Download - 123456.00 1 2 3 4 5 6 0 Handwritten · Example: 123456.00 PA Form UC-2A Supplement, Employer’s Quarterly Report of Wages Paid to Each Employee Information MUST be typewritten or

PA Form UC-2A Supplement, Employer’s Quarterly Report of Wages Paid to Each Employee Information MUST be typewritten or printed in BLACK ink. Do NOT use commas ( , ) or dollar signs ( $ ). If typed, disregard verticalbars and type a consecutive string of characters. If hand printed, print in CAPS and within the boxes as below:

SAMPLE 123456.00 SAMPLE Typed: Handwritten: 1 2 3 4 5 6 0 0

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 MM / DD / YYYY

7. Employee’s social security number

8. Employee’s name FI MI LAST

9. Gross wages paid this quarterExample: 123456.00

10. Credit weeks

11. Total gross wages for this page:

12. Total number of employees for this page:

13. Page of UC-2AS REV 06-16