Form Lb-0489 - Separation Notice Page 2
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2TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT
INSTRUCTIONS
SEPARATION NOTICES
Rule 0560-1-1-.02 of the Rules and Regulations of the Tennessee Employment Security Law, requires all
employers to furnish each separated employee with a Separation Notice, LB-0489, within 24 hours of the
employee's separation from employment.
Separation Notices do not have to be given to any employee who has been in your employ for less than a
week or who will be recalled within seven days.
Separation Notices reduce the administrative costs of processing an unemployment insurance claim and
helps make a more accurate determination of the claimant's eligibility for benefits.
Please complete the Separation Notice in its entirety.
Item 5
Check the appropriate block as to the reason the worker is separated. If the separation was for any reason
other than lack of work, give a clear explanation for the separation on the lines provided. Please indicate
whether the separation is permanent or temporary, and, if temporary, when you expect to recall the worker.
Item 6
If you paid wages beyond the separation date, indicate the beginning and ending date of the payments.
If you paid wages, equal to the worker's usual wages, in lieu of permitting the worker to work during the
notice period, check the block beside "Wages in Lieu of Notice."
If you paid the worker severance or separation pay based, at least in part, on the worker's length of service,
check the block beside "Separation Pay."
If you paid vacation pay, it will be important to have indicated the anticipated duration of unemployment,
permanent or temporary, in Item 5. If temporary, the expected recall date is important.
To obtain Separation Notice forms, please:
make copies of the form on the reverse side of these instructions, or
call toll-free:
1-800-344-8337 in Tennessee
1-615-253-6122 if out-of-state, or
go to our Web Site and to Forms, Unemployment Insurance Forms
- Employers, and scroll to Separation Notice, LB-0489
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