Begin Main Content Area

Forms - Miscellaneous

UC-10 (PDF): Pennsylvania Unemployment Compensation Payment Plan [Size=483k]
This form is used by an employer to enter into a payment plan with the Office of UC Tax Services. The normal length of an approved payment plan is 6 months. This form can be completed on your computer, printed and mailed to: Office of UC Tax Services, Room 430, 11 Stanwix Street, Pittsburgh PA 15222.

UC-46(A) (PDF): Petition for Appeal [Size=100k]
Complete Section 1 of this form when appealing a UC Referee Decision to the UC Board of Review.

UC-46(B) (PDF): Petition for Appeal [Size=79k]
Complete Section 1 of this form when appealing a UCSC, Employer Charge determination.

UC-162: (PDF) Petition for Reassessment
This form is used to petition for a reassessment when an employer does not agree with an assessment made by the department.

UC-168: (PDF) Application for Agreement to Compromise
This form is used by an employer to request a compromise of contributions, interest and/or penalties due the Office of UC Tax Services. Tax contributions are generally excluded by Law from the compromise unless the employer has been adjudged bankrupt.

UC-504: (PDF) Pennsylvania Unemployment Compensation State Information Data Exchange System (SIDES) E-Response
Employers can complete this form to participate in Pennsylvania SIDES E-Response.

UC-746: (PDF) Records to be Kept by Employers[Size=33k]
This form provides information for employers on the required content, location and retention of employment records.

UC-926: (PDF) Employer Records to be Examined
This form provides information for employers on the records requested in preparation for a UC tax compliance audit.

UC-1084 (PDF) Shared-Work Plan Application
This form is used by employers who would like to apply for Pennsylvania's Shared-Work Program.

UC-1084A Shared-Work Plan Application Instructions
This is an instructional form for employers to reference when applying for a Shared-Work plan.

UC-1089 (PDF) Shared-Work Bi-Weekly Claim Form
This form is used by employers to file bi-weekly claims for an approved Shared-Work plan.

UC-1091 (PDF) Application to Modify Approved Shared-Work Plan
This form is used by employers who wish to modify an approved Shared-Work plan.

UC-1098 (PDF) Shared-Work Brochure for Employers
This in an informational brochure about Pennsylvania’s Shared-Work Program.

UC-1208: (PDF) UC Benefits Address Confirmation and Power of Attorney (TPA)
This form is used by TPAs ONLY to change the employer’s UC benefit’s address.

UC-1212(W): (PDF)
UC-1212(W)(INS): (PDF) UC Benefits Address Designation (Non-TPA)
This form is used by NON-TPA’s to change an employer’s UC benefit’s address.

UC-1609 (PDF): Employer Information Form [Size=153k]
This form provides accurate information for use when unemployment claims are filed. If wrong information is given on a claim, it can create delays that can lead to a wrong financial determination, which could increase your tax rate. This form can help your company save money by reducing inaccurate claims, and subsequently, inaccurate charges to your account -- charges that would require extra time and energy on your part to remove. Complete the form, and provide a copy to every employee who leaves your organization. This simple step could save your company time and money.

*There is also a form available for your Spanish speaking employees Form UC-1609(ESP).

UC-1921W: (PDF) Employer Questionnaire Refusal Suitable Work
This form is used to help improve payment accuracy. Refusing an offer of suitable work/referral to work must be reported to the department within seven days of the offer. Use this downloadable form to notify the department of a refusal of suitable work offer or referral to suitable work.