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Declaration of Power of Attorney or Authorized Representative
68-0092 (07-16)
Instructions
Power of Attorney or Authorized Representation may be assigned online at: www.myiowaui.org
Iowa Workforce Development (IWD) will only discuss Who Must Sign the Declaration?
confidential Unemployment Insurance (UI) information with 1. Sole Proprietor
authorized parties. An employer must have a signed Must be signed by individual owner
Declaration of Power of Attorney or Authorized 2. Corporation or Association
Representative (herein after called Declaration) on file with Must be signed by an officer of the corporation or
IWD. association having authority to legally bind the
corporation or association. The corporation or
Purpose of Declaration association must certify that the officer has such
A Declaration is a legal document authorizing someone else authority.
to act on an employer's behalf. 3. Trust or Conservator
Must be signed by fiduciary authority
4. Partnership
Who Can Be Declared a Power of Attorney or Must be signed by all partners, or if executed in the
Authorized Representative? name of the partnership, by the partner or partners
·Attorney duly authorized to act for the partnership, who must
·Accountant, Firm certify that the partner(s) has such authority.
·Tax preparer or 5. Limited Liability Corporation
·Any individual acting on behalf of an employer. Must be signed by a member of the LLC
Privileges of Both Power of Attorney and Authorized Duration of Authority, Canceling or Withdrawing a
Rep Declaration
Both are allowed to perform one or more of the following on The Declaration will remain in effect until revoked. The
behalf of any employer: employer can do this by logging into their account on www.
·Sign and file reports for UI matters
myiowaui.org, select assign agent option, select the agent
·Make deposits and payments for UI
·Receive UI information, notices and other you want to revoke and enter an end date. The employer,
communication regarding authorization granted Power of Attorney, or Authorized Representative can also
·Access electronic records specific to the employer revoke the Declaration by notifying IWD in writing.
·Represent the employer in any formal or informal
meeting, hearing, decision or appeal, final or Submitting a New Declaration
otherwise. A new Declaration revokes a prior Declaration for the
specified transactions. The Declaration becomes effective
Additional Privileges for Power of Attorney Only the date it is received by IWD.
The Authorized Representative cannot be granted the
following privileges: Submission Options:
·Enter into any compromise with IWD
·Execute any release from liability required by IWD as · Online: www.myiowaui.org - Log into account,
a prerequisite to divulge otherwise confidential select assign agent option, enter agent R number,
information concerning the employer assign roles
·Other acts as expressly stipulated in writing by the
employer · Email completed form:
IWDUITAX@IWD.IOWA.GOV
Assign Agent Roles · Mail completed form: Iowa Workforce Development
As the true and lawful agent, you are able to represent the UI Tax Bureau
employer in all roles or only the specific roles selected in 1000 E Grand Ave
this section. See page 2 for description of roles. Des Moines IA 50319-0209
Note: Address change requests must be received in writing by IWD if form 68-0092 is submitted by email or mail.
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