Purpose
To notify the employer of benefits payable to a former employee who has filed a claim for unemployment benefits based on New Jersey wages in combination with wages earned in another state or states under the Combined Wage program. (See Form)

Use
We send the employer this form for each Combined Wage Claim filed against that New Jersey registration number. The form shows the total benefits payable based on all employment with the individual employer.

The amount of benefits payable and the claimant's eligibility to collect the benefits are determined by the state responsible for processing the claim (the "paying state").  The name and address of the paying state are indicated on the form.

Use by Employer
Keep this form for your records. The form explains your right of appeal. Direct any questions about the claimant's eligibility to collect benefits to the paying state.