ET HANDBOOK NO. 384
UNEMPLOYMENT COMPENSATION FOR EX-SERVICEMEMBERS (UCX)

CHAPTER VI - FORMS AND COMPLETION

to alter the form, the redesigned form must include the entries contained on ETA 841 except that:

(1) Items 21-22* may be omitted if such information is included on the UCX monetary determination form;

(2) If the State uses employment and wages information by weeks, hours, days, etc; in its determination of entitlement, the State agency may modify items 21-22* as necessary; and

(3) Items 25a and 25b may be added. However, these items are for official use only and should only be completed on the State agency copies of this form. No entries will be made on the copy given the claimant.*

State agencies may use item 25a to record the claimant’s ethnic group by entering the appropriate code number below:

State Agencies should leave item 25b blank.*

Any other proposed modification of this form should be submitted to the appropriate ETA Regional Office for review and approval.

VI-13

May 2003