Application for Trade Out-of-Area Job Search Allowance

A separate form should be completed for each Trade Out-of-Area Job Search to be made by the customer.

Customer Information / FOR LWIA STAFF ONLY
Original Calculations
Modification of Calculations
2002 - TAA Petition Requirements (60,000 - 69,999 or 80,000 - 80,999, as applicable) / 2009 - TGAAA Petition Requirements (70,000 - 79,999) / 2015 - TAARA Petition Requirements (85,000 and above)
1. LWIA #/ETC: / 2. Customer SSN: XXX-XX- / 3. Application Date: //
4. Last Name: / First Name: / Middle Initial:
5. Street Address (Residence): / Apt.:
6. City: / 7. State: / 8. Zip:

Trade Out-of-Area Job Search Information

9. Trade Petition Number: / 10. Interview Date: //
11. Name of Company: / 12. Title Applied for:
13. Contact Name: / 14. Phone Number: ()-; ext.
15. Street Address (Facility of Employment): / PO Box:
16. City: / 17. State: / 18. Zip:-

Trade Out-of-Area Job Search Allowance Determination

(To Be Completed by LWIA Career Planner)

19. The application was filed in a timely manner. / Yes No
20. If applicable - Equitable Tolling Date: // ; Justification:
21. The customer is/will be totally separated from adversely affected employment at the time this job search commences. / Yes No
22. The customer has been registered for Trade with the LWIA. / Yes No
23. There is no evidence of suitable employment in the customer’s commuting area. / Yes No
24. There is a reasonable expectation of obtaining suitable employment of long-term duration outside the commuting area and in the area where the job search will be conducted. / Yes No
25. Approved / If Yes is checked on all of the above reasons, Trade Out-of-Area Job Search shall be approved.
Denied / If No is checked for any of the above reasons, Trade Out-of-Area Job Search shall be denied unless # 20 applies. If denied for reasons other than Items #19 - #24 above, describe the reason: If Denied, proceed to Item #47.

Trade Out-of-Area Job Search Allowance History

(To Be Completed by LWIA Career Planner)

26. Previous Allowance Payments / 27. Available Allowance Calculation:
Date / Amount / (a)  Maximum Job Search Allowance:($1,250 or $1,500)
(b)  Previous Job Search Payments (Item #26):
(c)  Remaining Job Search Allowance (Item #27b from Item #27a): / $
$
$
(a) //
(b) //
(c) //
(d) additional payments*:
(e) Total All Previous Job Search Payments: / $
$
$
$
$
Note: The maximum allowable Out-of-Area Job Search Allowance is $1,250 for TAA, and TAARA or $1,500 for TGAAA. The customer may conduct multiple Job Searches to reach the full benefit amount. The customer is only eligible to receive a Trade Out-of-Area Job Search Allowance up to the total of Item #27c. If the total in #27c is $0, the customer is not eligible to receive further Trade Out-of-Area Job Search Allowances. Skip to Item #47.
* Provide listing of additional payments on a separate sheet.


Estimate of Trade Out-of-Area Job Search Allowance

This is an Estimate of the Expenses of the Trade Out-of-Area Job Search. The LWIA Career Planner should complete this with the customer.

Transportation Request: For current mileage rate, go to www.gsa.gov.
28. Date / 29. Departed From / 30. Arrived At / 31. Transportation / 32. Other Travel Expenses
(Tolls, parking, etc.) / 33. Line Totals
Auto Reimbursement
Miles X Rate = Compensation / Other
Mode* / Most Cost Effective Mode
Place / Time / Place / Time / Item* / Amount
// / X $ = $ / $ / $ / $ / $
// / X $ = $ / $ / $ / $ / $
// / X $ = $ / $ / $ / $ / $
// / X $ = $ / $ / $ / $ / $
*Note: Describe here the Other Mode of Transportation and "Other" Travel Expenses anticipated to be incurred: / 34. Total: / $
35. Travel Associated with the Out-of-Area Job Search was for more than 12 hours. If No, the customer is not eligible for Subsistence Assistance. (Skip to Item #40) / Yes No
Lodging and Meals Request: For the current per diem rate go to www.gsa.gov.
36. Date / 37. GSA Per Diem Rate
a. Total Lodging & Meals GSA rate / b. 50% of Per Diem
// / $ / $
// / $ / $
Total / $ / $
38. Total Lodging and Meals Estimate: / $
39. Lodging Information (* Provide additional Lodging information on a separate sheet)
Name:
Address:
City: / State: / Zip:
Phone: () -, ext. / Fax: () -
40. Out-of-Area Job Search Allowance Estimate (Sum of #34 + #38): / $
41. Out-of-Area Job Search Allowance (#40 X 90% for TAA and TAARA or 100% for TGAAA) / $
42. Calculated Out-of-Area Job Search Allowance (the lesser of Item #27c or #41): / $
43. Has the Customer requested an Advance Payment of their Out-of-Area Job Search Allowance?
Yes No / 44. If Yes to #43, Advance Payment Request Amount
(60% of #42, but Maximum of $360): $
45. Approved for Advanced Payment Denied for Advanced Payment
If denied, state the reason:
46. I understand that I am eligible for an Advanced Payment and am giving correct and complete information. I understand that penalties are enforced for willful misrepresentation.
I understand that I am not eligible for an Advanced Payment and this form serves as my written notification of such determination.
Customer Signature: / Date: //
47. I understand that I am eligible for a Trade Out-of-Area Job Search Allowance. I certify that the preceding information is correct to the best of my knowledge and that there is no intent to commit fraud. Furthermore, I understand that falsifying information or using the funds other than for the intended purpose is felony theft and is punishable under state law by up to 7 years in prison and fines of up to $25,000. Violators may also face federal felony charges. I understand that each job search activity must be completed within 30 days of the beginning of the job search. I agree to provide the career planner all required documentation and receipts to verify completion of the job search (Commerce/Trade Form # 012b, #012c, or #012d) and expenses incurred during the job search.
I understand that I am not eligible for the Trade Out-of-Area Job Search Allowance and this form serves as my written notification of such determination.
Customer Signature: / Date:
APPEAL RIGHTS
If you disagree with this determination, you may complete and submit a request for reconsideration/appeal. A letter will suffice if you do not have an agency form. Your request must be filed with the Illinois Department of Employment Security (“IDES”) within thirty (30) calendar days after the date at the top of this letter. If the last day for filing your request is a day that IDES is closed, the request may be filed on the next day that IDES is open. Please file the request by mail or fax at your local IDES office. To locate your reporting office, use this link: http://www.ides.illinois.gov/Pages/Office_Locator.aspx.
Any request submitted by mail must bear a postmark date within the applicable time limit for filing. If additional information or assistance regarding the appeals process is needed, please contact your local IDES office.
STAFF USE ONLY
AFFIDAVIT
I certify that the preceding information is correct to the best of my knowledge and that there is no intent to commit fraud. I hereby acknowledge that the information contained in this form that I am attesting to is complete and accurate and that the documentation described in the form is contained in the customer's file.
48. Career Planner Signature: / Date: //
49. LWIA Director Signature: / Date: //

NOTE: Make sure the Customer receives a copy of this form and keep the original in the Customer's file. Also, provide a copy to the fiscal staff to enter as obligations and accruals.

July 19, 2017 Page 3 of 3 Commerce/Trade Form #012