Forms UI-41 and
UI-41a, Supplemental Report of Service or Compensation,
are used to obtain reports of compensation at
a higher maximum than reported on your annual
report. This information may allow your employee
to receive additional Unemployment Insurance
(UI) or Sickness Insurance (SI) benefits. This
form is accepted as valid certification of service
and compensation provided it is signed by the
contact official or a designee.
The forms
are is designed to obtain service and compensation
information needed to determine eligibility
for benefits under the RUIA. Complete the information
for each item checked as follows:
Service
Months
Verify
whether the employee worked or is otherwise
entitled to service for the months checked.
Service
Months and Compensation Year(s)
Enter
the amount of employee's compensation up to
the maximum shown for each month he or she worked
or otherwise received compensation.
Rate of Pay for
Last Day Worked in Calendar Year
Enter
the employee's pay rate (per hour, day, month,
etc.) for the last day worked in the year shown.
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