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The New York State Department of Labor Unemployment Insurance Division's Shared Work Continued Claim Waiting Week Certification form serves a crucial function in the intersection of unemployment benefits and employer responsibilities within the Shared Work Program. Through this document, employees facing reduced hours under an approved Shared Work Plan can claim Shared Work benefits, affirming their partial unemployment while still being able to work, available for work, and underlining that their wage loss is through no fault of their own. It encapsulates a comprehensive process beginning with the employee's declaration regarding employment status and earnings outside their Shared Work employer and extends to capturing the employer's confirmation on the employee's reduced hours, any work refusal during off-scheduled hours, and company operational status. The careful delineation of earnings, employment status, including reasons for no longer working with the employer, amidst other critical pieces of information, highlights the rigorous checks and balances aimed at ensuring the integrity and correctness of claims. Additionally, instructions meticulously guide both parties through their respective roles in completing and submitting the form, emphasizing the importance of accuracy to avoid delays in benefits payment. This document not only facilitates the smooth execution of the Shared Work Program but also underscores the collaborative effort between employees, employers, and the Department of Labor to maintain a sustainable work environment during fluctuating economic conditions.

Ny Labor Unemployment Sample

New York State Department of Labor

Unemployment Insurance Division

Shared Work Continued Claim

Waiting Week Certification

(Instructions on second page)

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:

 

 

 

1. Did you work for anyone other than your Shared Work employer on any day in the week? (This includes

Yes

No

self-employment.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If “Yes,” complete “a” through “c.”

 

 

 

 

 

 

 

 

 

a. How many days did you work? 1

2

3

4 or more

 

 

 

b. Excluding earnings from self employment, did you earn more than $405 during the week? Yes No

 

 

 

c. Are you still working for this employer?

 

Yes

No

 

 

 

If No, complete the questions below.

 

 

 

 

 

 

 

 

 

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

Labor Dispute

iii.Employer’s name and address: ______________________________________________

_____________________________________________________________________________

Claimant Certification: I claim Shared Work benefits under the New York State Unemployment Insurance Law. I certify that the above statements are true and complete, that I was partially unemployed, able to work, available for work with my Shared Work employer and that my loss of wages was due to no fault of mine. I have not claimed Unemployment Insurance benefits under any other State or Federal system for this period nor will I receive any other payment (i.e., Sub Pay) to compensate me for this period. I realize the Law prescribes penalties for false statements.

Signature:

 

Date:

 

Address (complete only if changed):

 

 

 

Part B – Employer Statement

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.)

 

 

 

 

 

2. Did the employee leave the company?

 

 

 

Yes

No

 

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: ___/___/___

 

 

 

 

 

3.

Did the employee refuse any work made available to him/her during the hours he/she was scheduled off

Yes

No

 

due to Shared Work?

 

 

 

 

 

 

 

If “Yes,” number of days refused work: _ 1

2

3

4 or more

 

 

4.

Did you permanently shut down your company?

 

 

 

Yes

No

 

If “Yes,” what was the date the company was permanently closed: ___/___/___

 

 

 

 

 

 

 

 

 

 

 

I certify that the above 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 my knowledge.

-

Employer account no.Employer nameEmployer signature

98-

Locator code (if any)

Date

Employer telephone number

SW 4.1 (10/13)

Shared Work Continued Claim

Part A - Instructions to Employee

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.

Complete Part A, “Employee Statement,” on the other side of this form. New York Unemployment Insurance benefit weeks run from Monday through Sunday. 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.

If your name has changed, print your correct name and your previous name in the space provided at the top of the form.

If you have changed your address, print your new address in the space provided below your signature. Be sure to include your zip code.

Return this form to your employer, who will complete Part B and send it to the Department of Labor for processing.

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.

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.

Give one form to each employee covered by your Shared Work Plan on the Monday following the latest Sunday week ending date on the reverse of 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.

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. Send it within seven (7) days of the latest week ending date shown on Part A.

Mail the forms for all of the employees together in one envelope, if possible.

If you have a NY.GOV ID, you can send the forms by using the messaging feature after you log into your Unemployment Insurance Online Services account.

If the employee completed Part A and wishes to claim the week, submit the form for our 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.

File Overview

# Fact
1 The form is for Shared Work Continued Claim certification under the New York State Unemployment Insurance Division.
2 Claimants must accurately report any work outside their Shared Work employer, including self-employment.
3 Claimants must certify their partial unemployment status due to reduced work hours with their Shared Work employer.
4 The form includes both an Employee Statement (Part A) and an Employer Statement (Part B).
5 Benefits are contingent upon the correct completion and submission of the form, subject to New York State Unemployment Insurance Law penalties for false statements.
6 Employers must report the percentage of reduced hours and wages, and any separations, work refusals, or company shutdowns.
7 Governing law: New York State Unemployment Insurance Law.

Ny Labor Unemployment: Usage Guidelines

Filing a New York Labor Unemployment form is a crucial step in claiming your Shared Work benefits, particularly during times when work hours have been reduced. It's important to carefully complete this form to ensure you provide accurate and complete information, which will help expediate the processing of your claim. Below are the instructions guiding you through the steps of filling out your portion of the form, Part A – Employee Statement, followed by ensuring your employer completes Part B – Employer Statement.

  1. At the top of the form, clearly print your name as the claimant. If your name has changed since your last certification, you also need to print your previous name.
  2. Indicate the Sunday week ending date for the week you're claiming. This sets the timeframe for your benefit claim.
  3. Answer the questions provided, starting with whether or not you worked for anyone other than your Shared Work employer during the week claimed. This includes any self-employment:
    • If "Yes," specify the number of days worked.
    • Indicate whether your earnings, excluding those from self-employment, were more than $405 for the week.
    • Confirm if you are still working for this employer or not. If not, provide the last day of work and the reason for no longer working there, alongside the employer’s name and address.
  4. Sign and date the form to certify your claim for Shared Work benefits, attesting that the information provided is true and complete. This step also asserts that you were partially unemployed due to reasons beyond your control, able to work, available for work with your Shared Work employer, and did not claim unemployment insurance benefits elsewhere for this period.
  5. If your address has changed, ensure you provide the new address below your signature, including the zip code.

After completing Part A, return the form to your employer as promptly as possible. They are responsible for filling out Part B – Employer Statement and submitting the document to the Department of Labor. Timeliness from both you and your employer in completing and submitting this form ensures a smoother, more efficient process in validating your claim for Shared Work benefits. Remember, accurate and complete information is imperative to avoid delays in the processing and approval of your claim.

FAQ

  1. How do I claim Shared Work benefits in New York?
    To claim Shared Work benefits, you must complete Part A – Employee Statement of the Shared Work Continued Claim form. Indicate the Sunday week ending dates for the week(s) you wish to claim, provide your employment details, and answer all questions related to any additional work during that period. You must then sign the certification at the bottom of the form. After completing, return the form to your employer for Part B completion and submission to the Department of Labor.
  2. What are the eligibility criteria for claiming benefits under the Shared Work program?
    You must be partially unemployed, able and available for work with your Shared Work employer, and your loss of wages must be due to no fault of your own. Additionally, you cannot claim Unemployment Insurance benefits under any other state or federal system for the same period, nor can you receive other payments like Sub Pay that compensate you for the period claimed.
  3. If I work for someone other than my Shared Work employer during the week, can I still claim benefits?
    Yes, you can still claim benefits. However, you must report any work performed, the number of days worked, and any earnings more than $405, excluding earnings from self-employment. You should answer "Yes" to the relevant question on the form and provide the requested details.
  4. What should I do if my address has changed?
    If your address has changed since you last certified for benefits, you must print your new address in the space provided below your signature on the Shared Work Continued Claim form. Be sure to include your zip code. This ensures that all correspondence from the Department of Labor reaches you.
  5. How is the percent of hours and wages reduced calculated for the Shared Work program?
    The percent reduction is calculated by dividing the number of hours not paid due to work sharing by the total number of hours normally worked in a week. This calculation takes into account only the time not compensated by the employer, excluding vacation, holiday, and sick pay, as well as paid service time.
  6. What happens if the employee refuses work made available during scheduled off hours?
    If an employee refuses work made available during their scheduled off hours due to Shared Work, it must be reported on the form by the employer. The employer should indicate "Yes" to the question regarding refusal of work and specify the number of days the work was refused.
  7. What should employers do with the form after the employee completes Part A?
    After the employee returns the completed Part A, the employer must fill out Part B – Employer Statement, confirming the employee’s status and earnings for the week claimed. Submit the completed form within seven days of the latest week ending date shown on Part A to the New York State Department of Labor, either by mail or online if you have a NY.GOV ID. Employers should include all employee forms in one envelope, if possible, to expedite processing.

Common mistakes

Filling out the New York Labor Unemployment form can be a daunting task. Many people make mistakes that can delay the process or result in the denial of benefits. Understanding these common errors can help ensure that your application is completed accurately and efficiently.

  1. Not updating personal information: It's crucial to update your name if it has changed since you last certified. Neglecting to update your address, especially if it has changed, can lead to delays in receiving correspondence and benefits.

  2. Failing to accurately report work outside your Shared Work employer: If you worked for anyone other than your Shared Work employer or engaged in self-employment, it must be accurately reported. Overlooking or inaccurately reporting these details can lead to issues with your claim.

  3. Incorrectly reporting earnings: Excluding earnings from self-employment when asked if you earned more than $405 during the week is a common mistake. This can affect your benefit amount and eligibility.

  4. Omitting last day of work and reason for separation: If you’re no longer working for an employer, you must include the last day of work and the reason for separation. Failure to do so results in incomplete information that can stall the processing of your claim.

  5. Not accurately reporting the percentage of hours and wages reduced: For employers, failing to accurately enter the percent of hours and wages reduced due to Shared Work can affect the determination of benefits for employees.

  6. Overlooking work refusals: Employees must report any work refused during the claimed week. Employers need to be accurate when reporting whether the employee refused any work, as this can impact eligibility.

  7. Not specifying company closures: Employers must indicate if the company has permanently shut down and provide the closure date. This is vital for accurate record-keeping and benefit determination.

  8. Delay in submission: Both employees and employers are responsible for timely submission of the form. A delay can result in a delay of benefits or, in some cases, denial of the claim.

By paying close attention to these common mistakes and ensuring that all information is complete and accurate, applicants can navigate the process more smoothly and avoid unnecessary delays or issues with their unemployment benefits claim.

Documents used along the form

When navigating the processes associated with filing for unemployment benefits in New York, several additional documents and forms may complement the New York Labor Unemployment form for a comprehensive submission. These documents play a crucial part in ensuring individuals provide all necessary information, which may affect the eligibility and amount of unemployment benefits received. Below is a list of forms and documents often utilized alongside the unemployment form:

  • Proof of Identity: This includes any government-issued identification such as a Driver's License, State ID card, or Passport to verify the identity of the claimant.
  • Proof of Employment and Earnings: Documents such as pay stubs, W-2 forms, and employment letters help demonstrate previous employment status and earnings.
  • Federal Employer Identification Number (FEIN) of Your Last Employer: This number, found on your W-2, is needed to accurately identify your previous employer.
  • Direct Deposit Form: If opting for direct deposit, a completed form along with bank account and routing numbers must be submitted to facilitate payments.
  • Severance, Pensions, and Other Benefit Information: Documents that detail any severance pay, pensions, or other benefits received, which might affect unemployment benefits.
  • Alien Registration Card: For non-U.S. citizens, this card is required to prove that they are legally allowed to work in the United States.
  • DD Form 214: Members of the military who have been discharged must provide this form, which documents release or discharge from active duty.
  • SF-8 or SF-50 Form: Federal employees should submit this form, which provides information about federal employment status and earnings.
  • Notice of Determination: If previously received, this document outlines past decisions regarding unemployment benefit claims that might affect current eligibility.

Together, these documents support the information provided in the New York Labor Unemployment form, offering a comprehensive profile of the claimant's employment history, identity, and eligibility for benefits. It's essential for individuals to gather and submit all relevant documentation to ensure their claim is processed efficiently and accurately, leading to a correct determination of their unemployment benefits.

Similar forms

The New York Labor Unemployment form shares similarities with the IRS W-4 Form, chiefly in its personal information and certification sections. Both forms require individuals to provide accurate personal details, like their name and social security number. They each have certifications where the individual must attest to the truthfulness of the information provided, under penalty of law. This parallel underlines their shared objective of ensuring personal responsibility and accuracy in the submission of vital financial or employment-related information.

Another document that parallels the New York Labor Unemployment form is the Job Application Form. Job applications often ask for detailed employment history, much like the unemployment form requires information about the claimant's last employer, reason for unemployment, and earnings. Both forms serve to gather comprehensive employment data, but for different ends: one seeks to establish eligibility for employment while the other assesses eligibility for unemployment benefits.

The similarity between the New York Labor Unemployment form and a Weekly Time Sheet is evident in the detail and specificity required in reporting hours worked or not worked. Just as a time sheet requires employees to document their daily hours, the unemployment form asks claimants to report any work performed outside of their Shared Work employer, including self-employment, to calculate benefits correctly. This requirement ensures an accurate account of work and compensation, which is crucial for both managing payroll and determining unemployment benefits.

Finally, the resemblance between this unemployment form and Disability Claim Forms is significant, particularly in how they verify an individual's inability to work. While the unemployment form checks for partial employment and eligibility for shared work benefits, disability forms assess whether an individual's medical condition prevents them from working. Both necessitate detailed personal and employment information, alongside a certification of truthfulness, to process claims effectively. Despite their different contexts, the essential function of determining benefit eligibility links them closely.

Dos and Don'ts

When filling out the New York Labor Unemployment form, there are important dos and don'ts to consider ensuring the process is smooth and error-free. Here is a list to guide you:

Do:
  • Double-check your personal information for accuracy, including your name, social security number, and if applicable, any changes in your name or address.
  • Accurately report all employment, including self-employment, for the week you are claiming benefits.
  • Answer truthfully about your earnings during the week, excluding earnings from self-employment if asked.
  • Indicate clearly the last day you worked for any employer you are no longer working with, along with the reason for separation.
  • Sign and date the form to certify your claims are true and complete.
  • Return the form to your employer promptly for timely processing.
Don't:
  • Leave sections incomplete. If a question does not apply to you, make sure to indicate with an “N/A” or “None” as appropriate.
  • Forget to report any work you did during the week, even if it was for just a few hours or for a new employer.
  • Lie or omit information about your earnings or work situation. This can lead to penalties, including the denial of benefits.
  • Misreport the reason you are no longer working for an employer. Be it a layoff, discharge, or quitting, your answer impacts your benefit eligibility.
  • Delay sending the form back to your employer, as this can delay the processing of your claim.
  • Fail to reach out if you have questions. Contacting the Shared Work Unit or utilizing the NY.GOV messaging feature can provide assistance and prevent mistakes.

Misconceptions

There are several misconceptions about the New York Labor Unemployment form, particularly concerning the Shared Work Continued Claim. Below are seven common misconceptions and clarifications to provide better understanding:

  • Misconception 1: You cannot apply for shared work benefits if you've taken up self-employment.

    This is incorrect. Applicants who have engaged in self-employment can still apply; they need to disclose their work and earnings in the form.

  • Misconception 2: If you earn more than $405 from a side job, you are automatically ineligible for benefits.

    While there is a stipulation about earnings, it does not automatically disqualify an applicant. You must report earnings, and the amount may impact the benefit, but it does not necessarily mean ineligibility.

  • Misconception 3: The form is only for those who have been completely laid off.

    Actually, the Shared Work Program is designed specifically for employees whose hours and wages have been reduced. It aims to avoid layoffs by allowing employees to receive partial benefits.

  • Misconception 4: The employer portion of the form is optional.

    Part B – Employer Statement is a mandatory section of the form. Employers must complete their part for the claim to be processed.

  • Misconception 5: Vacation, holiday, and sick pay do not affect your Shared Work benefits.

    Contrary to this belief, these forms of compensation are considered employment for the purpose of calculating your benefit's percent reduction.

  • Misconception 6: You can claim benefits even if you refuse work offered by your employer.

    Refusing work without a valid reason can disqualify you from receiving benefits. It's essential to report any refused work on the claim form.

  • Misconception 7: The process of claiming benefits is complex and time-consuming.

    While the form does require careful completion, the process is straightforward. Understanding your responsibilities and the form's requirements will streamline the process.

Understanding these clarifications will help in accurately completing the New York Labor Unemployment form and ensure that applicants receive the benefits for which they are eligible.

Key takeaways

Filling out the New York Labor Unemployment form accurately is crucial for ensuring the timely processing and payment of Shared Work benefits. Here are four key takeaways to keep in mind:

  • Complete both Part A and Part B accurately. Part A must be filled out by the employee to provide personal details and information about any additional work during the claimed week. Part B is for the employer to confirm the employee’s work status and the percentage of hours and wages reduced. Any inaccuracies or missing information can lead to delays in processing.
  • Understand the definition of employment for Shared Work benefits. For the purposes of this form, employment encompasses not only the hours actually worked but also any vacation, holiday, and sick pay, as well as any payment for services performed. This is crucial for calculating the percentage reduction in hours and wages.
  • Report any changes in personal information. Employees must indicate any changes in their name or address since their last certification. This is important for maintaining accurate records and ensuring that communication from the Department of Labor reaches the claimant.
  • Submit the form promptly. Employees should return the completed form to their employer, who must then send it to the Department of Labor within seven days of the latest week ending date shown on Part A. Timely submission is essential for the prompt review and determination of benefit eligibility.

By paying close attention to these details, both employees and employers can navigate the process of claiming New York State Unemployment Insurance benefits through the Shared Work Program more smoothly and efficiently.

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