Fillable Printable Wages Notice Request Separation Pay/Or In-Lieu-Of-Notice Pay Information (De4808)
Fillable Printable Wages Notice Request Separation Pay/Or In-Lieu-Of-Notice Pay Information (De4808)
Wages Notice Request Separation Pay/Or In-Lieu-Of-Notice Pay Information (De4808)
DE 4808 Rev. 5 (11-15) (INTERNET)Page 1 of5 CU
WAGES NOTICE REQUEST
SEPARATION PAY/OR IN-LIEU-OF-NOTICE PAY INFORMATION
1.California Employer Account Number:__________________________________________________
(8 Digit Code)
2.Business Name:___________________________________________________________________
3.Other Business Names:______________________________________________________________
4.Mailing Address:___________________________________________________________________
(Address)
_________________________________________________________________________________
(City)(State)(Zip Code)
5.Phone Number: (_____)_____________________________________________________________
(Area Code)(Phone Number)
6.Please provide the following information (if you have different layoff periods list them separately):
Date(s) of Layoff
(MM/DD/YY–MM/DD/YY)
Number of California
Employees Laid Off
Location(s) of Affected Job Sites
in California
(City)
7.Union Name, Local, and Phone Number (if applicable):_____________________________________
8.Prior Wages Notice Number (if applicable):______________________________________________
9.Will the terminated employees receive any payments other than their regular wages through their last
day worked and accrued vacation? ____ Yes ____ No
If no, it is not necessary to complete this form. Issuance of a Wages Notice is only necessary if your
company will pay post-employment payments to the terminated employees.
SEPARATION PAY INFORMATION:
10.Does the company have a plan or policy that provides for separation payments when there is a
reduction in force or closure? ____Yes ____No
11.What is the basis for the payments (i.e., written policy, general practice, new policy for this reduction in
force, collective bargaining agreement, etc.)?
12.What does the company call these payments?
13.What is the purpose of the payments?
14.Who is eligible to receive the payments?
15.Do the employees continue to accrue all service credits, such as seniority, vacation time, etc., during
the period covered by the payment(s)? ____Yes ____No
16.Will the company make the payments in a ____ lump sum and/or ____ periodic payments?(check accordingly)
DE 4808 Rev. 5 (11-15) (INTERNET)Page 2 of5 CU
IN-LIEU-OF-NOTICE PAY INFORMATION:
17.Does company policy provide that advance notice be given in the event of a layoff or that payment be
made in lieu of such notice? ____Yes ____No
If yes, please explain company policy.
If no, please explain the reason for the payments.
18.Do the employees continue to accrue all service credits, such as seniority, vacation time, etc., during the
period covered by the payment(s)? ____Yes ____No
19.Does the company retain the right to call on the employees’ services, if needed, during the period
covered by the payments? ____Yes ____No
20.Will the company make the payments in a ____ lump sum and/or ____ periodic payments?
(check
accordingly)
21.Please provide the following
(if you issued layoff notices on different dates, please list each issuance
separately):
Affected Work Group
Date Employees
Notified
(MM/DD/YY)
Termination
Effective Date
(MM/DD/YY)
Employees’
Last Work Day
(MM/DD/YY)
Employees
Paid Notice Pay
Through
(MM/DD/YY)
GENERAL INFORMATION:
22.Are the terminated employees covered by a pension plan? ____Yes ____No
If yes, did the terminated employees at any time contribute to the pension fund and are those
contributions still part of the pension fund? ____Yes ____No
If no, is the pension based solely on employer contributions? ____Yes ____No
DE 4808 Rev. 5 (11-15) (INTERNET)Page 3 of5 CU
23.Does the company have any other plans set up for retirement purposes? ____Yes ____No
If yes, please provide: Type of plan:
Who can participate in the plan?
Who contributes to the plan? ____ Employee ____ Company ____Both employee and company
What are the terminated employees’ options with respect to the contributions in the plan?
24.Did any of the terminated employees elect voluntary layoff/retirement or refuse a transfer within the
company in lieu of lay off? ____Yes ____No
If yes, please explain.
25.Did any of the terminated employees elect to be laid off in place of less senior employees?
____Yes ____No
If yes, are those employees covered by a collective bargaining agreement that provides for
substitutionary layoff? ____Yes ____No
26.If the layoff was due to a merger, acquisition, etc., did any of the affected employees refuse an offer of
work from the new company? ____Yes ____No ____Not applicable
If yes, please provide:
Name of the new company:
Contact person:Phone number: ( )
(Area Code)(Phone Number)
27.Comments:
Employer Representative/Agent:
Name:
Title: Phone Number: ( )
(Area Code)(Phone Number)
Mailing Address (if different than the business address): _______________________________________
______________________________________
______________________________________
DE 4808 Rev. 5 (11-15) (INTERNET)Page 4 of5 CU
INSTRUCTIONS FOR WAGES NOTICE REQUEST
SEPARATION PAY/OR IN-LIEU-OF-NOTICE PAY INFORMATION
The Employment Development Department will prepare a Wages Notice based on the information you provide. The
Department issues a Wages Notice to reduce thenumber of calls to employers and to promote consistent decisions from
Department staff regarding payments received by Unemployment Insurance (UI) claimants. The Wages Notice will provide
Department staff with general information regarding the post-employment payments received by terminated employees
and a determination of whether the payments will affect the claimants’ eligibility for UI benefits.
The Department will also mail you a copy of the Wages Notice for your records.
Please follow the instructions carefully:
1.CALIFORNIA EMPLOYER ACCOUNT NUMBER - Enter your California state employer account number.
2.BUSINESS NAME – Enter the name by which your business is known.
3.OTHER BUSINESS NAMES – Enter other names by which your business is known and which your employees may
report as their employer.
4.MAILING ADDRESS – Provide business mailing address.
5.PHONE NUMBER – Enter business phone number including area code.
6.If you have different layoff periods list them separately.
DATE(S) OF LAYOFF – Enter the date(s) you laid off or plan to lay off the employees. If layoffs will occur over a period
of time and you do not have specific dates, you may indicate anticipated beginning and ending dates. Example:
02/05/14 – 06/30/14
NUMBER OF CALIFORNIA EMPLOYEES LAID OFF – Enter the total number of employees who work in California and
will be laid off during the period indicated.
LOCATION(S) OF AFFECTED JOB SITES IN CALIFORNIA – Enter the name(s) of the California city (ies) where the job
site(s) affected by the layoff is (are) located. If several job sites throughout California are affected you may indicate
“statewide” rather thanlisting the individual job sites.
7.If affected employees are covered by a collective bargaining agreement, please provide the union name and local
number.
8.If we have issued a Wages Notice for your company in the past, please provide the prior Wages Notice number, if
available.
9.If the terminated employees will not be receiving any payments other than their regular wages for services rendered
throughtheir last day worked and accrued vacation, it is not necessary to complete this form. The purpose of a Wages
Notice is to determine if post-employment payments, such as severance pay, in-lieu-of-notice pay, wage continuation,
bonuses, pensions, etc., affect the claimants’ eligibility for UI benefits.
10.Indicate if the payments will be made pursuant to company policy or plan that provides for such payments to a class or
group of employeesaffected by the reduction in force or closure. The plan or policy doesnot have to be a written
policy. It may be a company practice to provide such payments at termination or a plan created only for this layoff.
11.Enter whether the payments are made pursuant to a written company policy, collective bargaining agreement, plan
created for this layoff, etc. If payments are made according to different policies or agreements, please specify.
Example: Represented employees will be paid severance pay according to the collective bargaining agreement;
non-represented employees will be paid severance pay according to written company policy.
12.Enter what you call the payments. Examples: Severance pay, separation pay, dismissal pay, wage continuation, etc.
13.Explain the intent of the payment. Examples: To provide assistance while employees seekother work; to supplement
UI benefits; etc.
14.Enter the group or groups that are eligible to receive the payments. Examples: All terminated employees, production
workers, exempt employees, all employees who sign a general release, etc.
15.Indicate if terminated employees continue to accrue allservice credits (e.g., earn additional vacation time, accrue
seniority, etc.), just as if they were working, during the period covered by the payments.
DE 4808 Rev. 5 (11-15) (INTERNET)Page 5 of5 CU
16.Indicate if you will make one lump sum payment or periodic payments. If some employees will receive a lump sum
payment and other employees will receive periodic payments, check both lump sum and periodic payments.
17.Indicate if you have a company policy or agreement that requires that you give affected employees a specified amount of
advance notice in the event of a reduction in force or pay them if you are unable to provide the required notice.
If yes, briefly explain your company’s notice policy. Please include who is covered by the policy, the length of advance
notice required, and if only certain layoffs or closures are covered.
If no, briefly explain the purpose for the payment(s). Please include whether your company plans on making it a policy
to provide advance notice in the event of a reduction in force or pay in lieu of such notice.
18.Indicate if terminated employees continue to accrue allservice credits (e.g., earn additional vacation time, accrue
seniority, etc.), just as if they were working, during the period covered by the payments.
19.Indicate if you require the affected employees to remain available to perform services for your company during the period
covered by the payments.
20.Indicate if you will make one lump sum payment or periodic payments. If some employees will receive a lump sum
payment and other employees will receive periodic payments, check both lump sum and periodic payments.
21.If you issued layoff notices on different dates, please list each issuance separately with its respective pertinent dates and
information.
DATE EMPLOYEES NOTIFIED – Enter the date you issued the required notice to the affected employees.
AFFECTED WORK GROUP– Enter the work group that was issued the notice if it is only a specific group of
employees, e.g., assembly line workers, hourly employees, represented employees, etc. If the layoff involves several
sites and notice issued only to some sites on that date, you may enter the site location underWork Group. If you gave
notice to a range of employees in different work groups and classifications, no entry is required.
TERMINATION EFFECTIVE DATE – Enter the date the notice period ends.
EMPLOYEES’ LAST WORK DAY – Enter the last date you require the affected employees to report to work.
DATE EMPLOYEES PAID THROUGH – Enter the date through which you will pay the affected employees their regular wages.
22.Indicate if the affected employees are covered by a pension plan. If yes, indicate if they contributed some of the monies
currently in the fund.
23.Indicate if the company has any other plans, e.g., profit sharing, employee stock option plans, etc., that are set up for retirement
purposes. Provide the type of plan. Explain who is eligible to participate in theplan. Explain what are the employees’ options at
termination with respect to the contributions in the plan. Example: At termination, employees with at least $5000 in the plan
may leave the contributions in the plan or withdraw them. Employees with less than $5000 balance must withdraw the
contributions.
24.Indicate if any of the terminated employees could have continued employment with your company but volunteered to be laid
off, chose to retire, or refused a transfer within the company. Explain the circumstances. Example: Some employees not
scheduled for lay off volunteered for early retirement to take advantage of the separation incentive pay package the company
offered.
25.Indicate if some employees who would not have been otherwise laid off, volunteered to belaid off in place of other
employees. If yes, indicate if those employees are covered by a collective bargaining agreement that specifies an employee
with more seniority may elect to be laid off in place of an employee with less seniority when the employer has decided to lay
off employees.
26.If another company has taken over your business operations, indicate if to your knowledge, any of the terminated employees
were offered employment with the other company and refused it. If yes, please provide the name ofthe company who made
the offer of work and name and telephone number of a person who can provide more information regarding the offer of work.
27.COMMENTS - Provide any additional information regarding the payments that you feel is important and can assist the
Department in determining if the payments will affect the employees’ eligibility for UI benefits.
For more information about completing this form, please call (916) 403-6358and ask to speak to a representative in the Wages
Notice Group.
You may FAX the completed form to (916) 449-2192, or mail to Employment Development Department, UI Integrity and
Accounting Division, MIC 16A, Wages Notice Group, PO Box2228, Rancho Cordova, CA 95741-2228.
