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REQUEST FOR MONETARY RE-DETERMINATION - | does
Washington, DC 20019 REQUEST FOR MONETARY RE-DETERMINATION Form 193 Revised 02/14 INTERVIEWER’S REMARKS: Include any evidence or information which may be helpful to an investigator, such as other Social Security Numbers or names used, W-2 forms or pay slips to substantiate the wages being claimed.
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does.dc.govEmployee Acknowledgment The employee must acknowledge that they have disclosed their primary language by checking one of the two boxes and that the employee has received the form by signing and dating the form. Note: Employees have a right to receive this notice in a language other than English but only for those languages for
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