XXX
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XXX
Insert Date
Indiana Department of Workforce Development
IU Appeals Division
XXX
Indianapolis, XXXX
Fax: XXXX
TO WHOM IT MAY CONCERN:
RE: APPEAL OF DETERMINATION MADE IN CASE NO. XXXX
My name is XXXX, a law-abiding adult citizen of the City of XXX,
State of XXX. I am the Claimant in the above matter.
On [Insert Date], I made an application of unemployment benefits after the
termination of my employment at XXX. My application was denied with the
notice reading as follows: “The claimant was not able, available and actively seeking
full-time work effective week ending XXX because the claimant declined to discuss
his availability, claimant said he would call back in 48 business. Claimant did not call
back.”
I am appealing the above determination on the ground that it was made on the
basis of inaccurate information provided by the Claims Investigator. The Claims
Investigator stated that I was not seeking full-time work, and that I declined to discuss
my availability.
Contrary to the Claims Investigator’s false allegations, I was actively seeking
work during the week ending XXX. I called the DWD worker who informed me

that he did not have the access he needed to make a decision. He then told me that he
would call me back, which he failed to do.
I have been seeking active full-time employment since the termination of my
employment with XXX in March XXX, to no avail. The Claims Investigator
has failed to provide evidence that I have not been seeking full-time employment. The
burden of proof rests upon him to do so.
I continue to suffer due to my lack of access to unemployment benefits, as a
result of the determination that was made based upon false allegations made by the
Claims Investigator. In order to prevent further occurrence of the ongoing injustice, I
respectfully request you to issue a Declaration stating that I have been actively looking
for work and that I am eligible for unemployment benefits dating back to March XXX
I am ready to appear either physically or virtually to provide more information or
clarification on any matter. Thank you for taking the time to read this letter. I hope to
receive a positive response from you.

Yours Sincerely,
___________________________________

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