Free UCT-28G - Florida

UCT-28G R.04/07 Page1

ElectionofPublicEmployerMethodofPayment UndertheFloridaUnemploymentCompensationLaw

Legal Entity:

Street Address: UT Account Number City, State ZIP:

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As a public employer defined in section 443.036(35), Florida Statutes, we hereby elect the option checked below as our method of paying for the unemployment benefits paid to our former employees. The method is to be effective

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1. ReimbursableMethod (a) As a newly liable employer we elect the reimbursable method of payment for unemployment compensation benefits. (b) As an already liable employer we elect to change from the tax rate method to the reimbursable method of payment for unemployment compensation benefits.

2. TaxRateMethod (a) As a newly liable employer we elect the tax rate method of payment for unemployment compensation benefits at the initial tax rate for a public employer. (b) As an already liable employer we elect to change from the reimbursable method of payment for unemployment compensation benefits to the tax rate method.

Readtheinformationonpagetwoofthisformcarefully beforeselectingamethodofpayment.

www.myflorida.com/dor

UCT-28G R.04/07 Page2

A public employer electing the tax rate method will be assigned the initial rate for the first year under this method. After the first year, you will be assigned a rate based on your own experience rate record and the adjustment factors defined in Section 443.1313(4)(b) of the Florida Statutes. The tax rate may vary from .0010 to .0540. A public employer changing from the reimbursable method to the tax rate method will be required to pay under both methods until wages paid under the reimbursable method are out of the base period of claims. Invoices for reimbursement will be due, if there are charges, as well as tax payments for the quarterly report. Each of the options is for a mandatory period of two calendar years. Written application to terminate one method and change to another must be received at least 30 days prior to January 1 of the year for which the election is to be effective. Under both payment methods, a quarterly report must be filed within 30 days following the end of each calendar quarter. Any report not filed or filed late will be assessed a $25.00 penalty for each month or portion of a month the report is late. Payment of tax is required with the quarterly report for the tax rate method of payment. Failure to pay timely results in an interest charge of 1% for each full month unpaid. Payment of amount due under the reimbursable method is required within 30 days of the date mailed, shown on the Quarterly Reimbursement Invoice (UCT-29).
Signature: M Title: M

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Telephone Number

Haveyoucheckedthepaymentoptiononthefrontofthisform? Forthisformtobevalid,theeffectivedateformethodofpayment andyoursignaturemustbeincluded.
Mailcompletedformto: Account Management Florida Department of Revenue PO Box 6510 Tallahassee FL 32314-6510 800-482-8293 or 850-487-8099

www.myflorida.com/dor