UIA Collections Declaration Builder

This form may be completed in 10 minutes or less, especially if you have some key UIA documents available. Here are examples of forms you may be asked about to answer the questions (it is possible you may not have received all of these):

Monetary Redetermination (example)
Weeks of Overpayment (example)
Monthly Statement (example)
Notice of Garnishment (example)
Waiver letter (these have different formats) here is one (example)

UIA Collections Survey

A simple survey to build a declaration for electronic signature for individuals who have suffered collections from the Michigan Unemployment Insurance Agency.

I am an adult resident of(Required)

Before losing my job, an expected job, or suffering a reduction of income, I worked as a(n)(Required)

Note: Please insert occupation just few words, for example: "self employed, Driver"

The Agency has assessed an overpayment against me, saying I owe about(Required)

Please enter the total the Agency says you owe from your MiWAM account screen or an approximate total from any/all "Weeks of Overpayment" letters.

Have you received collection letters from the Unemployment Agency?(Required)

I have received letters called "Monthly Statement" demanding payments saying that my tax returns will be intercepted and other garnishment may occur if I don't pay.

I have received Monthly Statements AND then a "Delinquency Notice" or "Notice of Garnishment" stating the Agency will take 25% of my wages unless I admit that I owe the money and consent to wage garnishment of 15% of my wages (and also stating my taxes will be garnished).

So far, I have only received notices of "Weeks of Overpayments", but I am fearful that the Agency will try to seize my wages, taxes, or accounts next.

Have you received an individual letter granting a waiver of overpayment?(Required)

I never received any notice that the overpayment was being considered for a waiver based on the Agency’s error. I never received a determination that a waiver was denied, and I was never provided any way to appeal a denial or to request an Agency waiver determination based on Agency error.

I got a waiver letter, collection stopped, and I never had to repay anything.

I got a waiver letter, but I am still getting collection notices.

I got a waiver letter saying my overpayment was waived but I had already paid some money.

Because of the Agency Collection Activity...(Required)

Please select all that apply

I have been forced to make monthly payments in response to the collections letters

The Agency has seized my state tax return to pay what they say I owe

The Agency has seized my federal tax return to pay what they say I owe

The Agency has garnished my wages

The Agency has reduced current unemployment benefits to pay back what they say I owe

The Agency hasn't taken any money yet, but the letters say I owe the money and I am afraid collections will start next

Have you suffered hardship due to the actual or threatened collection activity?

choose all that apply

As of this date, the Agency has collected approximately(Required)

Did you receive a "PUA Monetary Redetermination" saying that your weekly benefit amount (WBA) was being reduced retroactively reduced to the start of your claim.(Required)

I received a PUA Monetary Redetermination from the Agency retroactively cancelling all benefits and saying I never qualified for benefits and I owe all the money back.

I received a PUA Monetary Redetermination from the Agency retroactively reducing my weekly benefit amount and the Agency now says I owe money back.

I did not receive a PUA Monetary Redetermination that reduced benefits, but the Agency has sent other determination letters retroactively cancelling my benefits and saying I owe money back.

Did you receive other "determinations" or "redeterminations" from the UIA (issues such as "ability" "availability" "voluntary quit" "remuneration")(Required)

I have received other determinations saying I am ineligible for the benefits previously paid.

Aside from the PUA Monetary Redetermination, I am not aware of any other determinations or reason I would be ineligible.

Were you cut off from weekly benefits when the determination/redetermination letters were sent?(Required)

I was immediately cut off from weekly benefits going forward.

I continued to receive weekly benefits.

I was already done collecting benefits.

Did you protest or appeal the above within 30 days (by fax, mail, message in miwam, or otherwise)?(Required)

Note: For this question we just want to know if you protested or appealed the agency letters within 30 days, regardless of whether or not the Agency acknowledged them or recorded them as timely

I protested/appealed within 30 days.

I didn't protest or appeal.

I protested/appealed, but it was not within 30 days because I didn't know about it until later.

When did you first protest or appeal?(Required)

Did you protest or appeal more than once?

I protested or appealed multiple times.

I only did it once.

I used the following methods to submit my protest or appeal(Required)

Please select all that apply, if you did it multiple ways.

I clicked on the link in MiWAM to upload my protest/appeal

I used the message function in MiWAM to send MiWam a message with my protest/appeal

I sent in my protest/appeal to the fax number provided by the Agency

I sent in my protest/appeal by mail

Are you still waiting for a decision or a hearing on your protest or appeal?(Required)

I am still waiting for a response.

I got a response in my favor after my protest/appeal and the collection stopped.

I got a response in my favor, but the collection letters have not stopped.

My protest/appeal was rejected and I did not appeal further.

I received a notice for a phone hearing coming up.

What's the status of your timely protest/appeal in MiWAM?(Required)

I timely sent in my protest/appeal within 30 days of the date it was sent, and it still shows as pending in MiWAM

I timely sent in my protest/appeal within 30 days of when it was sent, but it shows up as "late" in MiWAM

I timely sent in my protest/appeal within 30 days of when it was sent, and it was on MiWAM but has now disappeared or deleted

I timely sent in my protest/appeal within 30 days of when it was sent, but it never showed up in MiWAM

I timely sent in my protest/appeal within 30 days of when it was sent, but my claim is now closed in MiWAM (all gray)

I timely sent in my protest/appeal within 30 days of when it was sent, but I am not able to access the MiWAM account

What's the status of your late protest/appeal in MiWam?(Required)

I sent in my protest/appeal and it shows up as "late" in Miwam

I sent in my protest/appeal and it was on Miwam but has now disappeared or deleted

I sent in my protest/appeal but it never showed up in Miwam

I sent in my protest/appeal but I can't get into MiWam to check the status

How long was it from when you first qualified for PUA and when you received a PUA Monetary Redetermination retroactively reducing or eliminating your weekly benefit(Required)

This question asks for the amount of time passed from the original filed date, listed in the first Paragraph of your PUA Monetary Redetermination, to the Mail date in the upper right corner of the PUA Monetary Redetermination Letter. (Example provided at the top of this page).

My PUA Monetary Redetermination reducing or eliminating benefits was issued more than a year after I first qualified for benefits:

My PUA Monetary Redetermination reducing or eliminating benefits was issued less than a year after I first received benefits, but more than 30 days after I first qualified for benefits:

My PUA Monetary Redetermination reducing or eliminating benefits was issued less than 30 days after I first received benefits:

When did you receive the PUA Monetary Redetermination that reduced or eliminated your benefits?(Required)

(enter the "mail date" in the upper right corner of the "PUA Monetary Redetermination" that reduced your WBA or said that you were not eligible for PUA)

Do you have legal representation?(Required)

I am unable to afford a lawyer.

I can't find a lawyer to take my case.

I have a lawyer to fight my determinations, but I am still being collected against in the process.

Please confirm you understand you are not signing up for representation(Required)

Submitting a declaration to support the litigation does not create an attorney-client relationship.

I understand that I am not represented by Blanchard & Walker and I have not been offered anything in exchange for this declaration.

Please click to confirm(Required)

You will be notified if class-action is granted and informed of the process to join based on the Court's ruling.

If this case is certified by the Court as a class-action I wish to participate if I fit the class definition approved by the Court.

Confirmation

Please make sure your answers are true to the best of your knowledge, and dates are your best estimate.

I declare under the penalties of perjury that this declaration has been examined by me and that its contents are true to the best of my information, knowledge, and belief.

Name(Required)

First Last

Email(Required)

This field is for validation purposes and should be left unchanged.

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UIA Collections Survey

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