Request For Employer Information - Form E-10
To secure from the employer, wage and separation information previously supplied on the DS-1, but incomplete or in need of further clarification. (See Form)
We use this information to determine if the claimant is potentially eligible for benefits.
Use by Employer
If additional wage and separation information is not provided on a claim for temporary disability benefits, the Division sends the employer Form E-10, which must be completed and returned to the Division within 10 days of the date of mailing.