Enter the last month for the calendar quarter (03/YY, 06/YY, 09/YY, or 12/YY) to which this report applies.

Enter the state for which to set up unemployed report information.

Enter the name of the company to which this report applies; maximum of 50 characters. If the initialize feature was used previously (Initialize option, File menu), the company name defaults from HQ Company Setup.

Enter the company’s mailing address; maximum of 40 characters. If the initialize feature was used previously (Initialize option, File menu), the address defaults from HQ Company Setup.

Enter the location address as defined by state; maximum of 22 characters.

Enter the city in which the company is located; maximum of 25 characters. If the initialize feature was used previously (Initialize option, File menu), the city defaults from HQ Company Setup.

Enter a valid state (as defined in HQ States). The system validates the state based on the Default Country specified in HQ Company Setup for the active company. If not valid, an error displays, but entry is allowed. If you used the initialize feature (Initialize option, File menu), the state defaults from HQ Company Setup.

Enter the 5-character zip code. If you used the initialize feature (Initialize option, File menu), the zip code defaults from HQ Company Setup.

Enter the 4-digit zip code extension.

Enter the Federal Tax ID# (aka Employer Identification Number), omitting all non-numeric characters, such as hyphens. If you used the initialize feature (Initialize option, File menu), this number defaults from HQ Company Setup.

If an IRS form 941 (Employer’s Quarterly Federal Tax Return) or 943 (Employers Annual Tax Return) was submitted for the same tax year as this report, and the form used an EIN number other than the one indicated above (Federal Tax ID#), enter that number here. Otherwise, leave blank.

Maine Only: Use this field to enter your Revenue Service ID number.

Enter the name of the person (up to 30 characters) to contact concerning problems with this report. If the initialize feature was used previously (Initialize option, File menu), the contact name defaults from PR State Information (Unemp/Wage Reporting tab).

Enter the contact’s telephone number; up to 15 characters. If the initialize feature was used previously (Initialize option, File menu), the contact’s phone number defaults from PR State Information (Unemp/Wage Reporting tab).

Enter the contact’s email address. If the initialize feature was used previously (Initialize option, File menu), the contact’s phone number defaults from PR State Information (Unemp/Wage Reporting tab).

Enter the contact’s telephone extension number; up to of five characters. If you used the initialize feature (Initialize option, File menu), the contact’s telephone extension defaults from PR State Information (Unemp/Wage Reporting tab).

If a separate ID# is required for reporting unemployment information, enter the ID#; up to 20 characters. If you used the initialize feature (Initialize option, File menu), the unemployment ID # defaults from PR State Information (Unemp/Wage Reporting tab).

Enter the media transmitter or authorization number, up to six characters, assigned to you by the State. If you used the initialize feature (Initialize option, File menu), the transmitter ID # defaults from PR State Information (Unemp/Wage Reporting tab).

Used by the ICESA (Interstate Conference of Employment Security Agencies) format.

Enter the establishment identification number, up to four characters. This ID# may be used to designate various store or factory locations or types of payroll when a file contains multiple records with the same EIN#. If you used the initialize feature (Initialize option, File menu), the establishment ID # defaults from PR State Information (Unemp/Wage Reporting tab).

Used by the ICESA (Interstate Conference of Employment Security Agencies) format.

Enter C-3 data (1 character), as defined by the state requiring this information. If you used the initialize feature (Initialize option, File menu), the C-3 data defaults from PR State Information (Unemp/Wage Reporting tab).

Used by the ICESA (Interstate Conference of Employment Security Agencies) format.

If applicable, specify the plant code as defined by state, up to two characters.

If you used the initialize feature (Initialize option, File menu), the Plant code will default from PR State Information, if defined for this state.

Enter the 1-character tax type, as defined by the state requiring this information. If you used the initialize feature (Initialize option, File menu), the tax type defaults from PR State Information (Unemp/Wage Reporting tab).

Used by the ICESA (Interstate Conference of Employment Security Agencies) format.

If applicable, specify the branch code (up to three characters) as defined by state.

If you used the initialize feature (Initialize option, File menu), the Branch code will default from PR State Information, if defined for this state.

Select the electronic filing type for the State specified above.

· Original

· Amended

Enter the suffix code (up to five characters) as defined by the state requiring this information. If you used the initialize feature (Initialize option, File menu), the suffix code defaults from PR State Information (Unemp/Wage Reporting tab).

Used by the ICESA (Interstate Conference of Employment Security Agencies) format.

Enter the taxing entity (up to 10 characters) as defined by the state requiring this information. If you used the initialize feature (Initialize option, File menu), the taxing entity defaults from PR State Information (Unemp/Wage Reporting tab)

Used by the ICESA (Interstate Conference of Employment Security Agencies) format.

Enter the document control identification number (up to 10 characters) as defined by the state requiring this information. If you used the initialize feature (Initialize option, File menu), the document control ID# defaults from PR State Information (Unemp/Wage Reporting tab).

· Used by the ICESA (Interstate Conference of Employment Security Agencies) format.

Enter the 2-digit Federal postal code assigned to the State specified above. This is NOT the 2-character postal abbreviation. If you used the initialize feature (Initialize option, File menu), the state ID# defaults from PR State Information (Unemp/Wage Reporting tab).

Enter the state control number (up to seven characters) as defined by the state requiring this information. If you used the initialize feature (Initialize option, File menu), the state control number defaults from PR State Information (Unemp/Wage Reporting tab).

Used by the ICESA (Interstate Conference of Employment Security Agencies) format.

Enter the unit identification number (up to five characters) as defined by the state requiring this information.

Used by the ICESA (Interstate Conference of Employment Security Agencies) format.

Enter the county code (up to three characters) as defined by the state requiring this information. If you used the initialize feature (Initialize option, File menu), the county code defaults from PR State Information (Unemp/Wage Reporting tab).

Used by the ICESA (Interstate Conference of Employment Security Agencies) format.

Enter the out of county employee data (up to seven characters) as defined by the state requiring this information. If you used the initialize feature (Initialize option, File menu), the out of county data defaults from PR State Information (Unemp/Wage Reporting tab).

Used by the ICESA (Interstate Conference of Employment Security Agencies) format.

Enter the media creation date.

Enter the manufacturer's name, up to eight characters.

Defaults the unemployment insurance tax rate based on the SUTA liability code specified for the state in PR State Information and the rate assigned that code in PR Deductions/Liabilities; may be overridden.

Enter the employer assessment rate, up to nine digits (including decimal). This is an optional field used by some states for electronic filing.

Enter the employer assessment amount. This is an optional field used by some states for electronic filing.

Enter the employee assessment rate, up to nine digits (including decimal). This is an optional field used by some states for electronic filing.

Enter the employee assessment amount. This is an optional field used by some states for electronic filing.

Enter the previous underpayment amount. This is an optional field used by some states for electronic filing.

Enter the interest amount. This is an optional field used by some states for electronic filing.

Enter the penalty amount. This is an optional field used by some states for electronic filing.

Used by the state of New Mexico only.

Enter the additional penalty amount. This is the ‘late report penalty’ as defined by the state of New Mexico.

Enter the overpayment amount. This is an optional field used by some states for electronic filing.

Enter the allocation amount. This is an optional field used by some states for electronic filing.

Enter the total due amount. This is an optional field used by some states for electronic filing. Check your state’s requirements to determine if this information is needed.

For the state of Florida, this is a required field and is used to populate the 'total due' in the electronic media file.

For the state of New Mexico, this is the payment amount and includes tax due, interest, late report penalty, and late payment penalty.

Enter the total remittance amount. This is an optional field used by some states for electronic filing.

Multiple County Indisutry checkbox in the PR State Unemployment Form, Other tab.

Select this checkbox if this firm has employees in more than one county/industry included in this report.

Multiple Worksite Location checkbox in the PR State Unemployment Form, Other tab.

Select this checkbox only if this firm has employees at more than one location within the same county included in this report.

Multiple Worksite Indicator checkbox in the PR State Unemployment Form, Other tab.

Select this checkbox only if this firm is including multiple worksite data on wage reporting diskette in lieu of Form BLS-3200.

If this firm will report multiple worksite data using Form BLS-3200, do not check this box.

Electronic Funds Transfer Indicator checkbox in the PR State Unemployment Form, Other tab.

Select this checkbox only if this firm participates in electronic funds transfer (EFT) of quarterly UI payroll taxes.

Multi-State Employers Indicator checkbox in the PR State Unemployment Form, Other tab.

Select this checkbox only if this firm has employees included in this report who worked in multiple states.

Export File Type options in the PR State Unemployment Form, Other tab.

If this firm has 250 or fewer employees, select Small Employer.

If this firm has 251 or more employees, select Large Employer. The system enables the remaining fields.

FTE Employee Count field in the PR State Unemployment Form, Other tab.

The system enables this field when you select Large Employer.

Refer to the state's definition of full-time-equivalent employee.

Health Care Amt Due field in the PR State Unemployment Form, Other tab.

The system enables this field when you select Large Employer.

Refer to the state's requirement for this field's value.