Form ARK-DWS-BR-100 "Petition for Appeal to the Board of Review" - Arkansas

What Is Form ARK-DWS-BR-100?

This is a legal form that was released by the Arkansas Department of Labor - Division of Workforce Services - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 11, 2019;
  • The latest edition provided by the Arkansas Department of Labor - Division of Workforce Services;
  • 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 fillable version of Form ARK-DWS-BR-100 by clicking the link below or browse more documents and templates provided by the Arkansas Department of Labor - Division of Workforce Services.

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Download Form ARK-DWS-BR-100 "Petition for Appeal to the Board of Review" - Arkansas

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PETITION FOR APPEAL TO
BOARD OF REVIEW
P.O. BOX 8016
THE BOARD OF REVIEW
Little Rock, AR 72203
1.
Claimant
First Name:
Last Name:
2.
Social Security No.:
3. Address:
4. Telephone Number:
5.
6.
7. Appeal Tribunal Decision Number:
Date Claim Was Filed:
Date Appeal Tribunal Decision Delivered or Mailed:
8. I/We appeal from the decision of the Appeal Tribunal. (Check A or B below):
A.
I have no new evidence to present and petition the Board of Review to review all records and the testimony and render
its decision thereon.
B.
I petition the Board of Review to remand my case to the Appeal Tribunal because I have additional evidence to present. I
wish to present the following as evidence in my case: (Describe what the evidence is, i.e., your doctor's statement, etc.)
9. If you checked 8B, you must answer the following questions.
A.
Why is the evidence material to your case?
B.
Why was it not offered into evidence at the Appeal Tribunal hearing?
The Board of Review will decide whether or not there is good cause to remand your case to the Appeal Tribunal.
10.
11.
Date Filed:
Appellant:
12. Type of Claim:
UI
UCFE
UCX
EB
TRA
TAA
DUA
Other (Identify) (FSC, etc.)
13. Received By:
You should continue to call ArkLine or file a claim
each week if you wish to continue your claim.
14. Office:
Original - Board of Review
City:
State:
Zip Code:
Duplicate - Appellant
Benefit Year:
Page of
ARK-DWS-BR-100 v09112019
PETITION FOR APPEAL TO
BOARD OF REVIEW
P.O. BOX 8016
THE BOARD OF REVIEW
Little Rock, AR 72203
1.
Claimant
First Name:
Last Name:
2.
Social Security No.:
3. Address:
4. Telephone Number:
5.
6.
7. Appeal Tribunal Decision Number:
Date Claim Was Filed:
Date Appeal Tribunal Decision Delivered or Mailed:
8. I/We appeal from the decision of the Appeal Tribunal. (Check A or B below):
A.
I have no new evidence to present and petition the Board of Review to review all records and the testimony and render
its decision thereon.
B.
I petition the Board of Review to remand my case to the Appeal Tribunal because I have additional evidence to present. I
wish to present the following as evidence in my case: (Describe what the evidence is, i.e., your doctor's statement, etc.)
9. If you checked 8B, you must answer the following questions.
A.
Why is the evidence material to your case?
B.
Why was it not offered into evidence at the Appeal Tribunal hearing?
The Board of Review will decide whether or not there is good cause to remand your case to the Appeal Tribunal.
10.
11.
Date Filed:
Appellant:
12. Type of Claim:
UI
UCFE
UCX
EB
TRA
TAA
DUA
Other (Identify) (FSC, etc.)
13. Received By:
You should continue to call ArkLine or file a claim
each week if you wish to continue your claim.
14. Office:
Original - Board of Review
City:
State:
Zip Code:
Duplicate - Appellant
Benefit Year:
Page of
ARK-DWS-BR-100 v09112019