Unemployment Insurance Handbook for Employers (UCB-201-P)
Section 1 - Benefits

PART 9 - Benefit Reports and Forms Sent to Employers

Your help is needed to maintain the integrity of the unemployment insurance system. One way we solicit your assistance is by sending you reports that either ask for verification of information provided by the claimant, ask for additional information, or provide information to you about the status of the claim.

As mentioned in Part 5 - Benefit Reports Required by the Department, there are four required UI benefit reports. In addition to the four required reports, there are a number of other forms that you may receive.

When you receive one of our forms, please review it promptly. Complete and return all those that you are required to return or that ask for information. The reverse side of most forms will include an explanation of the report, instructions for completion, and/or telephone numbers to call for more information. If you find an error on any of the informational reports, notify us as soon as you can so that we can investigate the discrepancy and correct the record.

Remember that your account will be charged for all erroneously paid benefits as the result of a missing, late or incorrect/incomplete required report and if you fail to provide correct and complete information requested during a fact-finding investigation, including erroneously paid benefits that were charged to other employers' accounts.

Required Reports
A. Form UCB-16 Separation Notice
B. Form UCB-23 Wage Verification/Eligibility Report
C. Form UCB-719 Urgent Request for Wages
D. Quarterly Wage Report Instructions for completing Quarter Wage Reports are in Section 4

Sample Reports
E. Form UCB-20 Written Determination
F. Form UCB-29 Notice of Benefit Charging
G Form UCF-350 Weekly Earnings Report
H. Form UCB-701 Computation of Unemployment Insurance Benefits
I. Form UCB-708 Notice of Changed Liability for Unemployment Insurance Benefits
J. Form UCF-17275 Wage/Earnings Audit


As part of the UI Division's re-engineering project Form UCB-16 Separation Notice and Form UCB-23 Wage Verification/Eligibility Report, have been redesigned for automated scanner processing.  These are the first "benefits" forms that are being changed for this purpose.  Automated scanner processing is quick, accurate and will help save administrative time and expense.

Please use the following guidelines when completing these new forms:

  • Use blue or black ink;
  • Mark all check boxes with an X;
  • Print numbers clearly;
  • Stay inside the designated boxes;
  • The scanner cannot read information outside the boxes.  If you need to provide additional information, please attach a separate piece of paper.

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If all of the information on Form UCB-16 is correct and there are no eligibility issues or non-work payments that apply to the claim, the report does not have to be returned.

If any information on Form UCB-16 is incorrect or there is any eligibility issue or non-work payment that applies to the claim, provide detailed information regarding the eligibility issue or non-work payment and return this report by the due date.

1 & 2 Employer's UI Account Number

3 Date Last Worked and Expected Recall

4 Reason for Separation

5 Other Eligibility Issues

6 Vacation, Dismissal or Holiday Pay for Days/Weeks after the Last Day of Work

7 Signature, Date and Telephone Number

8 Date Report is Due

9 Where to Return the Report

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If all of the information on Form UCB-23 is correct and there are no eligibility issues that apply to the claim, the report does not have to be returned.

If any information on Form UCB-23 is incorrect or there is any eligibility issue that applies to the claim, provide detailed information regarding the eligibility issue and return this report by the due date. Refer to the following instructions for completion of a Form UCB-23 that must be returned.

1 & 2 UI Account Number, Name, & Address

3 Wages and Other Income for the Week

4 Hours and Minutes for the Week

5 Additional Work Available

6 Eligibility Issues

7 Signature, Date and Telephone Number

8 Date Due

9 Where to Return the Report

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Form UCB-719 must always be returned, even if the claimant did not work for you or you believe that the claimant is not eligible.

1 Due Date

2 UI Account Number

3 Quarterly Wage Chart

4 Claimant's First and Last Days of Work

5 Space for Messages

6 Signature, Date and Telephone Number

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See Section 4 Wage Reporting

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Form UCB-20 is used to notify claimants and employers of the results of a fact-finding investigation conducted to resolve issues of benefit eligibility and/or entitlement. See Part 7 for detailed information about common eligibility issues and the investigative procedure.

If you receive one of these determinations, you are considered the employer party of interest. The employer party of interest is the employer whose interests may be adversely affected by the decision.

Review the findings and effect of the decision. If you believe the facts are wrong or that the deputy has improperly applied the law, you may request a hearing. The request for a hearing (appeal) must be received or postmarked by the department by the date specified on the determination. See Section 3 for more information about the appeal process.

1 Claimant Name, Address and social Security Number

2 UI Account Number

3 Employer Name and Address

4 Issue Week and Week Ending

5 Applicable Wisconsin Law

6 Findings and Determination of the Deputy

7 Deputy

8 Date Mailed

9 Appeal Date

How and Where to File an Appeal

Information about filing an appeal is printed on the back of the determination. If you want to request a hearing, send your appeal to the UI hearings office listed there. The hearings office will process your appeal and can answer any questions you have about the hearing. Use this address and fax number for appeals only.

Who to Contact for More Information

If you would like more information about the determination or have other questions about the benefit claim, contact one of our benefit centers. The addresses, fax numbers and telephone numbers for our benefit centers are printed on the back of the determination. Do not send your request for a hearing to the benefit centers.

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This notice is sent to you whenever the claimant indicates that (s)he quit working for you and the subsequent work requalification requirement was satisfied before the application for unemployment benefits was made.

1 UI Office

2 UI Account Number

3 Employer Name and Address

4 Claimant's Name and Social Security Number

5 Week in which the Claimant Quit

6 Notice of Benefit Charging

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Form UCF-350 is used to obtain the employer's certification of gross wages earned. All wages reported must be gross wages, hours and minutes for each pay type. Wages includes all non-work payments (bonuses, tips, incentives, overtime, sick pay or any other supplements). Report each type of pay in its own column. While used as part of our fraud control initiatives, our requesting this information does not necessarily imply that the claimant failed to report work or wages properly.

1 The top section of the report includes the following claim information:

2 The letter includes:

3 Completing the Report:

5 Remarks:

6 Certification:

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Form UCB-701 lists employees who have established claims based on work with you.

The information entered on the front of the form is obtained from the wage data you submitted quarterly. If you did not file a quarterly report, either your Form UCB-719, Urgent Request for Wages, or the claimant's affidavit of earnings was used to determine the claimant’s potential entitlement.

1 UI Account Number

2 Report Period

3 Employee/SS Number

4 Liability Information

5 Quarterly Gross Wages

6 Eligibility Pending

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Form UCB-708 notifies employers of reduced liability when the resolution of a benefit year issue changes the claimant's remaining entitlement.

1 UI Account Number

2 Report Period

3 Employee's Name/Social Security Number

4 Liability Remaining

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Form UCF-17275 is used to audit the wages earned by certain claimants during a quarter in which they claimed and were paid UI benefits. It is used to prevent fraud and abuse by ensuring that the payments made to the claimant were proper.

Instructions for completing this report are identical to those for completing Form UCF-350 Weekly Earnings Report.

Updated: July 7, 2014