Form 1801 "Appeal to the Board of Review From a Department of Unemployment Assistance Hearing Decision" - Massachusetts

What Is Form 1801?

This is a legal form that was released by the Massachusetts Department of Unemployment Assistance - a government authority operating within Massachusetts. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2016;
  • The latest edition provided by the Massachusetts Department of Unemployment Assistance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 1801 by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Unemployment Assistance.

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Download Form 1801 "Appeal to the Board of Review From a Department of Unemployment Assistance Hearing Decision" - Massachusetts

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YOU MAY APPEAL THIS HEARING DECISION
This hearing decision becomes final unless you appeal in writing to the Board of Review no later
than thirty (30) calendar days from the mail date on the cover page of the hearing decision.
IMPORTANT
If you are disqualified from collecting benefits, you should continue to certify for benefits
for each week you are unemployed. This will protect your rights to collect benefits. If you
are entitled to benefits as a result of this hearing decision, and you meet all other eligibility
requirements, your check will be sent to you automatically. If you do not receive a check within
seven days of the date of this hearing decision, you may call the Check Status System at one of
the following numbers.
1-877-626-6800 from area codes 351, 413, 508, 774, and 978
1-617-626-6800 from all other area codes
Instructions for Filing an Appeal to the Board of Review
Please use the attached form: “Appeal to the Board of Review From a Department of
Unemployment Assistance Hearing Decision.” All appeal rights and deadlines are set forth under
the unemployment statute at G.L. c. 151A, §§ 40 – 42.
Deadline: A written appeal must be submitted to the Board of Review no later than 30
calendar days from the mail date on the cover page of the hearing decision.
Appeals filed by mail will be considered filed on the date contained in the U.S. Postal
Service postmark (not the date contained in a postal meter stamp.)
Faxed appeal forms must be received at the Board of Review office no later than 5:00
p.m. (Boston time) on the deadline date.
Appeals sent through any private courier or hand delivered must be received at the Board
of Review office before 5:00 p.m. on the deadline date.
If the 30-day deadline falls on a Saturday, Sunday, legal holiday, or day on which the
Board of Review office is closed, the deadline is the next business day.
Mail, fax, or hand-deliver your appeal to:
Board of Review
19 Staniford Street, 4
floor
th
Boston, MA
02114
Fax #: 617-727-5874
Please see important appeal instructions on the back
Ä
Form 2044 Rev. 01-16
YOU MAY APPEAL THIS HEARING DECISION
This hearing decision becomes final unless you appeal in writing to the Board of Review no later
than thirty (30) calendar days from the mail date on the cover page of the hearing decision.
IMPORTANT
If you are disqualified from collecting benefits, you should continue to certify for benefits
for each week you are unemployed. This will protect your rights to collect benefits. If you
are entitled to benefits as a result of this hearing decision, and you meet all other eligibility
requirements, your check will be sent to you automatically. If you do not receive a check within
seven days of the date of this hearing decision, you may call the Check Status System at one of
the following numbers.
1-877-626-6800 from area codes 351, 413, 508, 774, and 978
1-617-626-6800 from all other area codes
Instructions for Filing an Appeal to the Board of Review
Please use the attached form: “Appeal to the Board of Review From a Department of
Unemployment Assistance Hearing Decision.” All appeal rights and deadlines are set forth under
the unemployment statute at G.L. c. 151A, §§ 40 – 42.
Deadline: A written appeal must be submitted to the Board of Review no later than 30
calendar days from the mail date on the cover page of the hearing decision.
Appeals filed by mail will be considered filed on the date contained in the U.S. Postal
Service postmark (not the date contained in a postal meter stamp.)
Faxed appeal forms must be received at the Board of Review office no later than 5:00
p.m. (Boston time) on the deadline date.
Appeals sent through any private courier or hand delivered must be received at the Board
of Review office before 5:00 p.m. on the deadline date.
If the 30-day deadline falls on a Saturday, Sunday, legal holiday, or day on which the
Board of Review office is closed, the deadline is the next business day.
Mail, fax, or hand-deliver your appeal to:
Board of Review
19 Staniford Street, 4
floor
th
Boston, MA
02114
Fax #: 617-727-5874
Please see important appeal instructions on the back
Ä
Form 2044 Rev. 01-16
IMPORTANT APPEAL INSTRUCTIONS
It is very important to state the reasons why you think the hearing decision was
incorrectly decided on this form or in an accompanying letter. Be sure to include all
documents and arguments that are relevant to your appeal when you submit this form. The
Board will decide whether to accept your appeal based primarily upon what you tell us.
If you are a claimant whose unemployment benefits were denied, you should continue to
sign for benefits while your appeal is pending in order to preserve your rights to those
benefits.
After you receive the Board’s decision, you may appeal to the District Court. The appeal to the
District Court must be filed within 30 days of the mailing date on the Board’s decision.
See the Board of Review website www.mass.gov/dwd/bor for additional information, including
links to the unemployment statute, G.L. c. 151A; the DUA regulations; a list of legal referral
organizations; a list of District Courts by city and town; and important prior Board decisions,
listed by topic.
If you have questions, please call the Board of Review at (617) 626-6400.
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT
BOARD OF REVIEW
19 Staniford Street, 4
Floor, Boston, MA 02114
th
Phone: (617) 626-6400 • Fax: (617) 727-5874
Website Address: www.mass.gov/dua/bor
Appeal to the Board of Review
From a Department of Unemployment Assistance Hearing Decision
(signature on reverse side is required)
Appeal by:
Claimant
Employer
Department of Unemployment Assistance (DUA)
c
c
c
Claimant’s Name: ___________________________________________________________
(print)
Address: _________________________________________________________________
City or Town: ___________________________ State: ________ Zip Code: ____________
(
)
Telephone No.: __________________
Claimant ID: ______________________
Email address: ___________________________________________________
Employer’s Name: __________________________________________________________
(print)
Address: _________________________________________________________________
City or Town:______________________________ State: ______ Zip Code: __________
(
)
Telephone No.: ___________________________ DUA Employer ID#: ________________
Email address: ____________________________________________________
I appeal a DUA Hearings Department decision, Issue ID #
, issued on _________
(date)
I believe the decision was incorrectly decided for the following reasons:
(If you wish to submit your reasons separately, or if you wish to submit documents that are
relevant to your appeal, please include your Issue ID# on all additional documents.)
T
C
M
HE
OMMONWEALTH OF
ASSACHUSETTS
E
O
L
W
D
XECUTIVE
FFICE OF
ABOR AND
ORKFORCE
EVELOPMENT
Page 1 Form 1801 Rev. 01-16
If you did not participate in the hearing, please tell us the reasons why:
Are you prepared to attend a re-hearing, if so ordered by the Board?
I affirm under the penalties of perjury that the information contained within this
Appeal to the Board of Review is true and complete to the best of my knowledge and
belief, and that the factual representations and legal arguments upon which this appeal
is based have been advanced in good faith.
____________________________________________________________________
(appealing party/attorney/agent)
____________________________________________________________________
(date)
If you are an attorney or agent submitting this appeal on behalf of a party, please
provide thefollowing information:__________________________________________
____________________________________________________________________
Name of Attorney or Agent: ______________________________________________
(print)
Address:_____________________________________________________________
(
)
City or Town:___________________________ State: ______ Zip Code: __________
Telephone No.: __________________
Email address: ____________________________________________________
For Office Use Only
Hearing decision mail date: _______________
Date of Application for Review: _______________
Application for Review received by: _____________________________________
(full name of DUA representative)
Appeal received at:
Hearings Department
By mail
c
c
Board of Review
By fax
c
c
Other (specify name of dept.) __________________________
By hand
c
c
Page 2 Form 1801 Rev. 01-16