PART 9 - Benefit Reports and Forms Sent to Employers

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

Your help is needed to maintain the integrity of the Unemployment Insurance program. 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 three required unemployment benefit reports. In addition to the three 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.

Make your business name and address associated with your UI account number clear to your employees. Claimants select the employer(s) they worked for when they file for unemployment. Supplying your business name and address associated with your UI account to your employees helps ensure forms get to you in a timely manner and helps prevent erroneous payments.

Employers covered under Wisconsin Unemployment Insurance law are also required to file quarterly tax and wage reports as explained in Section 2 - Tax and Section 4 - Wage Reporting. These reports are used to determine the correct amount of base period wages paid to a claimant. Your account will be charged for any erroneously paid benefits that result from missing, late or incorrect/incomplete information on a Quarterly Wage Report.





SCANNING OF UI FORMS

Form UCB-16, Separation Notice, and Form UCB-23, Wage Verification/Eligibility Report, use automated scanner processing.

Please use the following guidelines when completing these 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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A. FORM UCB-16, SEPARATION NOTICE

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

  • Your UI account number should be printed here. If it is missing or incorrect, enter the correct number in the box provided.
  • If you do not have an account number, enter "no number assigned" in the box provided.
  • If the claimant did not work for you, place an "X" in the box provided.

3 Date Last Worked and Expected Recall

  • The date shown on the form is the Saturday date of the calendar week during which the claimant reported last working for you. If the correct last day of work falls in a different calendar week (Sunday through Saturday), please show the correct actual last day of work in the box provided.
  • The second paragraph will only appear if the claimant reported that (s)he expects to return to work for you by the Saturday week ending date printed on the form. If this is incorrect, place an "X" in the box provided.

4 Reason for Separation

  • The reason for separation provided by the claimant when (s)he filed this claim for benefits is shown here. If the reason shown is incorrect, indicate the correct reason for separation in the box provided. Provide detailed information regarding the separation. Attach a separate piece of paper for any supporting details and/or documentation and return by the due date. If you choose not to provide details regarding the separation, X the box on the bottom of the form and return it immediately.

5 Other Eligibility Issues

  • If there are any other eligibility questions that apply to the claim, report them in the box provided. Some common eligibility issues are listed on the reverse of Form UCB-16 under the explanation of this item. Also refer to Part 7 for a brief explanation of several common eligibility issues.
  • Provide details about the eligibility issue being reported in the box provided. Attach a separate piece of paper for any supporting documentation you want considered.

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

  • If vacation, dismissal or holiday pay has been assigned to days or weeks after the claimant's last day of work, this pay should be reported here. See Part 6 for more information about when these types of pay can be treated as wages and should be reported.
  • Show the type of pay, the week ending date(s) that the pay is assigned to, the gross amount of the pay and the hours and minutes for each week in the boxes provided.
  • When reporting holiday pay, show both the holiday and the date; i.e.
    Christmas - December 25
    Personal holiday - May 15

7 Signature, Date and Telephone Number

  • Sign and date the form.
  • Provide the name and telephone number (including area codes) of a person who can be contacted during regular business hours if additional information is needed.

8 Date Report is Due

  • Every Form UCB-16 will have a due date, however the report only needs to be returned if the reason for separation given by the claimant or any other information on the report is incorrect, or if there is any other eligibility issue or non-work payment that applies to the claim. Return the report as soon as possible to prevent erroneous payments. The report must be received by the department by the due date to be considered timely.

9 Where to Return the Report

  • If the report must be returned, please reply via one method only: online, fax, or mail:
    • To reply online, use https://dwd.wisconsin.gov/ui/sides. You must have a Wisconsin UI Account to reply online. Report hours and minutes of vacation, dismissal/severance, and holiday pay online in an electronic attachment or under Separation Comments. More information about replying online is available at https://dwd.wisconsin.gov/ui/sides.
    • To reply by fax, use the fax number shown on the report.
    • To reply by mail, send to the address shown on the report.

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B. FORM UCB-23, WAGE VERIFICATION/ELIGIBILITY REPORT

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.


EXAMPLE FORM: Example of UCB-23, Wage Verification/Eligibility Report

CAUTION: Any benefits improperly paid because you failed to question eligibility on Form UCB-23 in a timely manner will be charged to your account even if a later protest is raised on a form UCB-16 that is returned timely.


1 & 2 UI Account Number, Name, & Address

  • If the UI account number, name or address listed for your company is incorrect, write in the correct information in the box provided.
  • If no account number is printed on the report, enter your account number or write "no number assigned" in the box provided.
  • If the claimant did not work for you, place an "x" in the box provided.

3 Wages and Other Income for the Week

  • Review the wages and/or pay the claimant reported for the specified calendar week.
  • If any amount of wages or other income is incorrect, the form must be returned with the correct amount(s). You must return the report to correct the wages/pay even if the difference appears to be insignificant. Even a small difference between the wages reported by the claimant and the amount actually earned can affect the amount of benefits payable for the week.
  • Be sure to report all types of wages/pay for the week in the spaces provided, even for those that the claimant reported correctly. If one of the spaces is left blank, we will assume that the claimant did not receive the wage or income identified by that space.
  • See Part 6 for the definition of benefit year wages and when other types of income can be treated as benefit year wages.

4 Hours and Minutes for the Week

  • Review information reported by the claimant about hours/minutes for each pay type in the specified calendar week.
  • If the claimant’s information is incorrect, the form must be returned with the correct amount of hours and minutes You must return the report to give us the correct hours/minutes even if the difference appears to be insignificant.
  • Include only hours/minutes of actual work.

5 Additional Work Available

  • If the claimant was asked or scheduled to work more hours than (s)he did work place an "X" in the box provided.
  • If no, do not complete the rest of this section.
  • If yes, enter the number of additional hours available, the rate of pay that would have been paid for such work, the date(s) when the work was available and the total amount of additional wages the claimant could have earned in the boxes provided.

6 Eligibility Issues

  • Other Eligibility Issues: Place an "X" the appropriate box if any listed or unlisted eligibility issue applies to the claim and you have not yet received a determination regarding the issue:

    • Enter the last date the claimant worked for you in the box provided.
    • If the claimant refused an offer of work, also enter the date the work would have started.
    • For unlisted eligibility issues, place an "X" in the box that says "other" and provide details about the eligibility issue in the box provided. Attach a separate piece of paper for any supporting documentation you wish to be considered. (Refer to Part 7 for a brief explanation of several common eligibility issues.)

7 Signature, Date and Telephone Number

  • Sign and date the form.
  • Provide the name and telephone number (including area code) of a person who can be contacted during regular business hours if additional information is needed.

8 Date Due

  • Form UCB-23 must be received by the department by the due date shown on the report to be considered timely.

9 Where to Return the Report

  • If your report must be returned, either send it to the address or FAX it to the number shown on the report. Please do not do both.

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C. FORM UCB-719, URGENT REQUEST FOR WAGES

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



1 Due Date

  • This is the date your report is due. The same wage information requested by this report is also requested from the claimant. If your report is not received by the department by the due date, benefits will be paid based on the claimant’s records.

2 UI Account Number

  • This is the UI account number identified as the employer for whom the claimant worked and for which wages are missing. Refer to the instructions for completing the quarterly wage chart when the claimant’s wages were or should have been reported to a different UI account number.
  • If the wages you paid the claimant in the quarter were reported to a different UI Account # than the one shown on the report, write "wages reported to (correct UI Account #)".
  • If the claimant did not work for or with you in any capacity, check the box that says "Not Our Employee."

3 Quarterly Wage Verification and Eligibility Issues Chart

  • The quarters printed in the quarterly wage chart are the quarters that are included in the claimant’s base period.
  • For quarters where some wages have already been reported to Wisconsin for this UI account #, the wages have already been entered in the "Gross Wages Reported" column. If these amounts are incorrect, please show the correct amount in the "Correct Gross Wages" column.
  • For quarters where no wages have previously been reported, make the following entries:
    • Enter the total gross wages paid in each quarter in the Correct Gross Wages column.
    • If the claimant was your employee but was not paid wages in the quarter, enter "0.00" in the Correct Gross Wages column.
    • If the wages you paid the claimant in the quarter were reported to a different state, enter the wages and mark "X" in the box to the right in the "Reported to Another State" column. Provide any relevant details in Part 4: Explanation of Eligibility Issues.
    • If payments were made to the claimant but you considered him/her to be an independent contractor or self-employed, mark "X" in the box to the right in the "Independent Contractor" column. Provide any relevant details in Part 4: Explanation of Eligibility Issues.
    • If the wages you paid the claimant in the quarter were for work performed in excluded employment, enter the wages and mark "X" in the box to the right in the "Excluded Employment" column. Provide any relevant details in Part 4: Explanation of Eligibility Issues.
    • If you are a successor in a business transfer, do not duplicate wages already reported by your predecessor for this UI account #.
  • You must raise all eligibility issues that you were aware of as of the date this form was mailed to you.

4 Informational Messages

  • This space is used to give you any unique information or instructions that you may need to complete a particular Form UCB-719.
  • If you are a successor in a business transfer involving this UI account, a message will be printed in this area to remind you not to duplicate wages already reported for the claimant by your business predecessor.

5 Claimant's First and Last Days of Work

  • Enter the month/day/year of the claimant’s first day of work and last day of work for you in the base period.

6 Signature, Date and Telephone Number

  • Sign and date the form.
  • Provide the name and telephone number (including area code) of a person who can be contacted during regular business hours if additional information is needed.

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D. FORM UCB-20, DETERMINATION

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.

You can view determinations (UCB-20) online using SIDES E-Response. More information is available at https://dwd.wisconsin.gov/ui/sides.

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

  • The name and social security number of the claimant who is affected by the determination are shown here.
  • The determination is mailed to the most current address on file for the claimant.

2 UI Account Number

  • This is the employer UI Account number of the employer party of interest to the determination being made.
  • If the number is incorrect, call the Employer Assistance Line at (414) 438-7705 immediately so we can correct the record.

3 Employer Name and Address

  • The determination is mailed to the most current official name and address of record for the UI Account number listed.

4 Issue Week and Week Ending

  • The earliest UI calendar week affected by the determination is printed in this area. (Note: UI calendars have the UI week numbers printed next to each calendar week, see https://dwd.wisconsin.gov/uiben/calendars.htm.)
  • All UI weeks end on Saturday. This is the Saturday of the UI week number identified above.

5 Applicable Wisconsin Law

  • The statute of the unemployment law and/or administrative rule upon which the determination is based is printed here.

6 Findings and Determination of the Deputy

  • The legal conclusion reached by the department deputy is printed first.
  • A brief statement of the facts which support the legal conclusion follow.
  • The actual impact on the UI claim and the employer UI account is summarized under the "Effect".
  • The effect will indicate whether benefits are payable, or will ever be payable, from the UI account shown on the determination.
  • The effect also specifies periods of disqualification, whether erroneous benefits have been paid as a result of the determination and if so, who is at fault for the erroneous payments.

7 Deputy

  • The code number used to identify who investigated the issue and made the determination.

8 Date Mailed

  • The date the determination was delivered to the U.S. Post Office for delivery.

9 Appeal Date

  • The date by which a timely appeal must be postmarked if mailed or received if faxed or submitted online.

How and Where to File an Appeal

You can appeal benefit determinations online using SIDES E-Response. More information is available at https://dwd.wisconsin.gov/ui/sides.

Information about filing an appeal is printed on the back of the determination. If you want to request a hearing, use one of the following options:

  • To appeal online, use https://dwd.wisconsin.gov/ui/sides.
  • To appeal by fax, use the fax number listed on the determination.
  • To appeal by mail, send to the hearing office address listed on the determination.

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 our Help Center. The address, fax, and Employer Assistance Line number are printed on the back of the determination. Do not send your request for a hearing to the Help Center.

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E. FORM UCB-29, NOTICE OF BENEFIT CHARGING

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

  • The address of the Help Center handling the claim and the telephone number to call if you have questions about the notice.

2 UI Account Number

  • The account number of the employing unit identified as the employer from whom the claimant quit.

3 Employer Name and Address

  • The official name and address of record for the UI account number listed are printed directly below the number.

4 Claimant's Name and Social Security Number

  • The name and social security number of the claimant affected by the notice.

5 Week in which the Claimant Quit

  • The quit is assumed to have occurred during the week that includes the last day of work reported by the claimant. The week ending date that includes the claimant’s last day of work is printed here, along with the corresponding UI calendar week number. (Note: UI calendars have the UI week numbers printed next to each calendar week, see https://dwd.wisconsin.gov/uiben/calendars.htm.)
  • If the claimant quit in a different week, notify the department immediately.

6 Notice of Benefit Charging

  • This section informs you whether or not the UI Account identified will be liable for benefits based on work performed prior to the quit.
  • The accounts of "contributing or taxable" employers are not charged for such benefits.
  • "Reimbursable" employers, federal employers and out-of-state employers are billed for such benefits.

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F. FORM UCF-350, WEEKLY EARNINGS REPORT

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:

  • Address, phone number and fax number of the UI location requesting the information.
  • Official name and address of record of the employer for whom the claimant may have worked or is working.
  • Date report was mailed to you.
  • Name and social security number of the employee for whom wages are being verified.
  • The UI account number of the employer listed.

2 The letter includes:

  • Instructions for completing the report.
  • Date by which the department is requesting the completed report be returned.
  • Name of the department deputy sending the report.
  • Any special instructions or information that may help you complete the report.

3 & 4 Completing the Report:

  • Please complete the entire bottom portion of the form.
  • Provide all of the information requested in the top portion of the chart regarding the claimant’s current or former status with your company.
  • The beginning date (Sunday) and ending date (Saturday) of each calendar week for which wages are being verified, as well as the corresponding UI calendar week number, will be printed on the bottom portion of the chart. You are asked to report the gross earnings for each week listed and the date they were paid. You are asked to report gross earnings, hours and minutes for each week listed.
  • Be sure to include wages for all work performed in the week, as well as any other wages assigned to the week, such as vacation, holiday or dismissal pay.
  • If your company does not use a Sunday through Saturday calendar week payroll, you must adjust your figures to the calendar week dates shown.
  • Enter "NONE" in the space for each week in which there were no wages earned and/or for which no pay was assigned.

5 Remarks:

  • Enter any remarks in this space that you feel may be helpful.

6 Certification:

  • Be sure to sign and date the report and provide a telephone number where we can reach you during regular business hours if additional information or clarification is needed.

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G. FORM UCB-701, COMPUTATION OF UNEMPLOYMENT INSURANCE BENEFITS

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

  • This is the UI account that is potentially liable for unemployment payments based on the claims established during the report period.

2 Report Period

  • This is the time period that the report covers. All claims established during this period, for which the UI account listed on the report is potentially liable, are included on the report.

3 Employee/SS Number

  • The names and social security numbers for each claim established during the report period are printed in this column.

4 Liability Information

  • Total Maximum - This is the maximum amount of regular benefits potentially payable tot he employee, and it is the maximum amount that may be charged to your account.  In some situations, such as a voluntary quitting or a discharge for misconduct, these benefits may be charged to the balancing account or to the administrative account and not to your UI reserve account.  You will receive a written determination if these situations apply.
  • Weekly Maximum - The amount shown is the weekly maximum that could be charged to your account.  If the employee had other employers in the base period, the amount shown is your proportional share of each week paid.  The proportion potentially chargeable to you is based on the percentage of base period wages paid by you in relation to base period wages paid by all other employers.
  • Liable Until - The date the employee's benefit year ends is shown here. Benefits based on this computation cannot be carried over to a later benefit year.

5 Quarterly Gross Wages

  • The liability information in the prior column is based on the wages paid by you in the base period quarters of the claim. The gross wages paid by this UI account in each quarter of the employee's base period are shown.

6 Eligibility Pending

  • If there are eligibility issues yet to be resolved against your account, there will be an asterisk in this column. Actual payment of benefits will not be made until the investigations for such eligibility issues have been completed and you have been mailed written determinations (Form UCB-20) resolving the issues.

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H. FORM UCB-708, NOTICE OF CHANGED LIABILITY FOR UI BENEFITS

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

  • This is the UI account whose liability for listed claims has been changed by decisions issued during the report period.

2 Report Period

  • This is the time period that the report covers. All claimants whose entitlement from the listed UI account is changed by a decision issued during this period are included on the report.

3 Employee's Name/Social Security Number

  • The names and social security numbers of all claimants whose entitlement from the UI account shown was changed by a decision issued during the report period are printed in this column.

4 Liability Remaining

  • The first column lists the total potential entitlement remaining against the UI account number shown on the report before the decision was issued that changed the claimant’s entitlement
  • The second column shows the total potential entitlement remaining from the UI account shown on the report after the decision that changed the claimant’s entitlement was issued.

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I. FORM UCF-17275, WAGE/EARNINGS AUDIT

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.


  • Please reply via one method only: online, fax, or mail:

Updated: September 27, 2018