Employer Protest of Benefit Charge
Please complete all fields below and complete the Refusal of Work Questionnaire if appropriate, then click "Submit". You will receive a confirmation number which you should retain for your records. All protests will be addressed in the order in which they are received.
Please do not submit duplicate requests for the same employee.
Company Name:
Employer Registration Number (ERN):
(ERN: (10 Digits. Ex: 0012345678))
Company Contact Person:
Contact Person's Title:
Telephone Number:
(Ex: 401-999-9999)
E-mail Address:
Employee's First Name:
Employee's Last Name:
Last 4 digits of employee's Social Security Number:
Reason For Protest:
Fraudulent Charges – employee never unemployed (ID Theft)
Voluntary Quit Without Good Cause
Reasonable Assurance
Refusal Of Work
Valid Termination For Cause
Monthly Charge Statement Month/Year Protested:
May 2022
April 2022
March 2022
February 2022
January 2022
December 2021
November 2021
October 2021
September 2021
August 2021
July 2021
June 2021
Employee's Last Day of Work:
Reason Description:
"I certify under penalties of perjury that I am an authorized representative of the employer and that the information provided in this request for reconsideration of charges is true and correct to the best of my knowledge."
Attention Internet Explorer 10 Users:
In order to fill out the UI2A form online, you must choose “compatibility view” before advancing through this page.
To choose “compatibility view,” click on the broken-paper icon next to the URL at the top of the page.
DLT Home
|
UI Home
|
Mass Filing
|
Rapid Response
|
Workshare
|
Contact Us