Use
A claimant who worked in more than one state may combine his/her employment and wages under the Combined Wage program. The state responsible for processing the claim (the "paying state") requests wage information from the other state(s) where the claimant was employed.

This form will be mailed to you to complete only if the base year of the paying state is different from New Jersey's base year, or if we have no record of quarterly wage information for the named claimant on a properly completed Form WR-30, "Employer Report of Wages Paid."

Use by Employer
The form will identify the claimant by name and Social Security number, will show the mailing date and will specify the period of time for which wage information is needed. You are required by law to complete the form and return it within 10 days of the mailing date to the address shown in the lower left corner of the form.

Item 11 requests wage data for the base period of the paying state and should always be completed.

Item 12 refers to the New Jersey base period and should be completed only if requested (it is requested only if there is no record of wage information from you for the named individual).