Pa Form Uc-2b - Employer'S Report Of Employment And Business Changes - 2016
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1PA Form UC-2B 06-16, Employer’s Report of Employment and Business Changes
Complete this form to report any new or changed information about your business. Photocopy this form
or attach additional sheets if more space is needed. If this form is not used, detach it before returning
Forms UC-2 and UC-2A. Call the UC Employer Contact Center at 866-403-6163, which is staffed Monday
through Friday from 8:00 a.m. to 4:30 p.m. Eastern Time.
1. Enter the PA UC account number from Form UC-2.
2. Use the following chart to change any of the indicated items of information. Complete all sections of the chart that apply.
Form PA-100 must be completed to obtain a new account number if there has been a change in entity or legal structure.
Change
From
To
Reason for Change
Legal Name
Trade Name
Street Address
PO Box
City/State/Zip
FEIN
Telephone #
Other
3. To add another PA
business location, list the new address here:
4. Date wages last paid in PA.
If a date is entered in this field, the PA UC account listed above will be closed.
5. Date business discontinued in PA.
□
□
6. Did this business transfer all, or any part of, its PA business?...............................................................
Yes
No
□
□
7. Did this business acquire all, or any part of, another PA business?........................................................
Yes
No
□
□
8. Did this business transfer 51% or more of its PA assets?......................................................................
Yes
No
□
□
9. Did this business acquire 51% or more of the assets of another PA business?.......................................
Yes
No
□
□
10. Was this business, or any part of it, merged into another PA business?...............................................
Yes
No
□
□
11. Has any part of the workforce of this business been transferred to another PA business?.....................
Yes
No
12. If the answer to any question in items 6 through 11 is ‘Yes’, complete the following for the other entity involved in the transaction.
Legal Name
Trade Name
Telephone #
Street Address
City
Zip Code
State
If other than PA, list the primary location in PA.
13. Authorized signature for the entity listed in item 1 above.
Date
Print Name
Title
Telephone
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