This power of attorney, when properly executed, will permit the attorney-in-fact to represent the employer before the Office of UC Benefits Policy and the Office of UC Service Centers in matters relative to UC benefits under the Pennsylvania UC Law, and to receive designated correspondence on behalf of the employer. This power of attorney will revoke and completely replace any prior power of attorney to the extent that the prior power of attorney designated an attorney-in-fact to act for the employer in UC benefit matters, to receive UC benefit documents, or both.
INSTRUCTIONS
Employer Name - Indicate the employer’s name as it appears on the Pennsylvania Enterprise Registration Form (Form PA-100).
PA UC Account Number - Indicate the employer's Pennsylvania UC account number. This seven-digit number will be reflected on the New Employer Confirmation Letter (Form UC-1408), Notice of Pennsylvania Unemployment Compensation Responsibilities (Form UC-851) and the Contribution Rate Notice (Form UC-657). If an account number has not been assigned, please register with the department by submitting a PA-100 at www.pa100.state.pa.us.
FEIN (Federal Employer Identification Number) - Indicate the employer's FEIN. The FEIN will be two digits followed by a dash followed by seven digits, i.e., 23-0000000. If an FEIN has not been assigned, please apply for one at IRS.gov.
Part A: Benefits Address Confirmation: This is the address where benefits-related correspondence will be mailed unless the employer appoints an attorney-in-fact to receive one or more categories of correspondence.
Part B: Power Of Attorney: You may name an attorney-in-fact to represent you in benefits-related matters and to receive one or more categories of benefits correspondence. If you appoint an attorney-in-fact you must authorize the attorney-in-fact to receive at least one category of correspondence.
Insert a check mark in the appropriate box(es) - A check mark in:
Box 1 - will cause Monthly Notices of Compensation Charged (Form UC-640) to be mailed to the attorney-in-fact.
Box 2 - will cause Notices of Financial Determination (Form UC-44F(3)), Requests for Relief from Charges (Form UC-44FR), and determinations on requests for relief from charges (Form UC-560) to be mailed to the attorney-in fact.
Box 3 - will cause Employer Notices of Application (Form UC-45), Requests for Separation & Wage Information (Form UC-45), fact-finding questionnaires and eligibility determinations other than the Form UC-44F(3) to be mailed to the attorney-in-fact.
Signature Requirements - This form must be dated and signed by an authorized representative of the employer and the attorney-in-fact. For a corporation, it must be signed by the president, vice president, secretary or treasurer. For a partnership, this form must be signed by a general partner authorized to bind the partnership. For a sole proprietorship, this form must be signed by the proprietor.
Return by fax or mail - The completed power of attorney form can be emailed to: addresschangepoa@pa.gov, faxed to 717-783-3734, or mailed to:
Office of UC Service Centers Attn: Employer Information Center 651 Boas Street, Room 525 Harrisburg, PA 17121-0750
Please be advised that the department cannot guarantee the security of personally identifiable information submitted via unsecured means such as: fax or unencrypted email systems.
UC Taxes
This form may be used only to appoint an attorney-in-fact for UC benefit matters. Do not use this form for UC tax purposes. To appoint a third party administrator (TPA) to represent the employer in UC tax matters or to designate a mailing address for UC tax correspondence, go to www.uctax.pa.gov.
Employers: Save Money by Providing Accurate Information to Employees Who May File for UC Benefits The Employer Information Form (Form UC-1609(P)) can help your company save money. Use it to provide accurate information to separating employees and employees working reduced hours who may apply for UC. This simple, effective measure can help to ensure that the department sends requests for separation information to the appropriate employer address, which can reduce inaccurate UC benefit charges to your account that can increase your UC tax rate. This form is available at www.uc.pa.gov; click "Forms," click "Miscellaneous."
Auxiliary aids and services are available upon request to individuals with disabilities.
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