State All Employers Taxpaying Employers Reimbursing Employers

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1 Most recent Tax Rate Notice (UC-216C) form Statements of Benefits Charged (UC-212) REV Cost (UC-212-A) Alabama (UC-10- A This information can also be found This information can also be found Alaska (TQ01C Most recent Contribution Rate Notice (B1496A) form Notice of Benefits Paid 6 Most recent Notice of Benefits Paid Arizona (UC-018 Three most recent Determination of Unemployment Tax Rate (UC-603) Benefit Charge Notice (UC602A) 6 Most recent Benefit Charge Notice (UC602B) Arkansas (DRS- ARK-209 Three most recent Experience Rating Notice (WR8244) Quarterly Statement of Paid Benefits (ARK-546) 6 Most recent Quarterly Listing of Reimbursable Benefits Paid (ARK-547) California (DE-6) Three most recent Notice of Contribution Rate (DE-2088) Statement of Charges (DE-428T) 6 Most recent Statement of Reimbursable Benefit Charges (DE-428R) Colorado (UITR-I Three most recent Notice of Employer s Tax Rate (UITR-7) Statement of Benefit Charges (UIA-20) Charges Reimbursable Employers (UIA- 20R) Connecticut (UC-5B Most recent Unemployment Compensation Tax Rate Notice (UC-54A) form 12 most recent Statement of Experience Charges (UC-54Q) 18 Most current Statement of Reimbursable Charges (UC-540) Delaware (UC-8B Most recent Notice of Unemployment Insurance Assessment Rate form 12 most recent Notice of Benefit Wages Charged to Employer s Merit Rating Account (UC-12) 18 Most recent Reimbursable Monthly Statement of Amount Due

2 District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa (RT-6 (DOL-4 (TAX020 (Form 250) This information can also be found Three most recent Contribution Rate Notice (UC632) Unemployment Compensation Benefit Charge Statement Most recent Unemployment Compensation Tax Rate Notice (RT-20) form Notice of Benefits Paid (RT-1) Three most recent Employer Tax Rate Notice (DOL-626) Employer Quarterly Statement of Benefit Charges (DOL-620) Most recent Contribution Rate Notice form Statement of Benefit Charges Most recent Notice of Taxable Wage Rate (TAX011) form 12 Most recent Statement of Benefit Charges Most recent Annual Contribution Rate Determination form Complete a Temporary Authorization form 6 Most recent Benefit Charge Statement for Reimbursable Employers (UC244) 6 Most recent Reimbursement Invoice (RT-29) 6 Most recent Employer Quarterly Statement of Benefit Charges (DOL-620R) Charges Charges Complete a Temporary Authorization form Charges Most recent Merit Rate Notice form 12 most recent Statement of Benefit Charges (Form 535) 18 Most recent Statement of Benefit Charges (Form 1067) Most recent Notice of Unemployment Insurance Contribution Rate form Statement of Charges This information can also be found 6 Most recent Notice of Reimbursable Benefit Charges This information can be found

3 Three most recent Experience Rating Notice (K-CNS 404) Most Notice of Benefit Charges (K-CNS 403) form (ending June 30th) Government Rate Taxpaying Employers: Kansas Kentucky (K-CNS 100 (UI-3 Benefit Cost Rate Notice Three most recent Notice of Contribution Rate (UI-29) Statement of Benefit Charges to Employer s UI Reserve Account (UI-448) Three most recent Unemployment Insurance Contribution Rate (LWC T105AF) Statement of Benefit Charges 6 Most recent Reimbursing Employer s Quarterly Statement of Benefit Charges (K- CNS 026) Charges Request for Reimbursement (UI- R448-R) 6 Most recent Quarterly Reimbursable Statement of Benefit Charges Louisiana Maine (C1-ME Three most recent Notice of Contribution Rate Form (ME TAX-13) 12 most recent Record of Unemployment Charges (ME B-29) 18 Most recent Assessment for Benefit Payments (ME B-29) Maryland (DLLR/DUI 15 This information can also be found online at: mdunemployment.com, Click on WebTax Most recent Experience Rate Notice (DLLR/DUI 61) form Notice of Benefit Payments Charged to Experience Rating Account This information can also be found online at: mdunemployment.com, Click on WebTax 6 Most recent Statement of Reimbursable Benefits Paid (DLLR/DUI 64) This information can also be found online at: mdunemployment.com, Click on WebTax Massachusetts Three most recent Notice of Employers Unemployment Insurance Rate Visit ogin.aspx and print benefit charge summaries for the four most recent years Visit ogin.aspx and print benefit charge summaries for the four most recent years

4 Michigan Minnesota Mississippi Missouri Montana (UIA Go to: 2. Click Employer Login 3. Login to UI System 4. Click Benefit Charge Activities 5. Click Fiscal Year Summary 6. Print charge summary (UI-3 (MODES41) Three most recent Tax Rate Determination (UIA 1771) Summary of Statement of Benefit Charges and Credits (UIA 1770) 6 Most recent Reimbursing Employer Billing for Benefit Charges (UIA 1763) 7. Click Tax and Wage Detail Reporting 8. Click View History 9. Click to view Quarterly Wages, UI Taxes, Assessments and Fees (This link is towards the bottom of the page.) 10. Print wage summary Submit charge and wage summary to First Nonprofit Group along with your application. Most recent Employer s Contribution Tax Rate (EXER-8B) form 12 most recent Statement of Benefit Charges (EXR-5F) Most recent Employer s Experience Rating Statement & Notice of Contribution Rate (MODES-527) form Statement of Benefit Charges (MODES-34-R1-5) Most recent Notice of Unemployment Insurance Tax Rates (UI 273) form Complete a Temporary Authorization Form Charges (EXR-5R) 6 Most recent Reimbursable Benefit Payments (MODES-4115) Complete a Temporary Authorization Form Nebraska (UI-11W Three most recent Combined Tax Rate Notice (UI128A) Statement of Benefit Charges (UI87A) Benefit charges can also be found 6 Most recent Reimbursable Benefit Charge Billing (UIF87R) Three most recent Notice of Employer s Contribution Rates (NUCS-4291) Notice of Benefit Payments Charged 6 Most recent Reimbursable Employer Billing Statement (NUCS-28R) Nevada (NUCS Click Existing User Sign In or New User Registration. Click Existing User Sign In or New User Registration.

5 Most recent Tax Rate Determination form 12 Most recent Notice of Benefits Paid and 18 Most recent Notice of Benefits Paid and Charged to Employer Charged to Employer New Hampshire (NWHA jsp jsp New Jersey (NJ- 927-W Three most recent Notice of Employer Contribution Rates Form B187Qs 6 Most recent Reimbursement Billing (B187Q) New Mexico (ES903A) Three most recent Notice of Employer Contribution Rate Statement of Benefit Charges Charges New York North Carolina (NYS-45 (NCUI 101 Three most recent Notice of UI Tax Rate (IA 97) Notice of Experience Rating Charges (IA 96) Experience Rating Charge information is ation/index.shtm Please print and submit the following information found on your online employer account at Last Experience Rating Ledger Found in the Inquiries & Information section under Your unemployment Insurance Taxes ) List of potential charges (Found in the Inquiries & Information section under Your unemployment Insurance Claims ) List of charges to your account (Found in the Inquiries & Information section under Your unemployment Insurance Claims ) 6 Most recent Notice of Benefit Reimbursement Charges (IA 96R) ation/index.shtm Please print and submit the information listed to the right, not including the Last Experience Rating Ledger

6 North Dakota com/unemploymen t-business/ui-easy Three most recent Job Insurance Tax Rate and Taxable Wage Base Notice Statement of Benefits Paid s Paid Ohio ent.ohio.gov/wp/wp s/myportal Three most recent Contribution Rate Determination 12 Most recent monthly Notice of Benefits Paid and Charged to Employer yportal 18 Most recent Reimbursing Employers Monthly Statement (JFS 20156) yportal Oklahoma s.oesc.state.ok.us/ Most recent Notice of Employer s Contribution Rate (OES-48) form Statement of Benefits Paid 6 Most recent Quarterly Statement of Reimbursement of Benefits Paid (OES-876) Oregon (OQ Most recent Notice of Tax Rate (238) form 12 Most recent Statement of Benefit Charges (237A) Charges (237B) (UC-2 Pennsylvania ov/employers-ucservices-uctax/ucms/pages/def ault.aspx Most recent PA UC Contribution Rate Notice (UC-657) form 12 most recent Monthly Notice of Compensation Charged (UC-640) 6 Most recent Notice of Reimbursable Amount Due (UC-660)

7 Three most recent Notice of Tax Rate (TX 1016) 18 Most recent Notice of Unemployment 12 most recent Notice of Unemployment Benefits Paid (TX 100-R) Rhode Island Benefits Paid (DET-EA 100) South Carolina South Dakota Tennessee (LB Most recent Rate Notice form Statement of Employers Benefit Charges Most recent Contribution and Investment Fee Rate Notice (DOL-UID-45A) form 12 most recent Statement of Benefit Charges Three most recent Notice of Premium Rate (LB-0482) Statement of Benefits Charged to Employer s Experience Rating Account (LB-0481) Provide a copy of your most recent Tax Rate Notice (C-22) form 6 Most recent Statement of Employers Benefit Charges 18 most recent Statement of Benefit Charges s Charged (LB-0481) Texas (C-3 Provide copies of your four most recent wage reports along with information found online at ty/logon.do 1. Logon to your account 2. Select the "Report filing (C3)" tab 3. Select "Chargeback history" Provide copies of your four most recent wage reports along with information found online at ty/logon.do 1. Logon to your account 2. Select the "Report filing (C3)" tab 3. Select "Chargeback history" Utah v/ui/employer/empl oyerhome.aspx. Click on Tax Reporting. Most recent Contribution Rate Notice (Form 45) form rhome.aspx. Click on Tax Reporting. 18 most recent Reimbursible Employer Billing Statement (28R)

8 Most recent Contribution Rate Notice (C- 119) form 12 most recent monthly Notice of Benefit Charges to Your Experience Rating Record Vermont (B-84W) 18 Most recent Notice of Benefit Charges Virginia recent Most recent Tax Rate Notice (VEC-FC-29) form Quarterly Charge Statement (VEC-8-46) 6 Most recent Quarterly Reimbursable Billing (VEC-8-47) Washington employertaxes/about-eams Most recent Tax Rate Notice (EMS 174) form Statement of Benefit Charges Charges West Virginia Three most recent Notice of Contribution Rate (WVUC-MR-7) Statement of Benefits Paid s Paid (WVUC-B-206 & WVUC-MR-6) Wisconsin This information can also be found ent.wisconsin.gov/ SUITESPortalWelco me/employerportal Welcome.aspx?tar get=employerhome _Main.aspx Most recent Unemployment Insurance Tax Rate Notice (UCT-100B-E) form All Unemployment Insurance Reserve Fund Balance Statement received in the three most recent years This information can also be found ESPortalWelcome/EmployerPortalWelcom e.aspx?target=employerhome_main.aspx 18 Most recent Reimbursable Employer Statement (UCT E) This information can also be found ESPortalWelcome/EmployerPortalWelcom e.aspx?target=employerhome_main.aspx Wyoming (WYO56 Most recent Official Notice of Unemployment Insurance Tax Rate Notice of Unemployment Benefits Paid 6 Most recent Notice of Unemployment Benefits Paid