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Skip Navigation LinksSIDES Standardized Exchange Formats

  
  
  
  
  
  
State UI Agency Separation Information Request FormatState UI Agency Separation Information Request Format3/8/2016 2:29 PMState UI Agency Separation Information Request Format12/20/2014Separation Information Exchange
Employer or TPA Separation Information Request FormatEmployer or TPA Separation Information Request Format3/8/2016 2:36 PMEmployer or TPA Separation Information Request Format12/20/2014Separation Information Exchange
State UI Agency Earnings Verification Request Format - Note: Print outs are 8.5" x 14" (legal size) State UI Agency Earnings Verification Request Format - Note: Print outs are 8.5" x 14" (legal size) 3/8/2016 3:23 PMState UI Agency Earnings Verification Request Format - Note: Print outs are 8.5 x 14 (legal size) 1/21/2015Earnings Verification Exchange
Employer or TPA Earnings Verification Response Format - Note: Print outs are 8.5" x 14" (legal size)Employer or TPA Earnings Verification Response Format3/8/2016 3:23 PMEmployer or TPA Earnings Verification Response Format - Note: Print outs are 8.5 x 14 (legal size)1/21/2015Earnings Verification Exchange
State UI Agency Monetary and Potential Charges Request Format - Note: Print outs are 8.5" x 14" (legal size)State UI Agency Monetary and Potential Charges Request Format3/8/2016 3:23 PMState UI Agency Monetary and Potential Charges Request Format - Note: Print outs are 8.5 x 14 (legal size)6/12/2013Monetary and Potential Charges
Employer or TPA Monetary and Potential Charges Response Format - Note: Print outs are 8.5" x 14" (legal size)Employer or TPA Monetary and Potential Charges Response Format3/8/2016 3:23 PMEmployer or TPA Monetary and Potential Charges Response Format - Note: Print outs are 8.5 x 14 (legal size)6/12/2013Monetary and Potential Charges
State UI Agency Determination and Decision Request Format - Note: Print outs are 8.5" x 14" (legal size)State UI Agency Determination and Decision Request Format3/8/2016 3:24 PMState UI Agency Determination and Decision Request Format - Note: Print outs are 8.5 x 14 (legal size)9/29/2014Determination and Decision
Employer or TPA Determination and Decision Response Format - Note: Print outs are 8.5" x 14" (legal size)Employer or TPA Determination and Decision Response Format3/8/2016 3:24 PMEmployer or TPA Determination and Decision Response Format - Note: Print outs are 8.5 x 14 (legal size)9/29/2014Determination and Decision
Benefit Charge Back to Employer (Draft) Benefit Charge Back to Employer (Draft) 3/8/2016 2:54 PMBenefit Charge Back to Employer (Draft) 6/9/2009Benefit Charge Back to Employer

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