The Tribunal has specifically created this form for the sole purpose of allowing attorneys and hearing representatives the opportunity to appeal the Notice of Adjudicator’s Determination on behalf of claimants. This form may be used instead of entering an appeal on-line through the Nebraska Department of Labor’s BPS 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 claimant has already filed for an appeal, a subsequent appeal is not necessary. Only complete and return this form if the claimant 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 claimant’s name, street address (or PO Box), city, state, ZIP code and telephone number (with area code) in the space provided. Fax number and e-mail address can be included, but are not required.

QUESTION #2: Provide the claimant’s social security number.

QUESTION #3: Briefly state the reason that the claimant is appealing in the space below.

QUESTION #4: Provide the name and title of the attorney or hearing representative representing the claimant 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.

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, the appeal 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.

The Tribunal has specifically created this form for the sole purpose of allowing attorneys and hearing representatives the opportunity to appeal the Notice of Adjudicator’s Determination on behalf of employers. This form may be used instead of entering an appeal on-line 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.

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, the appeal 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, attorneys and hearing representatives may request their client’s hearing date be continued. Continuances must be requested at least FIVE DAYS before the hearing. Should an attorney or hearing representative 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 attorney or hearing representative requesting the continuance 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. 

QUESTION #2: Indicate what party the hearing representative or attorney represents.

QUESTION #3: Provide the specific reason for the request. Please state whether or not a party, witness, or representative will be available by telephone at the time of hearing.

QUESTION #4: If there are no other witnesses available, please answer “no." Also indicate “no” should the attorney or hearing representative have a conflict with the time or date of the hearing, and there is no one else able to replace that attorney or hearing representative. 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 #5: For this question, the employer should list alternate dates and times that the employer’s witness(es), attorney or hearing representative 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 ATTORNEY’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, attorneys or hearing representatives may request that the Tribunal issue a subpoena for a witness to testify at the appeal hearing. To have a subpoena issued, a request must be made 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 attorney or hearing representative requesting the subpoena 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. 

QUESTION #2: Indicate what party the hearing representative or attorney represents.

QUESTION #3: Provide the name of a witness to be subpoenaed. The Tribunal will not grant a subpoena should the attorney or hearing representative fail to provide the first and last name of the witness. If subpoenas are requested for more than one witness, separate subpoena will need to be filed for each additional witness.

QUESTION #4: Please answer yes or no if the attorney or hearing representative has asked this witness to testify without a subpoena. If the answer to question #3 is “no,” reasons should be provided as to why the attorney or hearing representative has not asked the witness to testify in the space provided.

QUESTION #5: If this question is answered with “Yes,” the attorney or hearing representative should 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 named in the subpoena.

QUESTION #6: Briefly state the testimony this witness will provide that is relevant to the case. 

QUESTION #7: 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 WITNESS SUBPOENA REQUEST 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, attorneys and hearing representatives may request that the Tribunal issue a subpoena for documents held by another parties. To have a subpoena issued, a request must be made 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 attorney or hearing representative requesting the subpoena 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. 

QUESTION #2: Indicate what party the hearing representative or attorney represents.

QUESTION #3: Identify the documents to be subpoena. List the name of the document and approximate number of pages in the document. If the attorney or hearing representative is not specific concerning the document that it wishes to subpoena, then the Tribunal will not grant the subpoena.

QUESTION #4: Please answer yes or no if the attorney or hearing representative has requested these documents from the person or company that has them. If the answer is “no,” please state the reason why the attorney or hearing representative has not asked for specific documents in the space provided.

QUESTION #5: Briefly state the reason why each document is relevant to the case. Attorneys or hearing representatives may attach the additional information to its request to explain the relevance of each document.

QUESTION #6: Please answer yes or no if these documents can be provided by another source. If the attorney or hearing representative answered “yes,” they 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 #7: 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, the 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 REQUEST 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.

The Tribunal has specifically created this form for the sole purpose of allowing attorneys and hearing representatives the opportunity to appeal the Tax Administrator’s determination regarding employer tax. This notice must be returned to the Tribunal within 20 days of the date that the Tax Administrator’s determination was mailed to the parties. Failure to return this notice on time will result in the appeal being dismissed.

When filling out this form, type or print answers neatly in the area provided. Attorneys and hearing representatives may attach additional documents, if needed.

QUESTION #1: Provide the name of the employer entering the appeal along with the employer’s business, street address (or PO Box) and business telephone number (with area code) in the space provided. 

QUESTION #2: Provide the employer’s account number.

QUESTION #3: Check the issue that indicates the basis of the appeal. More than one box may be checked. Attorneys and hearing representatives may attach additional documents, if needed.

QUESTION #4: Provide the name and title of the attorney or hearing representative requesting the subpoena 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.

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 NOTICE OF APPEAL (TAX) 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, attorneys and hearing representatives may request that the Tribunal reconsider its decision. Responses must be returned to the Tribunal within 10 days of the date that the order was mailed to the parties. Failure to return this response on time will result in the appeal being dismissed.

An Administrative Law Judge will review each response and rule on whether or not sufficient reasons has been provided to reopen or reconsider the appeal. These types of requests are rarely granted but may be considered if a mistake of law has been made, newly discovered evidence which could not have been presented at the time of the hearing through due diligence, of when a party did not receive notice of the hearing and did not appear. 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.

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 will result in this request being denied.

QUESTION #1: Provide the name and title of the attorney or hearing representative requesting the a reopening or reconsideration of the appeal 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. 

QUESTION #2: Indicate what party the hearing representative or attorney represents.

QUESTION #3: Briefly state the reason why the Tribunal should reconsider its decision in the space provided.

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 REQUEST TO RECONSIDER 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 attorneys or hearing representatives to request an interpreter for witnesses or clients that are deaf or hard of hearing. The Tribunal can accommodate either individuals who would prefer to have a hearing by text device or an in-person hearing. Attorneys or hearing representatives should realize that in-person hearings do take more time to arrange. To insure that a place and date are available, attorneys or hearing representatives should complete this form as soon as possible.

An Administrative Law Judge will review each request and rule on the decision. 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 attorney or hearing representative requesting the a reopening or reconsideration of the appeal 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. 

QUESTION #2: Indicate what party the hearing representative or attorney represents.

QUESTION #3: Mark the box stating the type of interpreter the witness would prefer. If the attorney or hearing representative is requesting an in-person hearing, please indicate a location for the hearing. 

QUESTION #4: For this question, attorneys or hearing representatives should indicate the dates and times that 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 ATTORNEY’S REQUEST FOR INTERPRETER (DEAF OR HARD OF HEARING) 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 hearing representatives and attorneys representing 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. Attorneys and hearing representatives 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 allows attorneys representing claimants to notify the Tribunal of the claimant’s contact telephone number, witnesses (if any) and their telephone numbers along with the certificate of service. This form may used if the claimant did not receive a Telephone Information Return Form with the Notice of Telephone Hearing form or the claimant lost the original 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 the 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, CLAIMANT'S INFORMATION: Please provide the claimant’s full name, current address (including apartment number, lot number, etc.), and the city, state, and zip or postal code of where the claimant lives. Please also provide the claimant’s social security number along with the date and time of the hearing (as listed the NOTICE OF TELEPHONE HEARING).

If the attorney wishes to have the claimant available at the attorney’s office at the time of hearing, please list that number as the telephone number the claimant will be for the hearing. If the claimant needs an interpreter, please mark the correct box and one will be provided by the Tribunal.

QUESTION #2, WITNESSES: Please list the full name (first AND last name) and the telephone numbers (with area code) of any witnesses in the spaces provided. The Tribunal will also need to know if these witnesses require an interpreter and what language they speak. Witnesses should know that they are to appear for the hearing. Attorneys should make sure that witnesses have agreed to participate in the hearing with before their names and numbers are submitted to the Tribunal.

QUESTION #3, ATTORNEY: Please list the name, firm or business name, mailing address, and telephone number (both contact number and the number where they will be available for the hearing) in the space provided. 

QUESTION #4, DOCUMENTS: : If a claimant has any documents that they wish to submit to the Tribunal as evidence to support their case, the claimant may then return them with this form. Please list the number of pages of documents that the claimant wishes to send to the Tribunal in the space provided. If the claimant has no documents to send, simply enter “0” in the space marked “I have ___ pages of documents that I wish to submit as evidence with this form” or leave space blank.

QUESTION #5, CERTIFICATE OF SERVICE: Claimants only need to complete Question Number 5 if they submitted documents to the Tribunal. If the claimant submitted documents, they will need to send copies to the employer or any other party (such as the Nebraska Department of Labor). By completing the Certificate of Service shows that the claimant sent the employer their documents before the hearing. If the claimant did not submit any documents to the Tribunal, this space may then be left blank.

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

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

This form allows hearing representatives and attorneys representing employers on Tax hearings to notify the Tribunal of an employer’s contact telephone number, witnesses (if any) and their telephone numbers along with the certificate of service. Attorneys and hearing representatives 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. 

CASE NUMBER: Please list the case number in the upper right hand side of this form. 

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 case number is listed on the form. 

HEARING DATE / TIME: : Please list the date and time of the hearing in the appropriate spaces.

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. 

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. Should the attorney or hearing representative be at a different number at the time of the hearing, please indicated this on the form.

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 Nebraska Department of Labor or any other party. 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. 

NAME / TITLE /ADDRESS, ETC: Please complete the information regarding the individual that completed the Certificate of Service.

Please return the TAX HEARING 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 respond 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 you list the DOCKET NUMBER of you case in the space required. If you do not know your docket number, you can find it in the upper right-hand corner of the NOTICE OF APPEAL FILED or the NOTICE OF TELEPHONE HEARING. If you do not provide the information required, your response will be ignored. 

QUESTION #1: Provide the attorney or hearing representative'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 of the party represented. 

QUESTION #3: For this question, the attorney or hearing representative should tell the Tribunal why their client is appealing such as "I quit because of health reasons" or "I was fired for showing up late." If the attorney or hearing representative wants to give a more detailed reason for the appeal, they 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 an attorney or hearing representative 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.

Please return the CLAIMANT'S REQUEST FOR INTERPRETER (HEARING IMPAIRED) to the Nebraska Appeal Tribunal, P.O. Box 98941, Lincoln, NE 68509-8491. You may also fax this to the Tribunal at (402) 471-1734.