"Employer Affidavit for Filing Electronic Partials" - Alabama

Employer Affidavit for Filing Electronic Partials is a legal document that was released by the Alabama Department of Labor - a government authority operating within Alabama.

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Download "Employer Affidavit for Filing Electronic Partials" - Alabama

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EMPLOYER AFFIDAVIT FOR FILING ELECTRONIC PARTIALS
WARNING:
Committing an act of unemployment fraud may result in loss of current and future benefits,
penalties, fines and imprisonment.
UI Account Number __________________________________
I certify under penalty of law that the individuals being submitted for unemployment benefits for this week:
(1)
are laid off temporarily for lack of work only
(2)
worked all available hours during the week
(3)
are not receiving a retirement pension
(4)
are not in school
(5)
do not have an active interstate claim
(6)
are not receiving Workers' Compensation payments
(7)
have been advised to report all pay received from odd-jobs or any other source and that this pay has been recorded in the
appropriate field
(8)
have been advised they must be able and available for work each day claimed
(9)
have been advised to call the automated phone system at 800-499-2035 to select their payment method.
I certify that the data submitted is complete and accurate information and authorize the Department to file unemployment
claims for each individual included in the electronic file. I certify these employees have authorized this employer to file these
claims on their behalf and to provide wage information to the Department. I certify that these employees have been allowed
to choose their preferred federal tax deduction option. I further certify that these employees have been advised that they must
provide me with their current address and if it changes they must notify me immediately.
I understand that any partial claims filed for my employees will be incomplete, and will not be processed, until my employee
makes a payment selection by calling the automated system at 800-499-2035. I understand that my employees may use this
line to enter direct deposit information or select the AL Vantage Prepaid Benefits Card. I further understand that my
employees' AL Vantage Benefit Card cannot be mailed to the employer’s address.
I understand that the law provides penalties for submitting false claims. I further understand that, under the Rules of the
Department, any employer found to be abusing the purpose and intent of the Partial Claims Program will be prohibited from
using the system. You are not allowed to file your own claim. Questions concerning this document should be referred to the
Payment Processing Unit at (334)956-7481.
Authorized Personnel __________________________ Title_________________________________ (Owner/Plant Manager)
Claims Filer___________________________________ Title_________________________________
Employer Name_____________________________________________________________________________________________
Address ___________________________________________________________________________________________________
Telephone (______) _______-__________________ Email __________________________________________________________
Date: _________________________________
Employers must acknowledge and accept an Employer Affidavit for Electronic Partials, which will be presented to
you as an online form during the Internet filing session. This form is to be completed and returned to the Payment
Processing Unit prior to filing a Partial claim. Fax number 334-956-7483.
ALABAMA DEPARTMENT OF LABOR
649 MONROE STREET
PARTIAL PAYMENT PROCESSING UNIT
MONTGOMERY, AL 36131
(334) 956-7481
EMPLOYER AFFIDAVIT FOR FILING ELECTRONIC PARTIALS
WARNING:
Committing an act of unemployment fraud may result in loss of current and future benefits,
penalties, fines and imprisonment.
UI Account Number __________________________________
I certify under penalty of law that the individuals being submitted for unemployment benefits for this week:
(1)
are laid off temporarily for lack of work only
(2)
worked all available hours during the week
(3)
are not receiving a retirement pension
(4)
are not in school
(5)
do not have an active interstate claim
(6)
are not receiving Workers' Compensation payments
(7)
have been advised to report all pay received from odd-jobs or any other source and that this pay has been recorded in the
appropriate field
(8)
have been advised they must be able and available for work each day claimed
(9)
have been advised to call the automated phone system at 800-499-2035 to select their payment method.
I certify that the data submitted is complete and accurate information and authorize the Department to file unemployment
claims for each individual included in the electronic file. I certify these employees have authorized this employer to file these
claims on their behalf and to provide wage information to the Department. I certify that these employees have been allowed
to choose their preferred federal tax deduction option. I further certify that these employees have been advised that they must
provide me with their current address and if it changes they must notify me immediately.
I understand that any partial claims filed for my employees will be incomplete, and will not be processed, until my employee
makes a payment selection by calling the automated system at 800-499-2035. I understand that my employees may use this
line to enter direct deposit information or select the AL Vantage Prepaid Benefits Card. I further understand that my
employees' AL Vantage Benefit Card cannot be mailed to the employer’s address.
I understand that the law provides penalties for submitting false claims. I further understand that, under the Rules of the
Department, any employer found to be abusing the purpose and intent of the Partial Claims Program will be prohibited from
using the system. You are not allowed to file your own claim. Questions concerning this document should be referred to the
Payment Processing Unit at (334)956-7481.
Authorized Personnel __________________________ Title_________________________________ (Owner/Plant Manager)
Claims Filer___________________________________ Title_________________________________
Employer Name_____________________________________________________________________________________________
Address ___________________________________________________________________________________________________
Telephone (______) _______-__________________ Email __________________________________________________________
Date: _________________________________
Employers must acknowledge and accept an Employer Affidavit for Electronic Partials, which will be presented to
you as an online form during the Internet filing session. This form is to be completed and returned to the Payment
Processing Unit prior to filing a Partial claim. Fax number 334-956-7483.
ALABAMA DEPARTMENT OF LABOR
649 MONROE STREET
PARTIAL PAYMENT PROCESSING UNIT
MONTGOMERY, AL 36131
(334) 956-7481