Second Request for Employer Information - Form E-20
To notify you that you have failed to submit information requested by the Division. (See Form)
We use this information to determine if the claimant is potentially eligible for benefits.
Use by Employer
If we have not received required wage and separation information for temporary disability benefits in a timely manner, we send the employer Form E-20. The employer must complete both sides, then sign and return the form to us within 10 days of the date of mailing. Failure to do so subjects the employer to a penalty assessment of $20.00
To expedite your response, you may fax it to (609) 984-4405.