SHARED-WORK PLAN
Application to Modify Approved Shared-Work Plan |
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Employer Information
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Employer Name:
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Employer Account No.
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Street Address:
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City:
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State:
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Zip Code:
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Phone Number:
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Fax Number:
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Email:
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Plan No.:
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Affected Unit:
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The employer requests to modify the approved Shared-Work Plan identified above as follows:
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Change the number of weeks the Shared-Work Plan will be in effect from weeks to weeks. (The maximum duration of a shared work plan is 52 weeks.).
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Change the reduction percentage from percent to percent. (The reduction percentage must be no less than 20 percent and no more than 40 percent.)
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Add newly anticipated weeks during the effective period of the plan when participating employees' hours of work will be reduced by more than the reduction percentage due to holidays, designated vacation periods, equipment maintenance or other similar circumstances. The applicable dates are:
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Other. Explain:
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Employer Signature
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Date
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Send completed application to modify approved shared-work plan to the following address:
Office of UC Benefits
ATTN: Shared-Work
651 Boas St., Room 605
Harrisburg, PA 17121
877-785-1531
The decision to approve or disapprove modification of an approved Shared-Work Plan is a matter within the department's discretion. If the proposed modifications would cause the plan to violate the requirements of the UC Law, the department will disapprove the proposed modifications.
UC-1091 02-12
