P.O.

Box 9046, Olympia, WA 98507

Date: Sep 10 2021

54000003-000114-01-00000000

Letter ID: L0041595456

Claimant ID: 3D29QG
SARAH K. YAGER 2ND
70 E ROBBINS RD # GRAPEVIEW
GRAPEVIEW WA 98546-9698

Request for information

part-time worker
New information shows your claim may be based entirely on part-time work. If so and you only
worked 17 or fewer hours each week during your base year (the period of time on which your claim
is based), you may be eligible for benefits even if you are looking only for part-time work of 17 or
fewer hours each week.

Please answer the following question and return this document to the address shown below.
Did you work 17 or fewer hours in each week during the one year period beginning Apr 1 2020
and ending Mar 31 2021? Yes o No o

The information I have provided is true to the best of my knowledge.

__________________________________________________ ____________________
Signature Date

After receiving your response, if additional information is needed, we will contact you by telephone.

Please return your response no later than Sep 21 2021 to:

State of Washington
Employment Security Department
UI Imaging
P.O. BOX 19019
Olympia, WA 98507-0019
Fax: 800-301-1796
Search more than 60,000 Washington jobs on WorkSourceWA.com. Visit WorkSource for free employment workshops and expert
job-hunting advice.
Read the Handbook for Unemployed Workers at esd.wa.gov to find everything you need to know about benefits, including training
for a new career.

L0041595456
REQUEST FOR INF-PART TIME WORK

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