refer to Revised Policy #13-03 for full requirements. |

| |

|Required: Will the applicant be totally separated from adversely affected employment at the time the job search commences? Yes No |

| |

|Date TAA Approved training ended:       Date Company Certified:       |

| |

|Deadlines: This application is being submitted before: (check the appropriate box) |

| |

|The 365th day after the date of the certification under which the individual is covered, or the 365th day after the date of the individual's last total separation, |

|whichever is later; or |

| |

|The 182nd day after the concluding date of Trade Act-approved training. If approved, completion of the job search must occur within a reasonable period not |

|exceeding 30 days after the day on which the job search began. |

| |

|A job search is deemed completed when the individual either secures employment (i.e., obtains a bona fide offer of suitable employment) or has contacted each |

|employer to whom referred by the State agency in connection with a job search. The State agency shall verify contacts with employers certified by the individual. |

|   |

| Job search allowance is requested to attend the following: _ |

| |

|Travel to and attendance at job fairs and interviews; if multiple interviews, check here and provide additional details on reverse side. |

|Travel to and attendance at prevocational workshops; |

|Making an in-person visit with a potential employer who may reasonably be expected to have openings for suitable employment; |

|Completing a job application in person with a potential employer who may reasonably be expected to have openings for suitable employment; |

|Going to a local one-stop, copy shop, Post Office, or similar entity to print, copy, mail, email, or fax a job application, cover letter, and/or a resume; |

|Going to a local one-stop, public library, community center, or similar entity to use online job matching systems, to search for job matches, request referrals, |

|submit applications/resumes, attend workshops, and/or apply for jobs; and, |

|Attending a professional association meeting for networking purposes. |

|Other- Please explain: __________________________________________________________________________ |

|      |

|Name and address of firm |Date of interview |Position(s) for which you will be considered. |

|      |      |Provide job title(s). |

| | |      |

|Name, address (if different from above), phone and email of the firm representative with whom you arranged the interview. |

|      |

|Date and time of |Departure:       |Return:       |

|Travel method and cost |Auto |Commercial carrier |

|      | | |

| |Round trip |Type |Cost |

| |Mileage       |      |      |

| Reimbursement |

|_ |

|The job search allowance is 90 percent of the total costs of an AAW's travel and lodging and meals up to the $1,250 limit. |

|Travel. The worker's allowable travel expenses may not exceed 90 percent of the prevailing cost per mile by privately owned vehicle under 41 CFR chapters 300 |

|through 304, the Federal Travel Regulation (FTR), for round trip travel by the usual route from the worker's home to the job search area, though other forms of |

|transportation may be utilized. |

|Lodging and meals - The worker's allowable lodging and meals costs cannot exceed the lesser of: |

|The actual cost for lodging and meals while engaged in the job search; or |

|50 percent of the prevailing per diem allowance under the FTR, found at , for the worker's job search area. |

|Once determined eligible for a job search allowance, an advance to the worker up to 60 percent of the estimated amount of the job search allowance may be granted |

|subject to the $1250 limit, but not exceeding $750, within 5 days before the commencement of a job search. The advance of any payment must be deducted from the |

|total amount approved. |

|Do you request advance payment? Yes No |

|Note: Adequate processing time is required in order to grant request. |

|Upon completion of job search effort, and if approved, please submit TAA-861B, Job Search Allowance – Worker’s Request for Final Payment. Attach all receipts. |

|If you prefer electronic reimbursement, visit: to sign up. |

|(Submit Forms SP-26 and W-9 to your counselor.) |

|Will you be entitled to receive payment or reimbursement for job search expenses from any other source? (i.e., employer to pay for hotel, |Yes No |

|flight, etc.) If yes, explain:       | |

|      | |

|The information contained in this request is correct and complete to the best of my knowledge. I understand that penalties are provided for willful |

|misrepresentation made to obtain allowances to which I am not entitled. Your typed name may substitute for a handwritten signature. |

|Signature:       Date :       |

| |

|Section B. Certification by TAA Counselor |

|Has the individual registered for appropriate reemployment services? |Yes No |

|Does the individual have a reasonable expectation of securing suitable* employment in the local commuting area? If no, why not?       |Yes No |

|__________________________________________________________________________________ | |

|Is there a reasonable expectation of obtaining suitable* employment of long-term duration outside the commuting area and in the area where |Yes No |

|the job search will be conducted? | |

|Did the worker submit this application timely (see Section A) and before beginning the job search? |Yes No |

|Job search allowance is recommended not recommended. |

|Signature of TAA representative:       Date:       |

|*Suitable employment – Work of substantially equal or higher still level than the worker’s past adversely affected employment and wages for such work that are not |

|less than 80 percent of the person’s average weekly wage. Part-time, temporary, short term, or threatened employment is not suitable employment. For the purposes of|

|relocation: employment that pays a wage of at least the 75th percentile of national wages, as determined by the National Occupational Employment Wage Estimates, and|

|otherwise meets the suitable employment requirements. |

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