Purpose 
To notify an employer that he or she is potentially liable for charges for the unemployment benefits received by the named individual for periods subsequent to the most recent separation. (See Form)

Use
This form is sent to an employer when:

We determine that the individual's reasons for separation from a contributory employer are not disqualifying under New Jersey's Unemployment Compensation Law, OR
The employer failed to return the request for additional information within 21 days of the mailing of the request, OR
The individual was separated from a nonprofit employer choosing to reimburse the Unemployment Trust Fund for benefit payments or the individual was separated from federal civilian employment, OR
We determine that the individual's refusal of suitable work occurred after their separation from that employer.

Use by Employer
Keep this form for your records. The right of appeal is explained on the form.