GUIDE SHEET 6

REPORTING REQUIREMENTS

State policy (conforming to and complying with the Federal Claim Filing Standards - ESM 5000-5001) dictates when, where, and how claimants are to file claims to maintain their continuing eligibility. State law, interpreted through State policy, also sets requirements for claimant reporting to provide information regarding a potentially disqualifying issue.

If a claimant does not report as required by State law and policy, a potentially disqualifying issue exists. Examples of failing to report are: reporting at a time other than that assigned by the SESA, failing to report at an appointed time to provide needed claim information to resolve another potential issue, failing to respond to a call-in notice from the SESA for factfinding or from the Employment Service office for placement or referral considerations, etc.

Failure to report may be due to the illness of the claimant. State law may permit the claimant to receive benefits for a specific period under these circumstances. However, there may be other factors which cause the claimant to be disqualified totally or partially for the week. For example, State law may require that benefits be denied or proportionately reduced if suitable work was offered to the claimant during the week(s) being claimed and the claimant was unable to accept the work because of the illness.

State law and policy dictate the protocols for resolving reporting requirements. The adjudicator must investigate the reason(s) for late reporting and/or failing to report to determine if the claimant had good cause for failing to report as directed or required, or for failing to file a continued claim timely.

State policy may require excusing the first instance of late reporting, but then direct the SESA to warn the claimant that future benefits will be denied for off-schedule reporting unless the SESA approves. This is important to remember when distinguishing reporting requirements from routine claimstaking functions. Where warnings are required, there can be no other initial outcome other than the acknowledgement in the claims file of the warning. There is no potential to deny until a second incident occurs, and no count can be taken for a nonmonetary determination because there is no issue.

Many States also apply their reporting requirements provisions (i.e., filing and registration) to a claimant's request for predating a claim to an earlier effective date. A request for predating may be based on the fact that the individual was: in partial unemployment for a period of weeks and unaware that benefits were payable during such periods of partial unemployment, given misinformation from State agency personnel regarding filing procedures, given erroneous information from his or her employer, or was affected by other situations such as illness, death in the family, etc., which are recognized by the State for establishing a basis for allowing or denying the request to predate the claim.

BASIC QUESTIONS AND FACTORS TO CONSIDER

A. WHAT ARE THE STATE REPORTING REQUIREMENTS?

1. State requirements (Law/Policy) dictate if an issue exists or not. Were there mitigating circumstances that the State recognizes which would influence the outcome of the adjudication?

2. If the State policy requires a warning before a reporting issue can be potentially disqualifying, then a review of the claim record must be made to determine if a warning was given to the claimant. If there was no prior warning, a countable nonmonetary determination does not exist.

B. DID THE CLAIMANT FAIL TO APPEAR AT A SESA OFFICE TO PROVIDE NEEDED CLAIM INFORMATION?

If the State law and policy require a claimant to provide information which is needed to establish the claimant's benefit rights, e.g. social security number, DD214, or alien registration card, and the claimant fails to comply with the requirement, the failure may result in the denial of benefits.

C. WAS THE CLAIMANT REQUIRED TO REPORT TO THE EMPLOYMENT SERVICE OFFICE FOR A POSSIBLE REFERRAL OR TO REGISTER IN ACCORDANCE WITH STATE POLICY?

1. It is important to determine under what circumstances a claimant failed to report to an ES office as directed. Many State laws provide for the denial of benefits to individuals who fail to: register with ES; report to respond to a call-in card, letter or message relative to a job opening; meet required conditions for allowing the predating of a claim to an earlier effective date, etc.

2. Failure to report provisions can carry different penalties depending on the type of failure to report (see #C.1. above). The adjudicator may also elect not to impose a denial once all the facts are obtained (provided that State law and policy allow adjudicator discretion).

D. WHAT WAS THE CAUSE OF THE CLAIMANT'S FAILURE TO REPORT?

1. A determination to approve or deny a claim on issues of failing to report, in many States, requires inquiry into the cause of the failure. If the claimant establishes good cause, as defined by the State, the claim may be allowed. However, the facts may also give rise to an able and available issue.

2. The facts established by the adjudicator must be sufficient to support the determination rendered.

HINT: If the documentation does not establish that the claimant was given an opportunity to explain the reason(s) for the late report or failure to report and the case file does not establish that there was a reasonable attempt made to obtain the claimant's explanation, Element 18 must have an entry of "N".

Factfinding

A. CAUSE(S) FOR LATE REPORTING OR FAILING TO REPORT

1. Claimant's circumstances

• Claimant unable to report due to illness or injury
  
  
• Lack of suitable transportation
  
  
  • Private transportation (car) broke down
    
    
  • Public transportation from claimant's residence to the SESA is unreliable, i.e., sporadic, irregular schedules
    
    
• Out of the area on reporting day for personal or other reasons
  
  
• Compelling personal reasons, e.g., death in family
  
  

2. Other

• Severe environmental conditions preventing appearance (natural disaster)
  
  
• Claimant back to work and unable to report
  
  
• Claimant provided misinformation by State agency
  
  
• Employer provided erroneous information to claimant
  
  

B. PREVIOUS WARNINGS ISSUED TO CLAIMANT

1. Prior incidents of failing to report

• Claimant reported late or failed to report in the past
  
  
• Warning(s) issued to claimant advising that another failure to comply will result in a denial of benefits
  
  
• Claim record substantiates previous reporting failure(s)
  
  

C. PERIOD TO WHICH FILING/REGISTRATION APPLIES

1. Identify week(s) to which the issue is applicable

• Weeks of total or partial unemployment
  
  
• Days worked or otherwise unavailable
  
  
• This identification aids in determining claimant's availability to report during the week(s) affected by the determination
  
  

2. Establish statutory period allowed for filing

• Flexibility of State law and policy allowing benefits for good cause under certain conditions when either totally or partially unemployed.