Form Tc 403 Ha PDF Details

Understanding the intricacies of unemployment benefits can often feel overwhelming, especially when you realize your initial monetary benefit determination may not fully reflect your earnings. This is where the TC 403 Ha form, provided by the New York State Department of Labor, plays a crucial role. It is designed for individuals who believe their wages have been underreported or omitted from their unemployment insurance claim, offering a lifeline to adjust their weekly benefits accurately. The form allows the applicant to request the use of an Alternate Base Period, potentially increasing their benefit rate by including wages from a different time frame than the initial calculation. This option, however, comes with the stipulation that once these wages are used to establish a claim, they cannot be leveraged for future claims. The form requires careful completion and submission within a strict ten-day window from the date the Monetary Benefit Determination was mailed, highlighting the importance of attentiveness and accuracy in the process. Applicants are encouraged to provide comprehensive proof of employment and wages, such as pay stubs and W-2s, ensuring all documentation is legible and complete. As individuals navigate through this process, understanding the parameters and requirements set forth in the TC 403 Ha form not only empowers them to potentially increase their weekly unemployment benefits but also underscores the importance of detailed record-keeping and prompt action in the realm of unemployment insurance claims.

QuestionAnswer
Form NameForm Tc 403 Ha
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesunemployment alternate period, unemployment request alternate period, request alternate period, request alternate base period form

Form Preview Example

Department of Labor

PO Box 15130

Albany, New York 12212-5130

www.labor.ny.gov

UnemploymentInsurance Request for Alternate Base Period

IMPORTANT!

We sent you a Monetary Benefit Determinations showing the weekly benefits you will receive. Those benefits are based on your wages. If you believe some of your wages were missed, please complete this form. This form must be received by us within 10 calendar days of the Date Mailed as stated on your most recent Monetary Benefit Determination notice. Please print clearly. If we cannot read your writing, we cannot process this form.

Please print

Last Name:______________________________ First Name:___________________ Middle Initial: ______

clearly

 

 

Address:______________________________________________________________________________

 

City:_________________________________________ State: ___________ Zip Code:________________

 

Claim Effective/Start Date: ____/____/____ Social Security #: XXX – XX - __ __ __ __

 

 

Form

If you wish to use the Alternate Base Period to increase your weekly benefit rate:

requirements

• Complete the steps below using black or blue ink.

•Include any documentation that could be considered proof of employment and wages such as pay stubs, W-2s, 1099s, vouchers, checks, tips, bonuses, meals, lodging, commissions, vacation pay and records of employment and/or payment.

•Photocopy all supporting documentation onto 8½ x 11 single-sided paper. Do not send originals.

•Write your name, the last four digits of you Social Security number and your phone number on each attachment.

•This completed form and all attachments must be received by the Response Due Date noted above. Please print clearly. If you do not, we cannot process this form.

If the wages in your last completed calendar quarter exceed the "High Quarter Wages" on your Monetary Benefit Determination, use of the Alternate Base Period may increase your benefit rate. If you choose the Alternate Base Period to establish a claim, you will not be able to use these wages for a future claim.

Step 1

Last Calendar

Quarter

Information

The last completed calendar quarter prior to your claim effective/start date is: ____/___/____ through ____/___/____

Month/Day/Year Month/Day/Year

Refer to your Monetary Benefit Determination for calendar quarter dates and compare the Alternate Base Period Quarter wages with your records, then check the appropriate box below and proceed to the "Step" indicated.

The Alternate Base Period Quarter Wages are incorrect or missing. (Proceed to Step 2)

The Alternate Base Period Quarter Wages are correct. (Proceed to Step 3)

Step 2

Wage

Information

Complete the information below, include proof of wages and attach an additional page if you have information for more than (3) three employers.

Employer Name:_________________________________Quarterly Gross Wages $_________________

Employer Address: ____________________________________________________________________

City:_________________________________State:_____________Zip:_____

If work was performed outside New

York State, indicate state _______

 

 

Employer Name:_________________________________Quarterly Gross Wages $_________________

Employer Address: ____________________________________________________________________

City:__________________________________State:____________Zip:_____

If work was performed outside New

York State, indicate state _______

 

 

Employer Name:_________________________________Quarterly Gross Wages $__________________

Employer Address: ____________________________________________________________________

City:__________________________________State:____________Zip:_____

If work was performed outside New

York State, indicate state _______

 

 

Step 3

Acknowledgement

I certify that the above information is true to the best of my knowledge and I am aware that there are penalties for making false statements. I understand if I use the Alternate Base Period, these wages cannot be used for a future claim.

______________________________________________

______________ ________ - _______ - _____________

Signature Required

Date

Area Code

Telephone Number

Step 4

Return

Instructions

This notice and all attachments must be received within the time frame noted above in the IMPORTANT! message.

FAX: (518) 457-9378

OR

MAIL: New York State

OR

ONLINE: www.labor.ny.gov/signin

This notice is your cover page.

Department of Labor

 

Submit via online account messaging

Indicate total # of pages_____

PO Box 15130

 

system. Select “Submit Documents” and

 

 

Albany, New York 12212-5130

then “Submit Wage Documents”. Use

subject line “Wage Documentation”.

Claim weekly benefits at www.labor.ny.gov

For more information visit:

or call Tel-Service at (888) 581-5812.

www.labor.ny.gov

 

For help, see the claimant handbook at

www.labor.ny.gov/uihandbook.

TC 403 HA (09/20)

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1. To begin with, while filling in the alternate base period form, start with the form section that includes the subsequent fields:

Stage number 1 in filling out request alternate base period form

2. When this part is finished, you'll want to put in the required particulars in Step Wage Information, The last completed calendar, Employer NameQuarterly Gross Wages, Employer Address, CityStateZip, If work was performed outside New, Employer NameQuarterly Gross Wages, Employer Address, CityStateZip, If work was performed outside New, Employer NameQuarterly Gross Wages, Employer Address, CityStateZip, If work was performed outside New, and Step Acknowledgement allowing you to move forward further.

Find out how to complete request alternate base period form part 2

It is easy to make an error when filling in your Employer Address, hence make sure that you look again before you'll submit it.

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