JS-55A (Rev 9/2007)

CONNECTICUT DEPARTMENT OF LABOR – TRADE ADJUSTMENT ASSISTANCE (TAA)

Jan. Feb. Mar. Apr. May Jun.
TRAINING WAIVER REVIEW Circle Month:
Jul. Aug. Sep. Oct. Nov. Dec. Year

Name SSN
To remain eligible for Trade Readjustment Allowances (TRA) and claim the Health Coverage Tax Credit (HCTC) as a TAA recipient after
the applicable training enrollment or waiver deadline, a worker who has not completed Trade Act-approved training must either be
enrolled in such training or covered by a waiver of the training requirement (prior to the deadline, no waiver or training enrollment is
required). Federal Trade Act regulations require that all training waivers be reviewed at least every 30 days to determine if the
conditions existing at the time of waiver issuance continue to exist. In the event conditions have changed and training becomes
feasible and appropriate, the waiver must be revoked. Failure to comply with the monthly waiver review process will result in waiver
revocation and jeopardize your eligibility for TRA and HCTC.

Complete and return this form on the first fifteenth of each month as directed by your Labor Department career
development specialist. The form must be received within ten days of the due date. Begin with the month following
waiver issuance.

Section One - Job Search Review

How many employers did you contact during the past month? 0 1-5 6-11 12-15 16-19 20 or more
How did you find most job leads during the past month? Check all that apply.
Job/Career Fairs Online Job Sites/Job Boards CT Department of Labor Referral
Networking Cold Contact/Direct Mail College Career/Alumni Offices
Help Wanted Signs Recruiters/Headhunters Professional/Trade Organizations
Union Hiring Halls Corporate Career Centers Want Ads/Newspaper Websites
How did you seek work during the past month? Check what was most typical.
I made phone calls. I submitted applications. I inquired or applied in person.
I applied online. I was interviewed. I submitted copies of my resume.
I made inquiries asking if any jobs were available. I applied for specific positions.
Other:
How many interviews did you have during the past month? 0 1 2 3 4 5 or more
Compared to prior months, is the number of interviews increasing? decreasing? remaining steady?
Were any of your interviews “second” or “third” interviews? Yes No
If you have not yet been offered a job, what reason(s), if any, have employers given you for not being selected? What
feedback have you received from employers about your qualifications? If you have been advised that you lack any
particular qualification(s), please indicate.

If you know of anything else that may be preventing you from finding work, please indicate.

Are you running out of employers to contact for suitable job opportunities? Yes No
If you have started to seek work that is less desirable than your past job, indicate how these job opportunities compare.
Lower Wages Lower Skill Fewer Fringe Benefits Less Desirable Shift Fewer Hours
Other:
Do you have an interest in training? Yes No If yes, what kind of training?

Section Two - Employment Status

I am currently unemployed. I am working as previously reported.
During the past month, I accepted work that is: full-time part-time and temporary permanent.
Employer: Start Date:
Title: Pay rate: $ per
If not working, what is your chance of being offered a job during the next month? Poor Fair Good Excellent
Do you request an in-person appointment with a career development specialist (if not already scheduled)? Yes No
If yes, indicate weekdays you are unavailable during the next month.
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Section Three - Waiver Review
Complete ONLY the section that corresponds to your waiver category and sign under the certification at the bottom of this
page. If you were issued a marketable skills waiver, there are no additional questions.
IMPORTANT: This monthly waiver review is conducted to determine your ongoing eligibility for a Trade Act training waiver.
Providing information here DOES NOT satisfy the reporting requirements of Unemployment Insurance (UI) or TRA claims in the
case of questions about circumstances “not previously reported.” Information provided here about any job refusals or change in
your employment or work availability status must also be given when answering similar questions on your weekly claims.

Recall: If you received a training waiver based on a written notice of recall from your former employer, is your return to
work still valid?
Yes - I will return to work on , as previously reported.
Yes - My recall date has changed from to .
No - My employer has withdrawn the offer of recall.
No - I am unable/unwilling to return to work for personal reasons.
If your employer has withdrawn the offer of recall or revised your return-to-work date, how and when were you notified?
What reason were you given for the change? If you have declined the offer of rehire, explain why. Use the space
below or attach a separate page or documentation.

Marketable Skills: If you received a training waiver based on possessing marketable skills for suitable employment, the
information you provided on the prior page will help us assess whether there is still a reasonable expectation of returning
to work that is, when compared to your trade-impacted employment, of equal or greater skill and paying at least 80% of
your average weekly wage.

Retirement: If you received a training waiver based on meeting (or being within two years of meeting) requirements for
entitlement to either social security benefits or a private pension, indicate the estimated amount of time you plan to remain
attached to the labor market. Less than two years Two to four years Five years or longer
If this is a change from what you previously indicated, check here . If you have an interest in training, be sure to
indicate your training interest where asked on the prior page.

Health: If you received a training waiver based on being unable to participate in training for health reasons, have
conditions changed in any way?
Yes - I am now physically able to participate in training.
No - I am still unable to participate in training for health reasons.
If you have an interest in training, be sure to indicate your training interest where asked on the prior page. If there has
been a change in your ability to seek and accept work, explain below or attach a separate page.

Enrollment Unavailable: If you received a training waiver based on a delayed start to your approved training program, is
your training start date still valid?
Yes - I will begin training on , as previously reported.
No - My training start date has changed from to .
No - I am unable or unwilling to begin training as planned.
If your scheduled training has been further delayed or cancelled, how and when were you notified? What reason were
you given for the change? If you are unable to participate as scheduled for personal reasons, explain. Use the space
below or attach a separate page or documentation.

Training Not Available: If you received a training waiver because training was previously unavailable, either due to lack
of training funds or because suitable training was not reasonably available to you or available at reasonable cost:
Have you become aware of additional training opportunities that are or may be suitable, reasonably available to you or
available at reasonable cost? Yes No
How did you become aware of this information? Self School Career Development Specialist (CDS)/
Employment Counselor/Case Manager Other. If source is not your CDS, provide additional details below.
Comments

I certify that the information I have provided is true and correct to the best of my knowledge and belief. I understand that the reporting
of any job refusals or change in my employment or work availability status here DOES NOT relieve me of my obligation to fully disclose
similar information requested of me during the filing of my weekly UI or TRA claims, unless expressly authorized by a Labor
Department representative.
Signature Phone Date JS-55A

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