PA Form     UC-2A     Supplement,        Employer’s Quarterly Report of Wages Paid to Each Employee 
Information MUST   be typewritten or printed in BLACK   ink. Do NOT use       commas ( , ) or dollar signs ( $ ). If typed, disregard vertical
bars and type a consecutive string of characters. If hand printed, print in CAPS  and    within               the boxes as below:
SAMPLE      123456.00                                SAMPLE 
Typed:                                               Handwritten:        1 2 3 4 5 6                          0 0   

Employer  name                                       Employer                                           Check        Quarter and year                           Quarter Ending Date 
(make corrections on Form UC-2B)           PA    UC account no.                             digit           Q  /       Y Y Y Y                                      MM / DD / YYYY 

7. Employee’s                        8. Employee’s name                                                                                9. Gross wages paid this quarter     10. Credit 
    social security number            FI      MI                              LAST                                                    Example:   123456.00                          weeks 

                                                 11.  Total gross wages for this page: 
                                                 12.  Total number of employees for this page: 

UC-2AS REV 06-16                                 13. Page             of