Unemployment Cost Contol Information Request

UNEMPLOYMENT COST CONTROL INFORMATION REQUEST

*Name:
Title:
Organization:
Address 1:
Address 2:
City:
State:		Zip:
Phone:		Fax:
*E-mail:
How many people do you currently employ?
How many W-2's did you issue this past year?
In which state is your primary office located?
What is your U.I. Tax rate in that state for the current year?
In what other states are you located?
Please fill in the following data taken from your Annual State Unemployment Insurance Notice:
Total Tax Payments made in previous fiscal year?
Total Benefits Paid in previous year?
Total Taxable Payroll for		years is?
Comments:
Fields Marked with * are Required