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* Confirm you are an Employer.
Employer
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* Name and contact information for person filing the appeal.
Character Count: (Max 200, remaining 200.)
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* What is the claimant's Social Security Number?
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What is the name of the employer?
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What are the Determination Number(s)?
Character Count: (Max 200, remaining 200.)
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What is the Determination Mailing Date?
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What is your Statement of Appeal?
Character Count: (Max 200, remaining 200.)
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What is your e-mail address?
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What is your phone number?