Employer Protest of Benefit Charge
Please complete all fields below and 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 claimant.
Employer Registration Number (ERN):
(ERN: (10 Digits. Ex: 0012345678))
Company Contact Person:
Contact Person's Title:
Claimant's First Name:
Claimant's Last Name:
Last 4 digits of claimant's Social Security Number:
Claimant's Last Day of Work:
Reason For Protest:
"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."
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