Form UIA 1718 at a glance
What it is: The Claimant's Statement of Wages is a form of the State of Michigan Unemployment Insurance Agency.
Who signs: Sign on the Signature line and enter the Date.
What to bring and attach to Form UIA 1718
Send clear, legible proof of wages to support the information you provide on this form; this can include check stubs, W-2s, payroll records, or a letter from the employer with payroll information.
Proof of wages must be included in the order for the Unemployment Insurance Agency to use the information you are providing.
A filled-in Form UIA 1718 example: a claimant disputes an employer's reported wages
How to fill out Form UIA 1718, box by box
Check the reason you are completing this form
Check Wages earned with, and write the Name of Employer, if wages earned with that employer that you included on your claim for unemployment benefits were not included in the calculation of your Monetary Determination.
Check I disagree with the wages reported by, and write the Name of Employer, if you disagree with the wages reported by that employer as shown on your Monetary Determination.
Check I never worked for or was not paid by, and write the Name of Employer, as shown on your Monetary Determination and to request the reported wages not be used; then complete Section E only.
First and Last name and Social Security Number
Enter your First and Last name and your Social Security Number.
Section B - Employer Information
In Section B, enter the Name of Company or Business and the Owner/Employer Name.
Enter the employer's Telephone Number, UIA Employer Account Number and Federal Employer Identification Number (FEIN).
Enter the Address, City, State and Zip Code.
Section C - Employment Information
In Section C, enter the physical location of your employment.
Enter the type of work you performed or your job title.
How were you paid, other employees and the employer still operating
Under How were you paid?, check Cash, Check, Direct deposit or Other, and for Other explain.
Under Was there other remuneration (e.g. bonuses, commissions, 401K, room and board, etc.) in your wages?, check No or Yes, and for Yes explain.
Under Were deductions made from your pay (e.g. FICA, income taxes, etc.) in your wages?, check No or Yes.
Enter the Total gross wages during current calendar year and during preceding calendar year, and check actual or estimated for each.
Under Were there other employees?, check No or Yes, and for Yes enter how many.
Under Is the employer still operating?, check No or Yes.
Add Additional comments if you have any.
Section D - Quarterly Wage Information
In Section D, report the quarterly gross wages (before taxes) on the chart.
There are four calendar quarters per year, numbered the same from year to year: 1st Quarter January 1 through March 31, 2nd Quarter April 1 through June 30, 3rd Quarter July 1 through September 30 and 4th Quarter October 1 through December 31.
Use the same quarters that are shown on your Monetary Determination under the heading Monetary Determination Calculations, and label the chart with the same quarter dates.
If you are completing this form because wages earned with an employer that you included on your claim were not used in the calculation of your Monetary Determination, complete all quarters that contained wages from that employer.
If you are completing this form because you disagree with the wages reported by your employer, complete only the quarters that you disagree with.
The quarterly charts allow you to enter wage information per week to help you determine your quarterly total wages; if you know your gross wages for each quarter, complete only the Total Quarterly Wage box for each involved quarter.
Wages are reported in the quarter they are paid to you: wages for work in the last week of March (1st quarter) that were not paid until April (2nd quarter) must be reported in the 2nd quarter, the quarter containing the date you were PAID.
Section E - Certification Statement
Section E, Certification Statement: by signing you certify that the information you have reported is true and correct.
If you intentionally make a false statement, misrepresent facts or conceal material information, you may be required to pay damages and could be subject to criminal prosecution.
Sign on the Signature line and enter the Date.
More rules for Form UIA 1718
Employers are required to report quarterly wages for each employee to the Unemployment Insurance Agency (UIA), and a claim for unemployment benefits is based on these reported wages; the Monetary Determination you were sent showed the wages reported by your employers and/or informed you that an employer(s) did not report wages for you.
If your address changes, it is important to update it with the Unemployment Insurance Agency.
Common questions about Form UIA 1718
Where do I file it?
Form UIA 1718, Claimant's Statement of Wages, must be completed by you if either you disagree with the wages reported by an employer or an employer did not report wages for you at all. Carefully read and follow the directions to complete this form. Mail to the Unemployment Insurance Agency, P.O. Box 169, Grand Rapids, MI 49501-0169 or Fax at 1-517-636-0427.
Where to get help with Form UIA 1718
For telephone or Local Office hours of operation, visit www.michigan.gov/uia.
TTY service is available at 1-866-366-0004.
Sources
[1] Form UIA 1718 (Rev. 09-21), Claimant's Statement of Wages, Michigan Unemployment Insurance Agency (the Official source link on this page).
