The Tribunal has specifically created this form for the sole purpose of allowing employers the opportunity to appeal the Notice of Adjudicator's Determination without using the on-line process through the Nebraska Department of Labor's UI-Connect site. This notice must be returned to the Tribunal within 20 days of the date that the Notice of Adjudicator's Determination was mailed to the parties. Failure to return this notice on time will result in the appeal being dismissed.

If the employer has already filed for an appeal, a subsequent appeal is not necessary. Only complete and return Notice of Appeal if the employer has not filed an appeal.

This form may be completed online, and answers may be inserted in the areas provided. The form cannot be saved with the information entered. To save the information, the form must be printed and either faxed or mailed to the Tribunal. Please remember to SIGN and DATE the form prior to returning it to the Tribunal.

QUESTION #1: Provide the employer's name, business address (or PO Box), City, State, ZIP code, and telephone and fax number (with area code) in the space provided.

QUESTION #2: Provide the employer's experience account number as listed with the Nebraska Department of Labor. If the account number is unknown, it can be found on the Notice of Adjudicator's Determination.

QUESTION #3: Provide the Claimant's name as listed on the Notice of Adjudicator's Determination.

QUESTION #4: Provide the Claimant's social security number (listed on the Notice of Adjudicator's Determination)

QUESTION #5: Briefly state the reason that the employer is appealing in the space below.

QUESTION #6: Provide the name and title of the attorney or hearing representative representing the employer along with the attorney or hearing representative's business, street address (or PO Box) and business telephone number (with area code) in the space provided. If there is no attorney or hearing representative OR the attorney or hearing representative has not agreed to appear at the hearing, please leave this space blank.

SIGNATURE LINE: Please remember to SIGN and DATE this request before sending it to the Nebraska Center. If the appeal is not signed and dated, it will not be filed.

Do not write in the space below the signature line that says CLAIMS CENTER ONLY.

Please return the NOTICE OF APPEAL to the Nebraska Appeal Tribunal, P.O. Box 98941, Lincoln, NE 68509-8491. This form may also be faxed to the Tribunal at (402) 471-1734.
 

On this form, the employer may request its hearing date be continued. Continuances must be requested at least FIVE DAYS before the hearing. Should the employer have a special circumstance, such as a witness being unavailable, the Tribunal may consider continuance requests up to the time of hearing. 

An Administrative Law Judge will review each request and rule on whether or not the continuance will be granted or denied. As with all other matters, the Tribunal Staff may not give legal advice. The Tribunal staff will not provide reasons or explanation for an Administrative Law Judge's decision on granting or denying a continuance request.

When filling out this form, type or print answers neatly in the area provided. The DOCKET NUMBER should be listed in the space required. The Docket number can be located in the upper right-hand corner of the NOTICE OF APPEAL FILED or the NOTICE OF TELEPHONE HEARING. Continuance requests will be denied if the form does not contain the docket number of the appeal.

QUESTION #1: Provide the name and title of the individual requesting the continuance along with the name of the employer's business, street address (or PO Box) and telephone number (with area code) in the space provided. 

QUESTION #2: Provide the specific reason for the request. Please state whether or not witnesses will be available by telephone at the time of hearing.

QUESTION #3: If there are no other witnesses available, please answer “no." If there are other witnesses that can provide the same testimony, please answer “yes” and provide the names of witnesses that can provide the same testimony as the person that is unavailable for the hearing.

QUESTION #4: For this question, the employer should list alternate dates and times that the employer's witness(es) would be available for the hearing. The Tribunal schedules hearings Monday through Friday, excluding legal holidays as recognized by the state of Nebraska. Hearings will only be scheduled between the hours of 8:30 a.m. to 3:30 p.m. Central Time. No exceptions will be granted.

SIGNATURE LINE: Please remember to SIGN and DATE this request before sending it to the Nebraska Appeal Tribunal. Unsigned requests will result in the continuance being denied. 

Do not write in the space below the signature line that says FOR TRIBUNAL USE ONLY.

Please return the EMPLOYER'S REQUEST FOR CONTINUANCE form to the Nebraska Appeal Tribunal, P.O. Box 98941, Lincoln, NE 68509-8491. This form may also be faxed to the Tribunal at (402) 471-1734

On this form, the employer can request that the Tribunal issue a subpoena for a witness to testify at the appeal hearing. To have a subpoena issued, the employer must make its request at least FIVE DAYS before the hearing. An Administrative Law Judge will review the employer's request and rule on whether or not the subpoena will be granted. An Administrative Law Judge may deny the subpoena based on whether or not a witness can provide relevant testimony or testimony that is material to the case. The Tribunal may also deny a subpoena should it request an excessive number of witnesses in a case. As with all other matters, the Tribunal Staff may not give legal advice. The Tribunal staff will not provide reasons or explanations for an Administrative Law Judge's decision on granting or denying a subpoena.

When filling out this form, type or print answers neatly in the area provided. The DOCKET NUMBER should be listed in the space required. The Docket number can be located in the upper right-hand corner of the NOTICE OF APPEAL FILED or the NOTICE OF TELEPHONE HEARING. Failure to list the Docket Number and the Employer's name will result in the subpoena being denied.

QUESTION #1: Provide the name and title of the individual requesting the continuance along with the name of the employer's business, street address (or PO Box) and telephone number (with area code) in the space provided.

QUESTION #2: Provide the name of a witness that the employer wishes to subpoena. The Tribunal will not grant a subpoena should the employer fail to provide the first and last name of the witness. If the employer is requesting subpoenas for more than one witness, it will need to file a separate subpoena for each additional witness.

QUESTION #3: Please answer yes or no if the employer has asked this witness to testify without a subpoena. If the answer to question #3 is “no,” the employer should provide a good reason why it has not asked the witness to testify in the space provided.

QUESTION #4: If employer answered “Yes” to this question, it must state if this testimony can be provided by another witness that is already planning to attend the hearing. Please state the name or names of witnesses who have agreed to participate and can provide the same testimony as the person the employer wishes to subpoena.

QUESTION #5: Briefly state the testimony this witness will provide that is relevant to the employer's case. 

QUESTION #6: In this space, provide the witness's name and the address where the Tribunal can send the subpoena.

SIGNATURE LINE: Please remember to SIGN and DATE this subpoena before sending it to the Nebraska Appeal Tribunal. If you fail to sign and date this subpoena, your request will then be denied. 

Do not write in the space below the signature line that says FOR TRIBUNAL USE ONLY.

Please return the EMPLOYER'S REQUEST FOR WITNESS SUBPOENA form to the Nebraska Appeal Tribunal, P.O. Box 98941, Lincoln, NE 68509-8491. This form may also be faxed to the Tribunal at (402) 471-1734.

On this form, the employer may request that the Tribunal issue a subpoena for documents held by the claimant or other parties. To have a subpoena issued, the employer must make its request at least FIVE DAYS before the hearing. An Administrative Law Judge will review each request and rule on whether or not the subpoena will be granted. An Administrative Law Judge may deny the subpoena based on whether or not a document can provide relevant information or information that is material to the case. The Tribunal may also deny a subpoena should an excessive number of documents be requested in a single appeal. As with all other matters, the Tribunal Staff may not give legal advice. The Tribunal staff will not provide reasons or explanations for an Administrative Law Judge's decision on granting or denying a subpoena. All other communications to the Tribunal challenging a Judge's decision will be disregarded.

When filling out this form, type or print answers neatly in the area provided. The DOCKET NUMBER should be listed in the space required. The Docket number can be located in the upper right-hand corner of the NOTICE OF APPEAL FILED or the NOTICE OF TELEPHONE HEARING. Failure to list the Docket Number and the Employer's name will result in the subpoena being denied.

QUESTION #1 Provide the name and title of the individual requesting the subpoena along with the name of the employer's business, street address (or PO Box) and telephone number (with area code) in the space provided.

QUESTION #2: Identify the documents that you wish to subpoena. List the name of the document and approximate number of pages in the document. If the employer is not specific concerning the document that it wishes to subpoena, then the Tribunal will not grant the subpoena.

QUESTION #3: Please answer yes or no if the employer has requested these documents from the person or company that has them. If the employer answered “no” please state the reason why the employer has not asked for specific documents in the space provided.

QUESTION #4: Briefly state the reason why each document is relevant to the employer's case. The employer may attach additional information to its request to explain the relevance of each document.

QUESTION #5: Please answer yes or no if these documents can be provided by the claimant or by another source. If the employer answered “yes,” it should state the name or names of documents that can provide the same information as the document or documents the employer wished to subpoena.

QUESTION #6: In this space, provide the name and the address where the Tribunal can send the subpoena.

SIGNATURE LINE: Please remember to SIGN and DATE this subpoena before sending it to the Nebraska Appeal Tribunal. If you fail to sign and date this subpoena, your request will then be denied. Do not write in the space below the signature line that says FOR TRIBUNAL USE ONLY.

Please return the DOCUMENT SUBPOENA FORM to: Nebraska Appeal Tribunal, P.O. Box 98941, Lincoln, NE 68509-8491. This form may also be faxed to the Tribunal at (402) 471-1734.

On this form, the employer may request that the Tribunal reconsider its decision granting benefits to claimants or allowing the employer's account to be chargeable. The Request to reconsider may also be used if the employer's case was dismissed. Responses must be returned to the Tribunal within 10 days of the date that the decision or order to dismiss was mailed to the employer. If the employer fails to return this response on time, its appeal will be dismissed.

An Administrative Law Judge will review each response and rule on whether or not the employer has provided the Tribunal with sufficient reasons to reopen or reconsider its appeal. As with all other matters, the Tribunal Staff may not give legal advice. The Tribunal staff will not provide reasons or explanations for an Administrative Law Judge's decision.

This form may be completed online, and answers may be inserted in the areas provided. The form cannot be saved with the information entered. To save the information, the form must be printed and faxed or mailed to the Tribunal. Please remember to SIGN and DATE the form prior to returning it to the Tribunal. 

The DOCKET NUMBER should be listed in the space required. The docket number can be located in the upper right-hand corner of the NOTICE OF APPEAL FILED or the NOTICE OF TELEPHONE HEARING. Reconsideration requests will be denied if the form does not contain the docket number of the appeal.

QUESTION #1: Provide the name and title of the individual requesting the Tribunal reconsider its decision or order along with the name of the employer's business, street address (or PO Box) and telephone number (with area code) in the space provided.

QUESTION #2: Briefly state the reason why the employer believes the Tribunal should reconsider its decision or order in the space provided.

SIGNATURE LINE: Please remember to SIGN and DATE this request before sending it to the Nebraska Appeal Tribunal. If the employer fails to sign and date this form, its request will then be denied.

Do not write in the space below the signature line that says FOR TRIBUNAL USE ONLY.

Please return the EMPLOYER'S REQUEST TO RECONSIDER DECISION to the Nebraska Appeal Tribunal, P.O. Box 98941, Lincoln, NE 68509-8491. This form may also be faxed to the Tribunal at (402) 471-1734.

This form is for employers who have witnesses that are hearing impaired. The Tribunal can accommodate either individuals who would prefer to have a hearing by text device or an in-person hearing. Employers should realize that in-person hearings do take more time to arrange. To insure that a place and date are available, employers should complete this form as soon as possible.

An Administrative Law Judge will review each request and rule on the request. Most requests are granted as long as they are not unreasonable. As with all other matters, the Tribunal Staff may not give legal advice. The Tribunal staff will not provide reasons or explanation for an Administrative Law Judge's decision.

When filling out this form, type or print answers neatly in the area provided. The DOCKET NUMBER should be listed in the space required. The Docket number can be located in the upper right-hand corner of the NOTICE OF APPEAL FILED or the NOTICE OF TELEPHONE HEARING. Failure to list the Docket Number and the Employer's name will result in this request being denied.

QUESTION #1: Provide the name and title of the individual requesting the subpoena along with the name of the employer's business, street address (or PO Box) and telephone number (with area code) in the space provided.

QUESTION #2: Mark the box stating the type of interpreter the witness would prefer. If the employer is requesting an in-person hearing, please indicate a location for the hearing. 

QUESTION #3: For this question, the employer should indicate the dates and times that its witness(es) would be available for the hearing. When suggesting dates, please remember that the Tribunal is only open Monday through Friday, excluding legal holidays as recognized by the state of Nebraska. Hearings will only be scheduled between the hours of 8:30 a.m. to 3:30 p.m. Central Time. No exceptions will be granted.

SIGNATURE LINE: Please remember to SIGN and DATE this request before sending it to the Nebraska Appeal Tribunal. If you fail to sign and date this form, your request will then be denied. 

Do not write in the space below the signature line that says FOR TRIBUNAL USE ONLY.

Please return the EMPLOYER'S REQUEST FOR INTERPRETER (HEARING IMPAIRED) to the Nebraska Appeal Tribunal, P.O. Box 98941, Lincoln, NE 68509-8491. This form may also be faxed to the Tribunal at (402) 471-1734.

This form allows employers to notify the Tribunal of an employer's contact telephone number, witnesses (if any) and their telephone numbers along with the certificate of service. Employers may use this form if the employer did not receive a Telephone Information Return Form with the Notice of Telephone Hearing form or lost the original Telephone Information Return Form sent in the mail. 

This form may be completed online, and answers may be inserted in the areas provided. The form cannot be saved with the information entered. To save the information, the form must be printed. Please remember to SIGN and DATE the form prior to returning it to the Tribunal. Users may also print the form and fill in the answers by either printing or typing the answers neatly in the space provided. 

The docket number can be found on the upper right-hand corner of the NOTICE OF APPEAL FILED or the NOTICE OF TELEPHONE HEARING. If the docket number cannot be found, other identifying information such as its employer experience account number, the claimant's name or claimant's social security number may be provided in the spaces below. The Tribunal will need this identifying information so it can quickly find the employer's case prior to the hearing.

QUESTION 1, EMPLOYER'S NAME: Please provide the employer's name as listed with the Nebraska Department of Labor. If the employer also knows its experience account number, please list the number on the form. The account number is not necessary if the Docket Number and claimant's name is listed on the form. 

QUESTION 2, CLAIMANT'S NAME: Please list the claimant's full name in the space provided. If the employer knows the claimant's social security number, it may be listed in the space provided. The claimant's social security number is not necessary if the Docket Number is listed on the form.

QUESTION 3, HEARING DATE: Please list the date and time of the hearing in the appropriate spaces. 

QUESTION 4, NAME AND TITLE OF EMPLOYER'S WITNESSES: Please list the full name and title of each witness, along with the telephone number (including area code or extension) where they can be reached at the time of hearing. 

QUESTION 5, NAME AND ADDRESS OF EMPLOYER'S ATTORNEY OR REPRESENTATIVE: In the space provided, list the name, address and contact telephone number of the employer's attorney or hearing representative. In the space marked “Hearing Telephone Number,” list the telephone number that the attorney or hearing representative will be at the time of the hearing if different than the office telephone number.

QUESTION 6, INTERPRETERS: In the space provided, indicate if any of the employer's witnesses require an interpreter. If an interpreter is needed, list the language that requires translation in the space provided. If a witness is hearing impaired, please use the Request for Interpreter (Hearing Impaired) form listed in this directory. 

QUESTION 7, DOCUMENTS: Indicate if the employer plans to submit any documents to the Tribunal as evidence to support its case and list the number of pages of documents in the space provided. If the employer does not have any documents to offer, enter this information in the appropriate area.

QUESTION 8, CERTIFICATE OF SERVICE: The employer does not need to complete the Certificate of Service if it did not submit documents to the Tribunal. If the employer submitted documents, it will also need to send copies to the claimant or any other party (such as the Nebraska Department of Labor). By completing the Certificate of Service, the Tribunal knows that the employer sent other interested parties its documents before the hearing. If the employer did not submit any documents to the Tribunal, this space may be left blank.

SIGNATURE LINE: Please remember to SIGN and DATE this subpoena before sending it to the Nebraska Appeal Tribunal. 

Please return the EMPLOYER'S TELEPHONE INFORMATION RETURN FORM to the Nebraska Appeal Tribunal, P.O. Box 98941, Lincoln, NE 68509-8491. The employer may also fax this to the Tribunal at (402) 471-1734.

This form is to allow parties to responds to an Order for More Definite Statement. An Administrative Law Judge will review and rule on the response. If a proper response is provided, the matter will be set for hearing. If the response is not made timely or is insufficient, the appeal will be dismissed. As with all other matters, the Tribunal Staff may not give legal advice. The Tribunal staff will not provide reasons or explanation for an Administrative Law Judge's decision. 

This form will need to be printed and information filled by typing or printing answers neatly in the area provided. Make sure the employer lists the DOCKET NUMBER of the case in the space required. If the employer does not know your docket number, it can be found it in the upper right-hand corner of the NOTICE OF APPEAL FILED or the NOTICE OF TELEPHONE HEARING. If the information required is not provided, the employer's response will be ignored. 

QUESTION #1: Provide the employer's name, street address (or PO Box), telephone number (with area code), and fax or e-mail address in the space provided. 

QUESTION #2: Mark the box whether you are the employer, or claimant. 

QUESTION #3: For this question, the employer should tell the Tribunal why you are appealing such as "the claimant quit without any reason" or "the claimant was discharged for violating the employer's attendance policy." If a more detailed reason for the appeal is needed, the employer may attach a longer statement to this form.

SIGNATURE LINE: Please remember to SIGN and DATE this request before sending it to the Nebraska Appeal Tribunal. If the employer fails to sign and date this form, the request will then be denied. 

Do not write in the space below the signature line that says FOR TRIBUNAL USE ONLY.