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THE COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT
DEPARTMENT OF UNEMPLOYMENT ASSISTANCE
REGISTRATION TO PAY DUA TAXES VIA ACH CREDIT
y Name: ______________________________________________________________________
Company Name: _____________________________________________________________________________
* DUA Employer Account Number: _________________________________________________________________

Federal Identification Number: ____________________________________________________________________

Street: ______________________________ City: ___________________ State: _________ Zip: _______________

**Agent/Professional Tax Preparer/Third Party? ID Number: ___________________________________________

Contact Person: _______________________________________________________________________________

Email: _______________________________________________________________________________________
(Please print clearly – you will only receive confirmation via email)

Phone: _______________________________________ Fax: ___________________________________________

Em ail form to: UIEmployerReports@DETMA.ORG
eFax: (617)626-6850
Customer Service: ( 617)626-5075

Note: After submittal of this registration, if approved, you will be provided via email with the DUA mandated ACH credit record layout and DUA bank account and routing transit numbers.

*Employers must have a DUA Employer Account Number (EAN) to apply.

**Agent/Professional Tax Preparer/Third Party computing their client’s amount owed and/or filing this form on behalf of their clients must register with DUA UI Online system as a TPA and receive a TPA ID number. This TPA ID number must be included on this form as part of the registration for ACH Credit Processing. To apply for a TPA ID number, go to: www.mass.gov/uima , and click on: Third Party Administrator (TPA) UI Online login.

If you want to pay online, please via UI Online and select to pay via ACH Debit.

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Removed Elements: - 1 - Enlarge image Coany Name:______________________________________________________________________ * DUA Employer Account Number: _________________________________________________________________ Mail form to: Department of Unemployment Assistance Attention: Employer Reports Unit, Revenue Service, 2 nd Floor 19 Staniford Street Boston, MA 02114 OR Fax form to: (617) 626-6850 Note: After submittal of this registration, if approved, you will be provided via email with the DUA mandated ACH credit record layout and DUA bank account and routing transit numbers. **Agent/Professional Tax Preparer/Third Party computing their client’s amount owed and/or filing this form on behalf of their clients must register with DUA UI Online system as a TPA and receive a TPA ID number. This TPA ID number must be included on this form as part of the registration for ACH Credit Processing. To apply for a TPA ID number, go to: www.mass.gov/uima, and click on: Third Party Administrator (TPA) UI Online login. If you want to pay online, please register for UI Online and pay via ACH Debit. 5/2018 PDF file checksum: 2078303105 (Plugin #1/8.13/12.0)