Fillable Employer Information Form Uc-1609 (Page 2 of 2) in pdf

Employer Information Form Uc-1609 Page 2

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EMPLOYER: Use of this form provides separating employees and employees working reduced hours accurate

information to be used when filing for UC benefits. Employees should be encouraged to include your UC

employer account number when filing for UC benefits. By doing so, the department can send requests for

separation information to your correct address. Providing this form to employees can help reduce inaccurate

UC benefit charges to your account that may increase your UC tax rate.

INSTRUCTIONS FOR EMPLOYERS WHEN COMPLETING THIS FORM

Employer Name - Indicate your business name as it appears on the Pennsylvania Enterprise Registration

Form (Form PA-100).

PA Employer Account Number - Indicate your Pennsylvania UC employer account number. This seven-digit

number will be reflected on the Monthly Notice of Compensation Charged (UC-640), New Employer

Confirmation Letter (Form UC-1408), Notice of Pennsylvania Unemployment Compensation Responsibilities

(Form UC-851), or the Contribution Rate Notice (Form UC-657). If your account number has an R or M, insert

it in the eighth space; if not, enter a zero for the eighth number.

Address - Enter your mailing address or address where you want the Employer’s Notice of Application (UC-45),

unemployment fact-finding forms, and determinations to be mailed. If your company uses a Third Party

Administrator (TPA) to handle your unemployment claims, please enter the address for the TPA.

Contact Person, Email Address - Provide the name, title, and email address of the human resource

representative in your company that the department can contact if additional separation information is

needed.

Expected Date of Recall - If your company will be recalling the employee in the near future, complete this

section and enter the date you expect to recall this employee.

SIDES: State Information Data Exchange System

The SIDES E-Response enables employers to receive and respond to Pennsylvania’s

Employer’s Notice of Application (similar to the yellow Form UC-45)

ELECTRONICALLY, rather than by mail. For Form UC-504 (Enrollment Application)

and more information on SIDES, please go to the Employers’ section of our website:

EMPLOYEE: The PA CareerLink

staff would like to help make your job search successful. To find a list of PA

CareerLink

offices located near you or to search current job openings, visit All PA

CareerLink

services are provided to you at no cost. Remember, if you file for unemployment compensation

benefits, the law requires you to register with JobGateway

within 30 days of filing your new claim.

Auxiliary aids and services are available upon request to individuals with disabilities.

Equal Opportunity Employer/Program

UC-1609 REV 05-16 (Page 2)

Employer Information Form Uc-1609 Page 2

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