Penalty Assessment for Delinquency in Reporting Wage and Employment Information - Form E-40
To notify you that you have failed to submit information requested by the Division of Temporary Disability Insurance, and that you are liable for a penalty. (See Form)
This notice will be mailed to you if, within 10 days of any request for wage and/or separation information (for example, forms E-15 and/or E-20), you fail to return the requested information. This notice identifies the request form, shows the date it was mailed, and identify the claimant.
Use by Employer
The assessment becomes payable immediately unless you show, to the satisfaction of the Division, good cause for your failure to respond. The Division will determine if your reason constitutes good cause and will notify you accordingly.