Department of Labor and Workforce Development | Employer Handbook Forms Appendix

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Employer Handbook Forms Appendix

Form	Info	Title
AA-1	More	Authorized Agent Registration Form
AC-174.1	More	Notice of Employer Contribution Rates
B-187Q	More	Unemployment Benefits Charged to Experience Rating Account
BC-2	More	Request for Wage Separation Information
BC-3E	More	Notice to Employer of Monetary Determination and Request for Separation Information
BC-3NC	More	Determination /Redetermination of Benefit Charge Liability
BC-6	More	Notice of Failure to Apply For, or to Accept, Suitable Work
BC-10	More	Instructions for Claiming Unemployment Benefits
BC-26B	More	Notice of Determination
BC-28	More	Request for Separation Information
BC-90RC	More	Notice to Employer of Fact-Finding Proceeding
BC-289DR	More	Determination of Denial of Relief of Benefit Charges
BC-289TO	More	Notice of Determination of Eligibility
BPC-83	More	Request for Wage Information for Dependency Allowance
BPC-98	More	Weekly Wage Information Request
BPC-178	More	Request for Information on Newly Hired Worker
CS-156	More	Notice of Contribution/Wage Report Delinquency
CSRS13001	More	Combined Assessment Bill
D-20	More	Notice of Eligible Determinations - State Plan
D-40	More	Notice of Ineligible Determinations - State Plan
DIS-89T	More	Notice to Employer of State Plan Disability Benefits Paid for Use in Preparing W-2 Forms
DS-1	More	Claim for Disability Benefits
DS-7CR2	More	Notice of Disability Benefits Charged or Credited
E-10	More	Request for Employer Information
E-20	More	Second Request for Employer Information
E-30	More	Request for Additional Wage Information
E-40	More	Penalty Assessment for Delinquency in Reporting Wage and Employment Information
FL-1		Application for Family Leave Insurance Benefits
		Part A, Claimant Information
		Part B, Bonding Certification
		Part C, Release of Medical Information and Medical Certificate
		Part D, Employer Statement
		Part E, Intermittent Family Leave Schedule
FL-2		Application for Family Leave Insurance Benefits, New Mother Bonding
IB-4.2 WR	More	Request for Wage Information on Combined Wage Claim
IB-4.3 WR	More	Notice to Employer of Benefit Determination on Combined Wage Claim (CWC)
NJ-REG	More	Business Registration
***	More	Power of Attorney
UC-9	More	Employer’s Claim for Credit or Refund by Reason of Erroneous Payment of Contributions
UC-9A	More	Employee’s Claim for Refund of Excess Contributions
UC-52	More	Employer Certification of Wages and Deductions

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