PA Form UC-2A, Employer’s Quarterly Report of Wages Paid to Each Employee 

See instructions on form UC-2INS. 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                                    SAMPLE                                                                SAMPLE 
Typed: 123456.00                 .        Handwritten:      1  2   3  4   5  6  .    0  0                       Filled-In: 
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           M M  /  D D  /  Y Y      Y Y 

1. Name and telephone number of preparer                    2. Total number of                3. Total number of employees listed           4. Plant number 
                                                             Pages in this report  in item 8 on all pages of Form UC-2A                         (if approved) 

5. Gross wages, MUST agree with item 2 on UC-2                   6. Fill in this circle if you would like the             
and the sum of item 11 on all pages of Form UC-2A                                     Department to preprint your employee’s 
                                                                                       names & SSNs on Form UC-2A next  
                        .                                                             quarter 
                                                                                                 RESET FORM                                 PRINT FORM
7. Employee’s           8. Employee’s name                                                                      9. Gross wages paid this quarter 10. Credit
 Social Security Number  Fl            MI                                        LAST                           Example:  123456.00              weeks 

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List any additional employees on continuation sheets in the required format (see instructions). 
              11. Total gross wages for this page:                                                                                          . 
              12. Total number of employees for this page: 
              UC-2A REV 07-21 
                                                   13. Page             of                       RESET FORM                                 PRINT FORM