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TRA-856 (Rev. 03/2016)

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Trade Readjustment Allowances (TRA)

Request for Extension of Training Enrollment Deadline

|IMPORTANTE - |

|TENGA ESTO TRADUCIDO INMEDIATAMENTE |

|Name |      |SS# |      |Petition # |      |

|Address |      |

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|You may not receive TRA after your training enrollment deadline unless, prior to the deadline, you either enrolled in Trade Act-approved training or received a | |

|waiver of the training requirement. Extenuating circumstances may justify an extension of your enrollment period for an additional 45 days. Additionally, an | |

|extension beyond 45 days may be possible for “good cause.” | |

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|“Enrolled in Trade Act-approved training” means the individual has been accepted by a training provider for admittance into a program approved by CTDOL and the |

|training will begin within 30 days. |

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|Instructions: Complete this questionnaire and attach copies of any available supporting evidence. For example, if illness, injury or a family emergency prevented |

|you from complying with the training enrollment requirement, appropriate documentation may include physician’s certification, hospital records, or your airline |

|itinerary. If there were factors outside of your control, be sure to explain the link between those factors and your failure to enroll in training, or receive a |

|waiver, before the deadline. Unless submitting this form through your local American Job Center, return it by mail or fax to: Connecticut Department of Labor - UI |

|Technical Unit, 200 Folly Brook Blvd., Wethersfield, CT 06109-1114; fax (860) 263-6631. |

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|Appeal status if denied TRA: |FOR OFFICE USE ONLY: |TRA denial issued on |Appeal received on |

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|Complete this section if you have already been denied TRA and receipt of your appeal is not acknowledged above. |

| |If you have not yet filed an appeal: If you are unsuccessful in requesting this extension, an appeal would be your only recourse. To be timely, an appeal must |

| |be filed within 21 calendar days of the date of the decision denying TRA. If filing your appeal more than 21 days after the decision date, include a statement |

| |about your reason for filing the appeal late. |

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| |I appealed the determination on |      |. |Appeal method: Internet in person by mail by fax |

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| |I did not previously appeal the determination but I wish for my submission of this completed questionnaire to serve as my appeal and application for a hearing. |

| |I disagree with the TRA denial, referenced above, for the following reason(s): |

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|1. |When and how did you receive information regarding the Trade Act certification of your worker group and your eligibility to apply for benefits? |

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|2. |Did you receive any of the following? (Check all that| notice to attend a scheduled Trade Act orientation session |

| |apply.) |determination approving TRA determination denying TRA |

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|3. |How long have you been at the address indicated at the top of this page? |      |

| |If your address changed since the Labor Department’s previous mailing of any Trade Act notifications, indicate your prior address and moving date. |

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| |Did you advise the Post Office to forward your mail? Yes No |

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|4. |Have you experienced any significant mail delivery problems? Were any of the Labor Department’s Trade Act notices delayed in reaching you? Yes No If |

| |yes, explain. |

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|5. |If you were scheduled to participate in a Trade Act orientation session and failed to attend, what circumstances prevented you from reporting to the American |

| |Job Center as directed? |

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|6. |If you did attend a Trade Act orientation session, explain why you ultimately failed to enroll in training or obtain a training waiver as directed. If any |

| |specific personal circumstances prevented you from satisfying the requirements, explain fully. What is or was the nature of these circumstances? When did |

| |these circumstances first occur? When were they over? If ongoing, explain. |

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|What actions did you take, if any, to comply in light of these circumstances? |

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|7. |If you were unable to either 1) attend your scheduled Trade Act orientation session or 2) actively participate in reemployment activities scheduled by the |

| |American Job Center (relating to the assessment of your skills or development of your reemployment plan): |

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| |What efforts did you make, if any, to notify the American Job Center regarding your circumstances and inability to attend or participate? When and how did |

| |you notify the American Job Center? |

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|What resulted from these efforts? If given any specific advice, explain and indicate the name of the contact person, if available. If you did not reschedule |

|or failed to attend any rescheduled appointment(s), explain why. |

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|TRA-856 |

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|8. |If, as a member of a reserve component of the Armed Forces, you were required to interrupt or postpone employment-related assistance, including Trade Act |

| |benefits, indicate whether either statement is true and provide service dates. (Applicable only if you are subject to either the 2009 or 2011 program rules.) |

| | |I served on active duty in the Armed Forces for a period of more than 30 days under a call or order to active duty of more than 30 days. Dates of |

| | |service:            to           . |

| | |I performed, as a member of the Army National Guard of the United States or Air National Guard of the United States, full-time National Guard duty under|

| | |32 U.S.C. 502(f) (regarding required drills and field exercises) for 30 consecutive days or more when authorized by the President or the Secretary of |

| | |Defense for the purpose of responding to a national emergency declared by the President and supported by Federal funds. Dates of service:            |

| | |to           . |

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|9. |Did any of the following reasons contribute to your inability to satisfy the training enrollment requirement and deadline? If yes, please explain. |

| | |Failure of the Connecticut Department of Labor, or any other cooperating state agency, to carry out its responsibilities. |

| | |Failure of your employer to comply with verification or other notification requirements relating to your trade-impacted employment following issuance of|

| | |the Trade Act certification under which you are covered. |

| | |Coercion or intimidation which prevented the prompt filing of a claim. |

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|CERTIFICATION |

|I certify that this information is true and correct, knowing the law provides penalties for false statements or the withholding of facts. If appealing the TRA denial|

|referenced on page one, I certify that I am instructed to continue to file claims for weeks of unemployment pending a decision by the referee on my appeal. I |

|understand that if I fail to file each week, as directed, no benefits can be paid for those weeks, irrespective of the decision of the referee. If my claim for Trade|

|Readjustment Allowances (TRA) is approved, I understand that the decision could be reversed by a higher authority, and I agree to repay any amounts to which it is |

|determined I am not eligible. Your typed name can substitute for a handwritten signature. |

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|Worker’s Signature | |Date | |Telephone # |

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|FOR OFFICE USE ONLY – WHEN SUBMITTING THROUGH AN AMERICAN JOB CENTER TRADE ACT REPRESENTATIVE |

|TAA BRI was/will be given on |      |Other scheduled appointments |      | |

| |JS-52/training proposal submitted on |

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| |“Equitable tolling” is a doctrine that permits the suspension of a deadline date where equity demands, and may only apply in egregious circumstances where an |

| |individual acted with due diligence to meet the deadline. Example: where an individual was not notified of the deadline until after the deadline expired; or, |

| |where an individual was notified of TAA benefits and deadlines and did everything necessary to enroll in training by the deadline, but was unable to do so because|

| |the state did not approve the training in time. |

| |If enrollment in approved training or issuance of a waiver is not possible within the 45-day period allowed for extenuating circumstances, should the “equitable |

| |tolling” doctrine be applied? Yes No Explain why or why not. |

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| |Print Name | |Title | |

TRA-856

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