Instructions For Partial And Part-Total Claimant'S Filing Through The Web - 2010

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Revised 11/16/10
INSTRUCTIONS FOR PARTIAL AND PART-TOTAL CLAIMANT’S
FILING THROUGH THE WEB
PARTIAL AND PART-TOTAL CLAIMANTS MUST HAVE THEIR EMPLOYER(S) SUBMIT A
“WEEKLY REPORT OF LOW EARNINGS” FOR EACH WEEK CLAIMED. SEE BELOW FOR SAMPLE.
Weekly Report of Low Earnings: In addition to filing your weekly claim certifications, you must have your
employer(s) complete and submit a “Weekly Report of Low Earnings” (UC-BP-52a) form to verify your
earnings, availability for work and continued employment for each week that you file for partial or part-total
benefits. Before giving the form to your employer(s), enter your name and the dates of the week for which you
are filing at the top of the form. Then, have YOUR EMPLOYER(S) complete and return the form as soon as
possible. If you file a claim certification but your employer(s) fails to return the “Weekly Report of Low
Earnings” form, your benefits will be delayed.
UC-BP-52(a)
WEEKLY REPORT OF LOW EARNINGS
MO
DAY
YR
MO
DAY
YR
TO
I, ______Your name_________________________________________ am claiming benefits for the week beginning:
(Sunday)
(Saturday)
Claimant name (Last, First Middle)
TO EMPLOYER (See reverse of this form for instructions.)
Before you submit this to your employer, please WRITE in the SUNDAY
to SATURDAY dates for the same week you are filing for.
1.
In the 7 day period indicated above:
a.
Rate of pay ____________
Total Hours Worked _______________
Gross wages earned. ______________________________________
b.
Did the individual accept all work offered?
Yes
No
If no, date did not accept all work ___________________________
Reason all work was not accepted ___________________________________________________________________________________________________
SAMPLE ONLY
2.
What was the last day worked prior to the week for which benefits are being claimed?
MO
DAY
YR
Reason for nonwork:
NO WORK
QUIT
DISCHARGE
OTHER
Explain
___________________________________________________________________________________________________________________________________
MO
DAY
YR
3.
Was the individual TERMINATED? If so, what was the LAST DAY OF WORK?
Reason for separation ?
NO WORK
QUIT
DISCHARGE
OTHER
Explain
I CERTIFY THAT THE INFORMATION IS CORRECT
_______________________________________________________
_______________________
_____________________________________
_________
Employer/Representative
Telephone No.
Title
Date
If you need more of the above “Weekly Report of Low Earnings” forms, please contact your local claims office
or write on your last form “Please send more forms”.

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