Forms & Publications for Claimants and Employers
Claimant Forms
PR-94, Unemployment Insurance: Your Rights and Responsibilities: This booklet contains information about eligibility for unemployment insurance benefits, instructions on how to claim benefits and information telephone numbers.
PR-94S, Seguro por Desempleo: Sus Derechos y Responsabilidades: Este folleto contiene información sobre su elegibilidad para beneficios bajo el seguro por desempleo, instrucciones en como reclamar sus beneficios y números de teléfonos par información.
Work Search Log: This form is used by claimants to keep a record of where they looked for work.
Request for Change in Withholding Status: This form is used to have Federal Income Tax (FIT) withheld from benefits or to stop the withholding of taxes from unemployment insurance benefits.
Notification of Address Change: This form is used to notify the Division of Unemployment Insurance of an address change after you stop collecting unemployment insurance benefits. This ensures receipt of any adjustment checks, determinations, tax statements (1099-G), and informational notices. The Division needs your correct mailing address for two years from the date of your unemployment claim. Do not use this form to report an address change while you are collecting unemployment insurance benefits.
BC-181, Application for Dependency Benefits: This form is used to claim Dependency Benefits. If your weekly benefit rate is less than the maximum amount, you may qualify to receive these additional benefits. You must provide proof of dependency within six (6) weeks of the date of your unemployment insurance claim. If your spouse or civil union partner is employed during the week you establish your claim, you cannot receive dependency benefits. If you and your spouse or civil union partner are both unemployed, only one may claim dependency benefits.
BPC-111, Agreement for Monthly Installment Payments: This form is used to enter into an agreement to make monthly installment payments towards an outstanding benefit overpayment.
NJES-930-TRA, You Could Be Receiving...Ask About Trade Adjustment Assistance: Trade Adjustment Assistance (TAA) is available to workers who lose their jobs or whose hours of work and wages are reduced as a result of increased foreign imports. TAA benefits may include training, testing, counseling, a job search allowance, and a relocation allowance. This form is used to request the U.S. Department of Labor to determine if your employer should be certified for the TAA programs.
Claim Record: You must claim your benefits as instructed and remain current with your requests for benefit payments. It is advisable to keep a record of your certifications as you will not receive notification informing you when to certify for benefits. This Claim Record will assist you in documenting your bi-weekly certifications.
Employer Forms
BC-6, Notice of Failure to Apply For, or to Accept, Suitable Work: This Form is used to notify the Division of Unemployment Insurance that an employee who filed a claim for unemployment insurance, failed to return to work when notified to do so by the employer. Failure to return to work, or accept an offer of suitable work may be a cause for disqualification of benefits.
BC-10, Instructions for Claiming Unemployment Benefits: Employers are required to provide this form to each employee at the time of separation.
PR-1, Poster-Unemployment & Disability Insurance: Employers are required to display this notice in a conspicuous place at the workplace.
PR-1B, Poster-Unemployment Insurance: Employers are required to display this notice in a conspicuous place at the workplace.
PR-1S, Cartel-Sequro por Desempleo e Incapacidad: Patrones son requeridos a exhibir este cartel en un sitio visible en el lugar de trabajo.
PR-2, Poster-Family Leave Insurance (FLI): Employers are required to display this notice in a conspicuous place at the workplace.
Employer Poster Packet - For additional material distributed in the Employer Poster Packet.
PR-94, Unemployment Insurance: Your Rights and Responsibilities: This booklet contains information about eligibility for unemployment insurance benefits, instructions on how to claim benefits and information telephone numbers.
PR-94S, Seguro por Desempleo: Sus Derechos y Responsabilidades: Este folleto contiene información sobre su elegibilidad para beneficios bajo el seguro por desempleo, instrucciones en como reclamar sus beneficios y números de teléfonos par información.
Work Search Log: This form is used by claimants to keep a record of where they looked for work.
Request for Change in Withholding Status: This form is used to have Federal Income Tax (FIT) withheld from benefits or to stop the withholding of taxes from unemployment insurance benefits.
Notification of Address Change: This form is used to notify the Division of Unemployment Insurance of an address change after you stop collecting unemployment insurance benefits. This ensures receipt of any adjustment checks, determinations, tax statements (1099-G), and informational notices. The Division needs your correct mailing address for two years from the date of your unemployment claim. Do not use this form to report an address change while you are collecting unemployment insurance benefits.
BC-181, Application for Dependency Benefits: This form is used to claim Dependency Benefits. If your weekly benefit rate is less than the maximum amount, you may qualify to receive these additional benefits. You must provide proof of dependency within six (6) weeks of the date of your unemployment insurance claim. If your spouse or civil union partner is employed during the week you establish your claim, you cannot receive dependency benefits. If you and your spouse or civil union partner are both unemployed, only one may claim dependency benefits.
BPC-111, Agreement for Monthly Installment Payments: This form is used to enter into an agreement to make monthly installment payments towards an outstanding benefit overpayment.
NJES-930-TRA, You Could Be Receiving...Ask About Trade Adjustment Assistance: Trade Adjustment Assistance (TAA) is available to workers who lose their jobs or whose hours of work and wages are reduced as a result of increased foreign imports. TAA benefits may include training, testing, counseling, a job search allowance, and a relocation allowance. This form is used to request the U.S. Department of Labor to determine if your employer should be certified for the TAA programs.
Claim Record: You must claim your benefits as instructed and remain current with your requests for benefit payments. It is advisable to keep a record of your certifications as you will not receive notification informing you when to certify for benefits. This Claim Record will assist you in documenting your bi-weekly certifications.
Employer Forms
BC-6, Notice of Failure to Apply For, or to Accept, Suitable Work: This Form is used to notify the Division of Unemployment Insurance that an employee who filed a claim for unemployment insurance, failed to return to work when notified to do so by the employer. Failure to return to work, or accept an offer of suitable work may be a cause for disqualification of benefits.
BC-10, Instructions for Claiming Unemployment Benefits: Employers are required to provide this form to each employee at the time of separation.
PR-1, Poster-Unemployment & Disability Insurance: Employers are required to display this notice in a conspicuous place at the workplace.
PR-1B, Poster-Unemployment Insurance: Employers are required to display this notice in a conspicuous place at the workplace.
PR-1S, Cartel-Sequro por Desempleo e Incapacidad: Patrones son requeridos a exhibir este cartel en un sitio visible en el lugar de trabajo.
PR-2, Poster-Family Leave Insurance (FLI): Employers are required to display this notice in a conspicuous place at the workplace.
Employer Poster Packet - For additional material distributed in the Employer Poster Packet.
