D.C. Unemployment Benefits Appeal - Official Form UI-001 Preparation Worksheet - District of Columbia
D.C. UNEMPLOYMENT BENEFITS APPEAL — OFFICIAL FORM UI-001 PREPARATION WORKSHEET
Use the official form: OAH requires a completed Unemployment Benefits Appeal Form UI-001 and a copy of the Department of Employment Services (DOES) written determination. This worksheet helps assemble information for that form; do not send this worksheet as your appeal.
1. Decision and deadline
Decision being appealed: [CLAIMS EXAMINER'S DETERMINATION / OTHER FINAL DOES WRITTEN DECISION]
Date DOES mailed it, as stated on decision: [__/__/____]
Address to which it was mailed: [________________________________]
If not mailed, date actually delivered: [__/__/____]
Decision copy ready to attach: ☐ Yes ☐ Still needed from DOES
D.C. Code § 51-111(b) gives 15 calendar days after mailing to the last-known address, or after actual delivery if not mailed. OAH Form UI-001 says that if the last day falls on a Saturday, Sunday, or legal holiday, the deadline moves to the next business day. The statutory period may be extended for good cause or excusable neglect, but the person filing must show why at the hearing.
2. Information for official UI-001
Filing party name and mailing address: [____________________________________________________________]
Telephone and email: [________________________________]
Ward, if known: [____]
Filing party: ☐ Claimant ☐ Employer
Representative, if any, and contact information: [____________________________________________________________]
Claimant's Social Security number, last four digits only: [____]
Self-employed? ☐ Yes ☐ No
Most recent D.C. government work? ☐ Yes, agency: [________________] ☐ No
Most recent federal government work? ☐ Yes, agency: [________________] ☐ No
Reason for requesting a hearing, in your own words:
[____________________________________________________________]
[____________________________________________________________]
Interpreter needed and language: [________________________________ / NO]
Reasonable accommodation needed: [________________________________ / NO]
Person preparing official form and contact details: [____________________________________________________________]
The official form has separate choices about email-only documents and sharing claimant contact information with a law school clinic. Make those choices on UI-001 itself and sign its preparer section.
3. File the official papers with OAH
OAH accepts the completed UI-001 and DOES decision through its e-filing portal, by mail or in person at 441 Fourth Street NW, Suite 450 North, Washington, DC 20001-2714, or by email to [email protected] with the papers attached as PDFs. OAH Form UI-001 says an email arriving after 5:00 p.m. or on a nonbusiness day is treated as filed the next business day. A mailed appeal must be postmarked by the U.S. Postal Service or otherwise actually received by OAH within the deadline. File with OAH, not a DOES office.
Official UI-001 completed: ☐ Yes
DOES determination attached: ☐ Yes
Selected filing route: [________________________________]
Date and time filed: [________________________________]
Proof of filing retained: [________________________________]
If you are a claimant, continue filing claim forms with DOES while the appeal is pending, as the OAH form instructs.
Sources
About this template
- Last updated
- October 27, 2026
- Citations checked
- October 27, 2026
- Jurisdiction
- District of Columbia
- Category
- Employment & HR
Legal authority
- D.C. Code § 51-111(b) (initial determination and appeal period)
- D.C. OAH Form UI-001, rev. 11/2024 (required appeal form and filing instructions)
Employment documents govern the relationship between a company and its workers, from offer letters and employment agreements through handbooks, performance reviews, and separations. Done right, they set clear expectations, protect against wrongful termination and discrimination claims, and give both sides a record to rely on. Done poorly, they invite lawsuits, agency complaints, and costly disputes.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on October 27, 2026.
D.C. Code § 51-111(b) (checked October 27, 2026): "The 15-day appeal period may be extended if the claimant or any party to the proceeding shows excusable neglect or good cause."
D.C. Office of Administrative Hearings, Unemployment Benefits (checked October 27, 2026): "To request a hearing, you need to file two things with OAH: a completed copy of the Unemployment Insurance Appeal Form and a copy of DOES’s written decision"
D.C. OAH Form UI-001, rev. 11/2024, filing instructions (checked October 27, 2026): "You MUST file your appeal with the Office of Administrative Hearings (OAH). OAH is not part of the Department of Employment Services (DOES)."
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