Penalty Waiver Request

Document Number: UCT-18687-1-E

Description: This form is used by employers who meet criteria to request a waiver on certain penalties assessed on an Unemployment Insurance account.

Comments: This form is available as a fillable PDF form. Please fill out all fields and click the submit button when you would like to submit the request to a collections specialist. Types of penalties:

• Non-filing penalty: A non-filing penalty is assessed when the detailed wage report is not received by the quarterly due date. The penalty is $100 or $20 per employee, whichever is greater.
• Late filing penalty: A late wage report penalty is assessed when the detailed wage report is received after the quarterly due date but filed within 30 days of the due date. The penalty is $50.
• Incorrect media - wage: An incorrect media penalty is assessed when the detailed wage report is submitted using a non-electronic medium to file the wage report. The penalty is $20 per employee for employers reporting, or who have reported, 25 or more employees.
• Contribution report incorrect media: A contribution report penalty is assessed when the detailed wage report is submitted using a non-electronic medium to file the contribution report. The penalty is $25 per report for employers reporting, or who have reported, 25 or more employees.
• Non-electronic payment: A non-electronic payment penalty is assessed when a payment is submitted using a non-electronic medium for employers with annual taxes due of $10,000 or more. The penalty is $50 or ½ of 1% of the total taxes due, whichever is greater.

Content Contact: Collection Specialist or (608) 266-9700

Document Attachment: UCT-18687-1-E (Electronic Version - pdf/134 KB)

NOTE: When using Google Chrome, you may notice overlapping text when you select file, print. Deselect the 'fit to page' option and the text will no longer overlap.

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.