Example of UCT-14384-1-E, Benefit Charges and Adjustments

Sample Form

Form Summary

1. Account No:
   • This is the reimbursable employer UI account that all benefit charges and adjustments were debited or credited during the period.
     
     
2. Statement for Transactions Posted:
   • This is the time period that the activity in your account covers.
     
     
3. Section A – Summary of Sections B and C, Benefit Charges and Benefit Adjustments
   • Total Section B Benefit Charges: This represents the total of all benefits charged to your account during the time period specified above for the individuals and amounts listed in Section B below.
   • Total Section C Net Benefit Adjustment: This represents the net of the amounts debited and/or credited to your account during the time period specified above for the individual benefit adjustments listed in Section C below.
   • Net Charge (Credit): This is the total of Section B benefit charges plus or minus the total of Section C net benefit adjustment. This amount represents the net charge or credit to the account for the time period indicated above.
     
     
4. Section B – Benefit Charges
   • This section lists all benefits charged to your account and may include payments made to more than one claimant. Individual claimants are listed separately
   • Week No.: The actual calendar week for which payments have been made. Payments for more than one week for a claimant may have been made during the report period. Each week is listed separately. A claimant’s payment for a given week may have a number of deductions for various reasons such as federal and state withholding, child support, and benefits withheld to repay a prior overpayment of benefits. Each distribution is listed separately on the report but the total of the distributions for a given week should never exceed your weekly liability for the claim.
   • Week ending: The last day of the indicated Week No.
   • Code: This code references an explanation of the charge listed in the legend that follows the table of benefit charges.
   • Amount Charges: This is the amount of benefits charged to your account for the indicated week and employee listed.
   • Wages Reported: These are the wages earned by the employee from all employers in the week listed. The claimant may or may not have earned any wages from you in the week listed.
   • Employee Name: Last and first name of the employee whose benefits have been charged to your account for the week listed.
   • SSN: Social security number for the employee listed.
     
     
5. Section C – Adjustments to Benefit Claims
   • This section lists all adjusting benefit entries make to your account including both credits and charges. Any action taken on a benefit claim that changes the employer’s liability for a particular payment will result in an adjustment to an employer’s account and will be listed in this section. Some examples include:
     1. Amendments made to a claim that affect the proration of liability charges to employers in the claim (even charges that are unrelated to the claimant’s work and wages from a given employer can affect the employer’s prorated share of the liability charges).
     2. Repayments made by a claimant whose benefits were previously charged to your account but were subsequently determined to be overpaid.
     3. Section C can also include quarterly charges from other states. These charges represent the employer’s share of liability for claims filed in other states which combined wages from more than one state to establish the claimant’s benefit eligibility.
   • Employee Name: Last and first name of the employee whose benefits have been adjusted and either charged or credited to your account.
   • SSN: Social Security number for the employee listed.
   • Week Number: The calendar week for which the original payment that is being adjusted had been made. In many cases there is no specific week listed.
   • Reason: The reason for the adjustment which is described more fully following the table of adjustments.
   • Amount Charged or (Credited): This is the amount that has been charged or credited to your account as a result of the adjustment.

Claimants Who are Still Working for You

If a claimant works for you in any week for which (s)he is paid unemployment benefits, you will initially be charged for your share of the payment in Section B. However, if the employee earned gross wages during that week which are equal to or greater than the average weekly wage paid to the claimant in the same calendar quarter of the previous year, your account will automatically receive a credit for the charge in Section C. The credit may or may not appear on the same report as the charge. Please see “Situations When Liable Employers are Relieved of Charges” in “Part 4 – Calculating your Liability for a Benefit Claim” of the Benefits Section for more detail on how the average weekly wage amount is determined.

Claimants Who Have Quit

Reimbursable employers are usually charged for benefits paid to claimants who have quit if the wages from the reimbursable employer are in the claimant’s base period.

Sample Form