Example of UCT-14384-E, Reserve Fund Balance Statement Form

Sample Form

Form Summary

1. Account No:
   • This is the UI account that all reserve fund balance activity was charged or credited to during the period.
     
     
2. Statement for Transactions Posted:
   • This is the time period that the activity in your account covers.
     
     
3. Section A – Activity Affecting Your Reserve Fund Balance (RFB)
   • Reserve Fund Balance at start of period: This represents the balance in your account at the beginning of the time period specified above. If the amount is shown with brackets (xxxx.xx), the balance is negative and means that benefit payments and/or benefit adjustments charged to your account have exceeded the basic portion of tax payments, voluntary contributions, and other adjustments credited to your account.
   • Total benefit charges (see Section B): 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.
   • Net benefit adjustment (see Section C): 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.
   • Various activities as labeled: These will be listed individually and represent amounts debited or credited to your account during the time period specified above for transactions such as tax payments, adjustments, voluntary contributions, etc.
   • Reserve Fund Balance at end of period. This represents the balance in your account at the end of the time period specified above. This is derived by taking the balance at the beginning of the period, subtracting the total benefits charged to your account, adding or subtracting the net benefit adjustments, and adding or subtracting the various other activities listed separately.
   
   
4. Section B – Benefit Charges to Reserve Fund
   • 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 Charged: 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 made 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 changes 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. A determination that benefits have been overpaid.
   3. A determination that benefits have been paid erroneously because an employer failed to raise a timely eligibility question or provided incorrect or incomplete information on a required report.
   4. 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 of how the average weekly wage amount is determined.

Claimants Who Have Quit

Payments made to a claimant who quit working for you will not appear on this report if you have been notified that your account will not be charged for benefits based on work performed prior to the quit.

Sample Form