Department of Labor PO Box 15130 Albany New York 12212-5130 www. labor. ny. gov Unemployment Insurance Request for Alternate Base Period Please print clearly IMPORTANT We sent you a Monetary Benefit Determinations showing the weekly benefits you will receive. Those benefits are based on your wages. If you believe some of your wages were missed please complete this form* This form must be received by us within 10 calendar days of the Date Mailed as stated on your most recent Monetary Benefit Determination notice. Please print clearly. If we cannot read your writing we cannot process this form* Last Name First Name Middle Initial Address City State Zip Code Claim Effective/Start Date // Social Security XXX XX - Form requirements If you wish to use the Alternate Base Period to increase your weekly benefit rate Complete the steps below using black or blue ink. Include any documentation that could be considered proof of employment and wages such as pay stubs W-2s 1099s vouchers checks tips ....
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How to fill out the NY TC 403 HA online
The NY TC 403 HA form is essential for individuals seeking to ensure their unemployment benefits are accurately calculated based on their wages. This guide provides clear, step-by-step instructions to assist users in filling out the form correctly and submitting it on time.
Follow the steps to complete the NY TC 403 HA online:
- Press the ‘Get Form’ button to access the NY TC 403 HA form online and open it in your preferred document editor.
- Enter your last name, first name, and middle initial in the designated fields. Then fill in your address, city, state, and zip code accurately.
- Indicate the claim effective/start date and your Social Security number, providing only the last four digits for privacy.
- In the 'Last Calendar Quarter Information' section, specify the dates for the last completed calendar quarter that is prior to your claim effective/start date.
- Fill in the 'Wage Information' section with accurate details regarding your employers and their corresponding quarterly gross wages. Be sure to include any proof of wages, and if necessary, attach an additional page for more than three employers.
- Check the appropriate box regarding the accuracy of the Alternate Base Period Quarter Wages as compared to your records. Depending on your selection, proceed to either Step 2 or Step 3.
- In the 'Acknowledgement' section, certify the information provided is true to the best of your knowledge. Remember there are penalties for false statements.
- Provide your signature, date, and telephone number where indicated.
- Submit the completed form, ensuring it is sent along with all attachments before the due date. You can choose to mail, fax, or submit online as directed.
Complete and submit your NY TC 403 HA form online to ensure your unemployment benefits reflect your accurate wage history.
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www.labor.ny.gov/uihandbook. Department of Labor ... MAIL: New York State Department of...
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