Unemployment Commission Form PDF Details

At the heart of managing unemployment insurance benefits claims lies the intricate process facilitated by the Unemployment Commission Form, specifically designed by the NC Department of Commerce – Division of Employment Security. This form serves as a critical link between former employers and the Division, requesting detailed separation information following a claim filed by an individual for unemployment benefits. The form emphasizes the importance of a punctual, readable, and comprehensive reply from employers, outlining that failure to respond adequately or attend any appeals hearing may lead to an increased tax rate for the employer. Additionally, it provides options to respond via mail or fax, discouraging the return of the paper form if the fax option is chosen and suggesting the provision of an email or fax number for any further correspondence. This form intricately categorizes reasons for the employee's unemployment and seeks specific details such as the effective date of the claim, social security number, first and last day worked, and types of payment the claimant received, among others. For temporary employment services employers, it specifies how to report on claimants who are not separated but for whom no suitable work assignments are available. Furthermore, it guides through the process of reporting if a claimant has quit or was discharged, necessitating detailed documentation of reasons, prior notifications, and any policy violations. The careful completion of this form plays a pivotal role in determining the eligibility of individuals for unemployment benefits, guarding against undue charges on the employer’s account and ensuring the integrity of the unemployment insurance system.

QuestionAnswer
Form NameUnemployment Commission Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesnc clm 500ab, ncu1500ab form, form ncui 551l, nc clm 500 ab

Form Preview Example

NC DEPT. OF COMMERCE – DIVISION OF EMPLOYMENT SECURITY

REQUEST FOR SEPARATION INFORMATION FROM EMPLOYER

The individual named below filed a claim for unemployment insurance benefits and listed you as the last employer. Your reply will be considered when determining the individual’s eligibility if it is received by the due date. Failure to provide a timely, legible and detailed response or failure to attend any appeals hearing related to this claim may result in an increase in your tax rate. You may respond by mail or by fax. If your reply is submitted by fax, please do not return the paper form. Please provide an email address or fax number in case additional information is needed. If the individual is unemployed due to “lack of work” or “inability to perform available work,” the separation will not be examined and your account will be subject to charges for any benefits paid to the claimant.

Return To:

Division of Employment Security

 

 

 

Fax Number: (919) 733-1371

 

 

 

 

Tel Number : (888) 737-0259

 

1.

Date Mailed

2. Response Due Date

3. If the claimant is filing an initial claim and you are also a base

 

 

 

period employer, you will receive, under separate mailing, Form

 

 

 

NCUI 551L Notice of Unemployment Claim, Wages Reported, and

 

 

 

Potential Charges.

 

4.

Claimant Name

 

5. Effective Date of Claim

6. Social Security Number

 

 

 

7. If the claimant did not work for you, check this box.

EAN:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8. Reason why claimant is no

9. If still employed, please check one of the following boxes. Enter the number of hours

longer working:

worked if applicable.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please check only one box

 

This claimant was hired full-time (

 

 

) hours and now working reduced (

 

 

) hours.

Temporary Agency (go to Item 14)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This claimant has not separated but was hired part-time and continues to work part-time.

Quit (complete Item 15)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. First Day Worked

 

 

 

11. Last Day Worked (i.e., last

 

12. Rate of Pay

 

 

 

 

 

Discharge (complete Item 16)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

day physically worked)

 

 

 

 

 

 

 

 

 

 

 

 

Inability to perform the work

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lack of Work/Laid Off

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

per

 

______

 

Other (complete Item 17)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

M

D

D

Y

Y

Y

Y

M

M

D

 

D

Y

 

Y

Y

Y

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13. Did claimant receive:

 

 

 

 

 

 

 

 

 

Gross Amount

 

Date Paid

 

 

 

Number of

 

 

 

 

 

 

 

 

 

 

 

Weeks

 

 

Days

 

 

Hours

a. Regular wages for last week worked?

 

Yes

No

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. Wages in Lieu of Notice (payment to

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

compensate the employee for no notice or

 

Yes

No

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

short notice of layoff)?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c. Vacation Pay (report unused vacation)?

 

Yes

No

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d. Severance Pay or Separation Bonus?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Compensation for weeks not worked after

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

separation. Each payment impacts the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

claim differently.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Severance Pay?

 

 

 

 

Yes

No

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Separation Bonus?

 

 

 

 

Yes

No

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

e. Other Payment(s)? If Yes, for what

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

reason did you make the payment?

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

f. Company Pension?

 

 

 

 

Yes

No

$

 

 

 

 

 

 

How Paid?

Lump Sum

Monthly

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(office use only)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(see other side)

NCUI-500AB (Revised 06/30/2013)

Claimant:SSN:DD:

14. COMPLETE THIS SECTION IF YOU ARE A TEMPORARY EMPLOYMENT SERVICES EMPLOYER:

The individual is not separated, is eligible for suitable work assignments, but no suitable work assignments are currently available.

Was claimant offered a new assignment?

Yes

No

If yes, did he/she accept?

Yes

No

If the questions above do not apply to this claimant, please respond to either Item 15 or 16.

Please provide the following information regarding work refused:

Date offered Type of work

Pay Rate: $

 

 

 

Days Hours Distance

Reason

 

HR WK

MO

BI-WK

YR

to site

refused

 

 

 

 

 

 

Go to #17

The following questions refer to the claimant’s last assignment:

Employer name and location:

Claimant’s job:

 

 

 

 

First day worked:

Last day worked:

 

 

 

 

 

 

 

Pay rate: $

 

 

 

 

 

Work hours:

Days worked:

HR WK

MO

BI-WK

YR

 

 

 

 

 

 

 

 

 

 

15.COMPLETE THIS SECTION IF THE CLAIMANT QUIT.

a. What reason did the claimant give for quitting? (If you need more space, continue in Item 17.)

b. Did claimant give prior notification of resignation?

Yes

No If yes, please provide date:

If claimant gave notification was it:

Oral

Written

(Please provide copy)

16.COMPLETE THIS SECTION IF THE CLAIMANT WAS DISCHARGED. a. When you informed the claimant of the discharge, what reason did you provide?

Was this a policy violation? ?

Yes

No

If Yes, please provide documented proof as necessary.

b. Was the claimant warned regarding this behavior?

?

Yes

No

 

 

Date(s) of warnings for this behavior?

 

 

 

 

 

 

The warning(s) was:

Oral

 

Written

 

Both

 

 

 

(Provide details regarding the nature of the warnings in Item 17. Attach documentation.)

c. Did the reason for discharge involve tardiness or attendance? ?

Yes

No If Yes, please provide the dates and reasons

regarding incidents.

 

 

 

 

 

 

 

 

 

17. COMPLETE THIS SECTION OR A SEPARATE SHEET FOR ADDITIONAL INFORMATION.

Name of the individual to contact for additional information:

 

Contact Telephone Number:

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

Signature

Name Printed

 

 

Title

 

Date Signed

 

 

 

 

 

 

 

 

Email address:

 

 

 

Fax number: (

)

 

 

(Please fax both front and back sides to DES)

NCUI500AB (Revised 06/30/2013)

How to Edit Unemployment Commission Form Online for Free

Filling in nc clm 500ab form is easy. Our experts designed our editor to make it user friendly and assist you to fill in any form online. Here are some steps that you should follow:

Step 1: Search for the button "Get Form Here" on the webpage and hit it.

Step 2: After you have accessed your nc clm 500ab form edit page, you will notice all options you can take concerning your document within the upper menu.

The next few parts are what you will need to create to get your ready PDF form.

writing nc clm 551l form part 1

You need to write down the appropriate data in the Compensation for weeks not worked, Severance Pay Separation Bonus e, Yes, Yes, Yes, f Company Pension, Yes, How Paid, Lump Sum, Monthly, office use only, see other side, and NCUIAB Revised field.

Completing nc clm 551l form stage 2

It's essential to note certain particulars inside the area COMPLETE THIS SECTION IF YOU ARE, The individual is not separated is, available, Was claimant offered a new, Yes, If yes did heshe accept, Yes, If the questions above do not, Please provide the following, Type of work, Pay Rate, HR WK, BIWK, The following questions refer to, and Employer name and location.

nc clm 551l form COMPLETE THIS SECTION IF YOU ARE, The individual is not separated is, available, Was claimant offered a new, Yes, If yes did heshe accept, Yes, If the questions above do not, Please provide the following, Type of work, Pay Rate, HR WK, BIWK, The following questions refer to, and Employer name and location blanks to fill out

As part of box b Did claimant give prior, Yes, No If yes please provide date, If claimant gave notification was, Oral, Written Please provide copy, COMPLETE THIS SECTION IF THE, a When you informed the claimant, Was this a policy violation, Yes, No If Yes please provide, b Was the claimant warned, Yes, Dates of warnings for this behavior, and The warnings was Written Provide, specify the rights and responsibilities.

stage 4 to filling out nc clm 551l form

Review the fields Signature, Name Printed, Title, Date Signed, Email address, Fax number, Please fax both front and back, and NCUIAB Revised and thereafter complete them.

Finishing nc clm 551l form step 5

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