State of Tennessee Department of Labor and

Workforce Development Monetary Determination

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l 220 French Landing Drive
Nashville, TN 37243-1002
LWDSUPPORT.TN.GOV Claimant/Job Seeker:
Tiffany Sage
Claimant ID Number:
0008992232
Claim Effective Date (BYB):
01/23/2022
Tiffany A Sage Claim Ending Date (BYE):
700 Haddon Ln 01/21/2023
Winchester, TN 37398-0000

IMPORTANT INFORMATION ABOUT YOUR UNEMPLOYMENT INSURANCE CLAIM

Mail Date: 01/26/2022

Dear Tiffany A Sage:

We received your unemployment claim with the effective date of 01/23/2022. The amount of your claim will be based on
wages you earned between 10/01/2020 and 09/30/2021. We need you to confirm that the information below includes
ALL your wages during that time, and if the employers listed are correct:

Oct - Dec Jan - Mar Apr - Jun Jul - Sep

Employer
2020 2021 2021 2021
No Base Period Employer information available for this claimant

If everything listed above is complete and correct, you do NOT need to contact us. If you have additional
employers and/or wages to report, or if corrections are needed, and you have not previously reported this
information to us, see the back of this page.

IMPORTANT: This monetary determination will not reflect wages earned out-of-state or wages earned from federal civilian
or military service. See Special Instructions for Federal, Military, or Out-of-State Wages on the back of this page.

Based on what we know: If we determine that you are eligible for unemployment benefits, you MAY possibly receive:

Weekly Benefit Amount (WBA): $0.00

Maximum Benefit Amount (MBA): $0.00
Benefit Year begins (BYB): 01/23/2022
Benefit Year End* (BYE): 01/21/2023
*the last date to receive benefits associated with this claim
You may earn up to $0.00 without reducing your weekly benefit amount of $0.00.

Does this mean I will receive unemployment benefits? NOT NECESSARILY. Every claim has to be reviewed before a
decision can be made. That is why it is important that you send us information on missing wages or employers as soon as
possible.

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 Why not more money? Under state law, the weekly and maximum benefit amounts of your unemployment claim are
calculated using wages you earned during the base period of 10/01/2020 to 09/30/2021. The maximum amount of weekly
unemployment benefits in Tennessee is $275.00 a week. The maximum amount of time you can receive state funded
benefits is 26 weeks.

For more information, such as how the weekly and maximum benefit amounts are calculated, please refer to the Benefits
Rights Information (BRI) document on our website, JOBS4TN.gov.

If you have additional employers and/or wages to report, or if corrections are needed – You need to let us know as
soon as possible. If any wages are missing, you will need to submit proof of the missing wages (e.g., check stubs, W-2s,
etc.). If you did not work for one or more of the employers listed, you will need to provide a copy of a government issued
photo ID and your social security card, along with a signed statement advising that the wages do not belong to you. The
fastest way you can do this is by logging into JOBS4TN.GOV at https://www.jobs4tn.gov/vosnet/Default.aspx and selecting
"File a Wage Protest" under Unemployment Services on your dashboard.

Can't do it online? Then please complete this form and return it, along with your proof of wages and/or supporting
documentation by email to support@jobs4tn.zendesk.com or by mail to the return address shown on this form. Check the
type of employer in the boxes in the first column. Look on your check stubs or W-2s for the employers' names and mailing
addresses. Use an additional page if necessary.

Employer Employer Employer Employer Dates Amount

Description Name Phone Mailing Address Employed Earned
Tennessee-based
Federal
Out-of-state
Military
Tennessee-based
Federal
Out-of-state
Military

By signing your name below, you acknowledge that you have read the important notice about what could happen to you if
you report false information in order to receive unemployment benefits.

Signature of claimant Date

Wage Protest - If the wages showing in the above quarters are incorrect, you have the right to file a wage protest of the
Monetary Determination within 90 days of the determination mail date displayed in this letter. You can submit a Wage
Protest online at www.jobs4tn.gov or by telephone at 844-224-5818. To file a Wage Protest online, log on to
www.jobs4tn.gov, go to your Dashboard, look for Services for Individuals on the left-hand side of the screen, scroll over
Unemployment Services, then click File a Wage Protest. IMPORTANT: Failure to notify us of missing or incorrect wages
may result in an underpayment, overpayment, or possibly even fraud.

Special Instructions for Federal, Military, or Out-of-State Wages - If you reported on your initial claims application that
you earned wages in another state or from the federal government (federal civilian or military), then a request has already
been submitted for these wages. You will receive notification once we have received the wages. If you earned federal or
military wages, you must submit documentation such as check stubs, W-2s, SF-8s, or SF-50s (if federal civilian employer)
or DD214s member 4 (for military wages) in order for your claim to be processed. You can submit these documents by e-
mail to federal.unit@tn.gov or fax to 615-253-0808.

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 IMPORTANT NOTICE ABOUT UNEMPLOYMENT FRAUD THAT YOU SHOULD KNOW

Reporting false information in order to receive unemployment benefits could result in a determination of fraud. If you
receive any benefit payments that are later determined to be disqualified, those benefit payments will be determined
overpaid. All overpayments of unemployment benefits must be repaid in full. We will automatically recoup any
overpayment balances through the offset of future unemployment benefit payments. In addition, JOBS4TN reserves the
right to assess penalties, garnish your federal and/or state income tax refunds, suspend recreational licenses, and other
legal collection actions as prescribed by law. If your overpayment is found to be the result of fraud, you will be disqualified
from receiving unemployment benefits from the point the fraudulent act was committed to the end of that claim's benefit
year. In addition, you will be disqualified from receiving unemployment benefits for 52 weeks from the date the fraud
determination was made.

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