Shared Work Continued Claim Waiting Week Certification (SW 4.1) at a glance
What it is: Shared Work Continued Claim Waiting Week Certification of the New York State Department of Labor Unemployment Insurance Division.
Where and when to file: Return this form to your employer, who will complete Part B and send it to the Department of Labor for processing.
This form is used to claim Shared Work benefits during a week(s) in which your normal hours of work were reduced according to a Shared Work Plan agreed to by your employer.
A filled-in Shared Work Continued Claim Waiting Week Certification (SW 4.1) example: a Shared Work employee completes Part A
How to fill out Shared Work Continued Claim Waiting Week Certification (SW 4.1), box by box
Claimant name, SSN and Waiting Week
Claimant name (print): SSN. If your name has changed since you last certified, print your previous name. Part A - Employee Statement Waiting Week (Sunday Week Ending Date). Enter the date and answer the questions for the week claimed.
Be sure to show the Sunday week ending date(s) for the week(s) you wish to claim in the space provided at the top of the form.
New York Unemployment Insurance benefit weeks run from Monday through Sunday.
If your name has changed, print your correct name and your previous name in the space provided at the top of the form.
Complete Part A, “Employee Statement.”
Question 1: Did you work for anyone other than your Shared Work employer
Question 1: Did you work for anyone other than your Shared Work employer on any day in the week? (This includes self-employment.) If “Yes,” complete “a” through “c.” a. How many days did you work: 1, 2, 3 or 4 or more? b. Excluding earnings from self employment, did you earn more than $405 during the week? Yes No (checked November 12, 2026) c. Are you still working for this employer? Yes No If No, complete i through iii. i. What was your last day of work with this employer? ii. What is the reason you are no longer working for this employer? Quit, Discharged, Lack of Work or Labor Dispute. iii. Employer's name and address.
Claimant Certification, signature and address
Claimant Certification: By signing, you claim Shared Work benefits under the New York State Unemployment Insurance Law. You certify that the statements are true and complete, that you were partially unemployed, able to work, available for work with your Shared Work employer and that your loss of wages was due to no fault of yours. You have not claimed Unemployment Insurance benefits under any other State or Federal system for this period nor will you receive any other payment (i.e., Sub Pay) to compensate you for this period. The Law prescribes penalties for false statements. Signature. Date. Address (complete only if changed).
If you have changed your address, print your new address in the space provided under your signature. Be sure to include your zip code.
Part B 1. Percent reduced due to Shared Work
Part B - Instructions to Employer: The purpose of this form is to confirm the status of employees you have listed in your Shared Work Plan.
For the week claimed: 1. Enter the percent of hours and wages that were reduced due to Shared Work. (Note: Vacation, holiday and sick pay are considered “employment” for the purpose of calculating the percent reduction. See second page for details.)
The percent reduction is calculated by dividing the number of hours for which the employee was not paid due to work sharing by the number of hours normally worked in a week.
Shared Work benefits are not available for time that is paid for by the employer to the employee. That is, all time for which the employee receives compensation from the employer is considered “employment” for the purpose of calculating the percent reduction. This includes vacation, holiday and sick pay as well as payment for services performed.
Example: Employee's normal schedule is 40 hours a week, 8 hours a day. Employer is shut down on Friday due to Shared Work. a. Employee works Monday through Thursday: this is a 20% reduction. b. Employee works Monday through Wednesday, gets paid sick leave for Thursday, is off Friday due to shutdown: this is a 20% reduction. c. Employee works Monday through Thursday and gets holiday pay for Friday: this is a 0% reduction.
Part B 2. Did the employee leave the company
Did the employee leave the company? If “Yes,” please indicate the reason for separation and the employee's last day of work: Quit Discharged Lack of Work Labor Dispute Last day of work: ___/___/___
Part B 3. Did the employee refuse any work
Did the employee refuse any work made available to him/her during the hours he/she was scheduled off due to Shared Work? If “Yes,” number of days refused work: 1, 2, 3 or 4 or more.
Part B 4. Did you permanently shut down your company
Did you permanently shut down your company? If “Yes,” what was the date the company was permanently closed: ___/___/___
Employer certification and account no.
By signing, you certify that the information concerning the status of this company and the status/earnings of this employee for the purpose of participating in the Shared Work Program is true and correct to the best of your knowledge.
Employer account no. 98-, Employer name, Employer signature, Locator code (if any), Date and Employer telephone number.
More rules for Shared Work Continued Claim Waiting Week Certification (SW 4.1)
Give one form to each employee covered by your Shared Work Plan on the Monday following the latest Sunday week ending date on the form, or as soon as possible thereafter if the employee is not working on Monday. This will be the second Monday after the date your Shared Work Plan becomes effective and every other Monday thereafter.
If the employee completed Part A and wishes to claim the week, submit the form for review and determination even though you protest payment. Include a statement explaining why you protest the payment.
Review the completed form to be sure that it is correct. Any errors or omissions will cause a delay in payment of benefits.
If you have questions, contact the Shared Work Unit at (518) 485-6375.
Common questions about Shared Work Continued Claim Waiting Week Certification (SW 4.1)
Is there a deadline?
Part B - Instructions to Employer: Send it within seven (7) days of the latest week ending date shown on Part A.
Where do I file it?
After the employee completes Part A and returns the form to you, complete Part B, “Employer Statement,” and send it to: NYS Department of Labor, Unemployment Insurance Division, Attention - Shared Work, PO Box 621, Albany, N.Y. 12201-0621.
Sources
[1] Shared Work Continued Claim Waiting Week Certification, SW 4.1 (10/13), New York State Department of Labor (the Official source link on this page).