Request #RIC0033022 - Claim
Submitted 10/31/2024 08:08:24
Welcome to the Claim Filing System
This site allows current and former South Dakota workers to submit a claim for Reemployment
Assistance benefits.
Before you begin, you will need the following information:
1. The names, addresses, and phone numbers of your employers from the past 18 months.
2. The dates you worked for each of your employers.
3. The name, address, and phone number of your union, if you are a member of a referring
union.
Important Instructions
Please read the questions carefully. You will be given an opportunity to review your answers before
submitting your application.
The date your application is submitted will determine the effective date of your claim. A claim filed
on a Sunday is effective that Sunday. A claim filed Monday through Saturday is effective on the
previous Sunday.
Your application is not official until you hit “Submit.” You must complete and submit your
application before the claim week ends (midnight on Saturday) or the claim will be canceled.
If for any reason you are unable to file online, please call our Claims Call Center at 605.626.3179
Monday through Friday from 8:00 AM to 4:20 PM Central Time (except for state holidays).
Claimant Certification
I certify the information I provide is true and correct to the best of my knowledge and belief. I am
aware the law prescribes penalty of fine and imprisonment for false statement to obtain benefits. I
understand the information submitted by me will be used by the South Dakota Department of Labor
and Regulation (DLR) to determine my eligibility and amount of reemployment assistance benefits. I
understand the information submitted will be shared with other federal, state and local agencies in
accordance with the Deficit Reduction Act of 1984 (Public Law 98-369). I also understand, pursuant
to South Dakota Codified Laws title 61, any information I provide to DLR in connection with this
claim may be shared with former employers or their representatives.
I have fully read and understood instructions
Yes
above and accept these conditions
Let's start on your application. Please review your personal information below to make sure the
information is accurate.
SSN XXX-XX-9175
First Name ANDREW
Middle Initial W
Last Name MURPHY
In the last 3 years have you been known by any
No
other name?
Date of Birth 04/01/1982
Phone (971) 207-9254
Email fritzsjm@gmail.com
Mailing Address 307 N CHICAGO AVE
Mailing City MADISON
Mailing State South Dakota
Mailing Zip 57042-2536
Is this also your residential address? No
Residence Address 307 N CHICAGO AVE
Residence City MADISON
Residence State South Dakota
Residence Zip 57042-2536
Identification Type Driver's License
What state issued the ID? South Dakota
ID Card Number XXXXX1647
Gender Male
Are you Hispanic/Latino? No
Race White
Preferred Language English
Education Associate Degree
Do you have a disability? No
Are you a military veteran? No
Are you a US Citizen? Yes
Residence County Lake
Employment Summary
Employment Summary
Okay, here's what we have so far about the employers you have worked with over the past 18
months.
Your history should include ALL employers you worked for during this period. This helps determine
whether you can receive benefits. A recent employer may not appear yet. You will need to add the
employer to your employment history. If you need to add an employer or self-employment, select
"Add."
If you do not recognize one of the employers listed, do not automatically delete it. An employer’s
legal name may differ from the name the employer does business as. Verify the legal name against
your W2s and paystubs. If you are certain you have not worked for an employer listed, select “x” to
delete.
Select "edit" (the pencil icon) to enter information for an employer.
Have you worked in the last 18 months? Yes
In the last 18 months, how much did you normally
Full-Time
work?
In the last 18 months, what days of the week did
Monday-Friday
you normally work?
In the last 18 months, what shift did you normally
Rotating (no overnight)
work?
Employer Section Lack of Work
I have finished adding employers and made all
Yes
necessary edits.
Based on the information entered you last worked on
Last Worked Notice
10/18/2024.
Last Worked Date 10/18/2024
30 Day Employer
Please answer the questions below in regards to
Avera Queen of Peace Health Services
your separation from the employer listed:
Will you be returning to work full-time? Yes
Is your lack of work due to weather related
No
conditions?
Do you have a recall date? No
What was the name of the person who laid you off
Deanne Larson
or reduced your hours?
What was their title? RN
Did the Employer notify you in advance? No
Was anyone else laid off or reduced in hours at
No
the same time?
Did you volunteer to be laid off or reduce your
No
hours?
Could you have continued to work for the
No
employer in a different location?
Could you have continued to work for the
No
employer in a different position?
Claim Eligibility
Claim Eligibility
Please answer the following questions so we can understand more about you and your situation.
How many hours are you willing to work each
40
week?
Are you a member of a union? No
Are you self-employed including farming or
No
ranching?
Are you a corporate officer or member of a
No
board/committee?
Do you have a way to get to work or look for
Yes
work?
Have children or dependents that require care
No
while you look for or go to work?
Are you attending or registered to begin school or
No
a training program?
Are you available to accept work immediately if
Yes
offered?
Are you physically and mentally able to work? Yes
Do you have a medical condition that currently
No
affects your ability to work?
Have you applied for or are you currently
No
receiving workers compensation?
Have you applied for or are you currently
No
receiving disability benefits?
Current Payment Method: Direct Deposit
Account ending in: XXXXX8187
Do you want to continue using this method? Yes
Masked Bank Routing Number XXXXX3150
Masked Bank Account Number XXXXX8187
Do you want to have federal income tax withheld
No
from your payments?
Your application draft is complete and ready for review. This is the last step before submitting your
application.
NOTE: Inaccurate or incomplete applications will result in processing delays. Carefully review your
answers as you will not be able to make changes after submission.
I have fully reviewed and confirm the information
Yes
entered is correct.
IMPORTANT INFORMATION
Now that you have activated your claim, it is your responsibility to know and understand your
requirements to remain eligible for benefits. You must read all the materials that are sent to you and
respond to requests for information.
Fraud is a serious crime. If you intentionally make false statements or hide information to gain or
maintain benefits you are committing fraud. Penalties for fraud include repayment, denial of future
benefits and a monetary penalty on top of the benefits you should not have received.
MAINTAINING ELIGIBILITY
Every week you claim benefits you must:
• Search for work.
• Participate in re-employment services if required.
• Be mentally and physically able and available for work.
• Accept any offer of suitable work.
• Report any hours worked and money you earned.
WORK SEARCH REQUIREMENT
You are required to make an active, good faith effort to secure employment each week for which
benefits are claimed. You will need to contact at least 2 different employers each week. You must
apply in the manner directed by the employer. Telephone contacts are not allowed. You cannot
repeat a job contact with the same employer unless 30 days has elapsed between the contacts.
Keep a detailed log of your job contacts including sent emails and confirmation numbers. Your work
search efforts will periodically be verified.
WORK REGISTRATION REQUIRED
You must register for work with the state workforce agency in the state you reside. If you live in
South Dakota, you have already been registered. If you live out-of-state, you have 14 days from today
to register with their local workforce agency and submit proof of registration to the South Dakota
Department of Labor and Regulation. The workforce agency may go by names such as Workforce
Development, Career Center, Job Service, or Employment Services.
REQUESTING PAYMENT
To receive benefits, you will need to make a request for payment each week. You must wait for the
week to be over before requesting payments for that week. Requests must be completed by 11:59 pm
CT on Saturday of each week you are claiming benefits.
You can request payment online or by calling 605.626.3212. Both options are available 24 hours a
day, seven days a week.
The first weekly request of your claim is considered a non-paid waiting week. You must submit a
request and meet all eligibility requirements during this week, but you will not be paid.
REOPENING YOUR CLAIM
Reopening your claim is required if you:
• Work and then separate from any employer even if you work less than one day.
• Have not requested a weekly payment for four weeks or more.
• Change your address because you moved from one state to another.
You can reopen your claim online or by contacting the Claims Call Center at 605.626.3179.
If you have questions about your requirements for reemployment assistance, contact Customer
Service at 605.626.2452.
I have fully read and understood the information
Yes
above and accept these conditions.
Employer #1 History
Is this self-employment? No
Avera Queen of Peace Health
Employer Name
Services
Start date of employment 01/01/2009
Last date of employment 10/18/2024
I confirm the dates entered are correct to the best of my knowledge. Yes
Employer's phone (605) 995-2000
Address 525 Foster St
City Mitchell
State South Dakota
Zip Code 57301
In what city and state did you work? Mitchell, SD
Are you the owner or related to the owner? No
Job Title Accelerated Coordinator
Is this military employment? No
What type of work did you do for this employer? Nurse Practitioners
How many hours did you physically work during your last week of
32
employment?
How many hours were you hired to work each week? 40
Are you receiving additional pay from your employer? No
What was your rate of pay? 1500
Is this hourly or salary? Salary
Is salary weekly, monthly, or annual? Weekly
Are you still working for this employer? No
Who made the decision to end or reduce your employment? Employer
What reason did they give? Lack of Work/Reduced Hours
Is employer a school, contracted service provider for a school, pro
No
sports team?
