Submitting Wage Information - State Plan Employer

Accurate and timely wage information reported by employers is essential for prompt processing of claims. Wage information is obtained primarily from either Part D of the FL-1 Form, or from the Wage Request Form, E15. If the claimant has indicated on his/her claim form that he/she has worked for you at some time during his/her base year period (52 weeks immediately preceding the week in which the disability began) you may receive a wage report request from the Division.

You are required by law to supply the requested wage information. If you do not comply within 25 days from the date that the form was mailed to you, a $250.00 penalty will be assessed by the Division.

Please keep the following in mind when completing Part D of the FL-1 or E-15 Form:

  • Verify the claimant's Social Security number with your records.
  • Give exact dates. The last day worked is particularly important.
  • If you have paid the claimant any money during the family leave period, provide the exact beginning and ending dates for which the payment was made, the gross amount and the type of continued pay (sick pay, vacation pay, etc).
  • All money should be gross figures. Wages should include tips, overtime and commission.
  • When providing the weekly wages for the ten weeks prior to the disability date to use Saturday week-ending dates.
  • Date and sign the form and provide a telephone number where you can be reached.
  • If there is any additional information you wish to include, attach a note to the form you are completing. If you have received Form E-15, complete and return the form within 10 days from the date of mailing to avoid the penalties. Be sure that all attachments contain the employee's social security number.
  • If the form was mailed to an incorrect address, include the correct address when you return the E-15 Form.
  • Please be sure that you complete both sides of the E-15 form.