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LWD Home > Employer Handbook > Forms > Employer Handbook Forms Appendix

Employer Handbook Forms Appendix

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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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