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

Sample Form

Form Summary

  1. Account No:
  2. Statement for Transactions Posted:
  3. Section A – Summary of Sections B and C, Benefit Charges and Benefit Adjustments
  4. Section B – Benefit Charges
  5. Section C – Adjustments to Benefit Claims

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

Form Sample UCT-14384-1-E, Page 1

Form Sample UCT-14384-1-E, Page 2