Form Uin-18/20 - Magnetic Tape Reporting - Unemployment Insurance March 2001 Page 10
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17UIN-20
Page_____of_____
NEBRASKA UNEMPLOYMENT INSURANCE DIVISION
TH
550 SOUTH 16
STREET
PO BOX 94600
LINCOLN, NE 68509-4600
TRANSMITTER REPORT OF MAGNETIC MEDIA
Type of Print in Ink:
TRANSMITTER OF INFORMATION
1. Name of Company
2. UI Employer Acct # (required)
3. Reporting
Year_______Quarter________
TAPE SUMMARY INFORMATION
4. Total # of Tapes:
5. Total # of Employers
6. Total # of Employees
7. Total Gross Wages on
On Tape:
On Tape:
Tape:
EMPLOYER SUMMARY INFORMATION
Use additional UIN-20’ s if reporting for more than 24 employers
8. UI Employer
9. # of
10. Total Gross
8.UI Employer
9. # of
10.Total Gross
Account #
Employees
Wages
Account #
Employees
Wages
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
CERTIFICATION
I CERTIFY THAT ALL INFORMATION CONTAINED IN THIS REPORT
AND ON THE ACCOMPANYING MAGNETIC TAPE(S) IS TRUE AND ACCURATE.
11. Signature/Title/Date:
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