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TO BE FILED WITH THE DIVISION OF EMPLOYER ACCOUNTS , PO BOX 910, TRENTON, NJ 08625-0910
                                                                                                                                 EMPLOYER'S NAME AND ADDRESS
          UC-9 (R          -2-09)
          State of New Jersey
Department of Labor and Workforce Development
 DIVISION OF EMPLOYER ACCOUNTS
          EMPLOYER'S
          CLAIM FOR CREDIT OR REFUND
          BY REASON OF
ERRONEOUS PAYMENT OF CONTRIBUTIONS                                                                                               EIN

No credit or refund can be allowed unless application                                                                                                              AMOUNT OF THE CLAIM
therefore has been made within two years after the
calendar year in which the contributions under
consideration were erroneously paid to this Agency                                                                                  UNEMPLOYMENT     DISABILITY        WORKFORCE            FAMILY LEAVE INS (FLI)        TOTAL
                                                   EMPLOYER
                                                      WORKER
                                                      TOTAL

BASIS OF REFUND REQUEST

WERE THE ERRONEOUSLY PAID WORKERS' CONTRIBUTIONS DEDUCTED FROM WORKERS' WAGES?                                                                                     Yes No
IF DEDUCTED, HAVE SUCH CONTRIBUTIONS BEEN REFUNDED TO THE WORKERS' ENTITLED THERETO?                                                                               Yes No
                                                  LIST BELOW ONLY THE EMPLOYEES' WAGES THAT ARE BEING CORRECTED
                                                                                                                                                 QUARTER ENDED                                             Difference in  Difference in 
Social Security Number                            Employee Name                                                                          Previously Reported Wages Correctly Reported Wages                Excess Wages   Taxable Wages

                                                                                                                                    TOTAL
IF THE SPACE ABOVE IS INSUFFICIENT, YOU MAY ATTACH ADDITIONAL SHEETS OF PAPER WITH THE SAME HEADINGS.
IMPORTANT: Section 43:21-16(b)(1) of the New Jersey Unemployment Compensation Law provides penalties for false statements or misrepresentations made to avoid or reduce
any contributions required from an employing unit.

STATE OF                                                                                                                            I affirm that the foregoing statements are complete and true; that this
                       ss                                                                                                           Claim is just and correct and should be allowed; and that the wages on
COUNTY OF                                                                                                                           which refund is claimed were reported as taxable and contributions paid
                                                                                                                                    thereon to the New Jersey Employment Security Agency.

                                                                                                                                    Signature
Subscribed and sworn before me this                              day of                                                        20
                                                                                                                                    Official Position
                                                                                                                                    Telephone No.
                       Notary  Public
                                                                                                                                    APPROVED BY:
REFUND  $

                                      COMPLETION INSTRUCTIONS FOR UC-9 
                                                       
General Instructions 
  
The UC-9 must be completed to claim credit or refund by reason of erroneous payment of contributions  - UI, DI, 
WF and FLI. 
  
The New Jersey Unemployment Compensation Law (43: 21-14(f)) establishes a two-year Statute of Limitations for 
refunding any payments, even if the payment was remitted in error. 
  
In addition, the quarterly reports  - NJ927 and WR30 - must be amended on-line to reflect any reduction in gross 
and/or taxable wages.  The amended forms are located on-line at: 
https://www1.state.nj.us/TYTR_BusinessFilings/jsp/common/Login.jsp?processType=RETURN .
A refund check will be issued after all reports and form(s) have been submitted and audited. A refund check can 
not be issued if outstanding liability or reporting delinquencies exist on the account. A credit will be established and 
applied to the outstanding liability. 
  
Specific Instructions 
  
1.  The UC-9 must include the following information: 
  
  a.   Employer's Name, Address and Employer Identification Number (EIN). 
  b.   Amount of the claim. Each cell must be completed. 
  c.   Basis of Refund Request: State a detailed explanation for correction. 
  d.   The quarter in which the erroneous payment occurred.  If more than one quarter is to be corrected, a   
  separate UC-9 must be completed.  However, only one form must be notarized as long as all corrected 
  quarters are attached and submitted at the same time. 
  e.   Employee Social Security Number and Employee Name.  Please list only the employees whose wages are 
  being corrected and the appropriate figure in each of the columns. 
  f.    Worker contributions will not be included in your refund, unless you have reimbursed your employee(s) for 
  any deductions made from their wages in error. Please be certain to mark the appropriate blocks on the 
  form. 
  g.   Difference (increase (+) or decrease (-)) in excess wages as reported on the amended NJ-927. 
  h.   Difference (increase (+) or decrease (-)) in taxable wages as reported on the amended NJ-927. 
  
2.  The UC-9 must be signed, dated, notarized and returned to:   NJLWD, Division of Employer Accounts,    
     Refund Unit,PO Box 910,Trenton,NJ08625-0910.