Follow the steps to successfully complete the PA PA 78A form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the case load and date of notice in the designated fields. Make sure to input the correct dates to avoid any discrepancies.
3. Fill out the worker name, telephone number, and fax number. This information is essential for any follow-up communication regarding the form.
4. Provide the employee's name, Social Security number, last known address, and a comment if necessary. This identifies the individual in question.
5. Complete the employer information section, including the telephone number and current employment status. Specify if the individual is currently employed and whether they received the Earned Income Tax Credit.
6. If applicable, provide the medical insurance company information and details about the coverage, including policy numbers and type of coverage.
7. Enter earnings information by pay period from the specified start date to the present. Ensure to include actual pay dates and gross amounts as well as any pre-tax deductions.
8. If additional space is needed for comments, utilize the designated area. This can provide necessary context for your submission.
9. Finally, the employer's representative should print their name, title, and signature. Include a contact phone number and the date of completion.
10. Once finished, save your changes. You may then download, print, or share the form as needed.

Complete your PA PA 78A form online today to ensure timely processing.