Question Title

* 1. Employer Name:

Question Title

* 2. What is your PA UC account number?
(Account number is a 7 digit numeric number with a hyphen:) (12-34567)
(If your account number ends with an M or R please add this after the 7th digit)

Question Title

* 3. What were your total employee count for each month below?

Question Title

* 4. What were your gross wages?

T