Forms - Miscellaneous
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.
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.
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.
Pennsylvania Unemployment Compensation State Information Data Exchange System (SIDES) E-Response
Employers can complete this form to participate in Pennsylvania SIDES E-Response.
Records to be Kept by Employers[Size=33k]
This form provides information for employers on the required content, location and retention of employment records.
Employer Records to be Examined
This form provides information for employers on the records requested in preparation for a UC tax compliance audit.
Shared-Work Brochure for Employers
This in an informational brochure about Pennsylvania’s Shared-Work Program.
Shared-Work Plan Application
This form is used by employers who would like to apply for Pennsylvania's Shared-Work Program.
Shared-Work Plan Application Instructions
This is an instructional form for employers to reference when applying for a Shared-Work plan.
Shared-Work Bi-Weekly Claim Form
This form is used by employers to file bi-weekly claims for an approved Shared-Work plan.
Application to Modify Approved Shared-Work Plan
This form is used by employers who wish to modify an approved Shared-Work plan.
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 Benefits Address Designation (Non-TPA)
This form is used by NON-TPA’s to change an employer’s UC benefit’s address.
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
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.