Form Ub-400 - Shared Work Plan Application printable pdf download

Form Ub-400 - Shared Work Plan Application

Form UB-400

and 400-2

Shared Work Plan Application

This form consists of two parts—the Shared Work Plan Application and the Participant

Listing.

parts must be completed and submitted to the Arizona Department of

BOTH

Economic Security for approval.

You may have two or more plans in effect at the same time covering separate groups of

employees. Each plan must include at least two (2) employees and all must be

identified by name and Social Security Number. Each plan must specify the beginning

date for the plan (which must be a

SUNDAY

Explanation of Items on the Plan Application form:

Enter the name of the corporation, individual or organization

that owns or controls the business.

Enter the Arizona Account Number, which appears on your

Unemployment Tax and Wage Report (Form UC-018 that

you submit to the Department each quarter).

Enter the name by which the business is commonly known

(doing business as).

4-5.

Self-explanatory.

Enter a future

date—your plan

be effective

SUNDAY

CANNOT

prior to the Department’s approval date.

Enter the total number of employees to be included in the

plan as listed on the Participant Listing.

8-9.

Self-explanatory.

10.

Complete this item if any employee on the Participant Listing

is represented by a collective bargaining agreement and

submit the plan to the collective bargaining representative for

signature. If there are more than three representatives,

prepare an attachment providing a similar format.

11.

Self-explanatory.

12.

For Department use only.

Form Ub-400 - Shared Work Plan Application