Legislative Centralized Response Team (CRT)

Unemployment Constituent Contact Request (Internal Use Only)

DATE:

Legislator Contact Information:Legislator: ________________________________ OfficeContactName _____________________________LegislatorPhone: __________________________ ContactPhoneNumber: ___________________________LegislatorE-mail: ___________________________ ContactFaxNumber: _____________________________Constituent Contact Information:ConstituentName: _________________________ LetterID#(if known) ______________________________ConstituentPhone: _________________________ ConstituentAddress:________________________________________________________________________

Please explain your concern below:

Response from CRT

CRTRepresentative:___________________________________________Date:_________________________

TEDisanequalopportunityemployer/program.

RICK SNYDER GOVERNOR

WANDA STOKES TIA DIRECTOR

STATE OF MICHIGANTALENT INVESTMENT AGENCY

Unemployment InsuranceMichelle Beebe, Senior Deputy Director3024 W. Grand Blvd., Detroit, MI 48202

www.michigan.gov/uia

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Authorized byMCL 421.1 et seq.

UIA 1522(Rev. 2-17)