The interactive sample form shown below will display a detailed description when you move your mouse cursor over each section. A complete description of all sections is provided beneath the form.
Notice to Base Period Employer: indicates an unemployment claim has been filed by an individual and you are a base period employer who reported wages that are being used to establish the claim.
Claimant: name of the individual filing for unemployment benefits.
Soc. Sec. #: provided by the individual at the time of claim filing.
Date: mailing date of the Notice to the Base Period Employer.
Effective Date: the effective date or beginning date of the claim.
Employer Acct #: your employer account number that you report the individual's wages under.
Base Period: in most circumstances, this will be the first four of the last five completed calendar quarters prior to an employee filing a valid claim for benefits; not the dates the claimant has worked. If you reported any wages during this base period, you will be notified that these wages are being used to establish a claim.
Employer name and address of record attached to the employer account number. If the address is incorrect or needs to be updated, the employer must contact 775-684-6300 or obtain an Employer's Report of Changes (NUCS-4074) on the employer website at https://uitax.nvdetr.org, General Services, Forms for Employers.
Return To: the mailing address to return the Notice to Base Period Employer; the Carson City address is for mailing purposes only.
Benefits for Which Claimant Is Eligible: benefit amount the individual is eligible to receive; Weekly Amount: the weekly amount the individual may receive each week; and Maximum Amount: the total amount of benefits the individual may be entitled to receive during the benefit year.
Potential Benefit Cost: For the benefit year listed, the employer's potential liability is the total dollar amount the employer may be charged for the claim. The percentage is the employer's percent of wages used in the base period. Base period employers are liable for their percentage of any benefits paid during the benefit year. As a contributory employer whose percentage is less than 75% of the total base period wages, you will not be entitled to a Ruling and you are liable to be charged your portion of benefits paid.
Your Reported Wages Are: The calendar quarters used to establish the claim for benefits. These wages have been reported quarterly by you and are used in establishing a claim for unemployment insurance.
This is an explanation regarding the only time you may protest any potential charges to your account. Generally, a base period employer who paid less than 75% of the total wages will not be entitled to a Ruling of charges. However, if the individual was discharged for a crime in connection with the work, supporting documentation is required for the wages to be removed from this claim. Exception: If you are the individual’s next to last employer and the individual’s reason for voluntary quitting employment was to solely accept work with their last employer, the employer account may be relieved of charges.
Statement: This area is for you to explain the details regarding why the individual was discharged for proven crimes in connection with the employment. If the space provided is not adequate, additional documentation can be attached along with any proof of the crime committed.
The Notice to Base Period Employer should only be completed, signed and returned by a company official if the individual was discharged for proven crimes in connection with the work. Proof must be attached.
If you should have additional questions regarding this notice, please call the number indicated on the form.
You may fax the notice to the fax number provided on the form. (E-mail responses can not be accepted at this time.)
A contact name must be provided. A Division Representative will speak with the contact person to obtain additional information.
An authorized company official must sign the notice and provide their title. The telephone number provided may be the contact name's number or your main number.
