Employee Attestation Form. Web 3.0 completing section 1: Employer or authorized representative review and verification.
[PDF] Attestation Form PDF Download InstaPDF
The following attestations will be required for a complete claim submission: Web worker bonus (“hwb”) for the employer. Section 1 should never be completed before you have accepted a job offer. Employer information (to be completed by the employer) employer name: The employer must maintain contemporaneous records for all claims related information and any other data or documents used to demonstrate that an employee was eligible to receive such bonus, including but not limited to employee attestations. See specific eligibility requirements and claiming guidance available through the hwb webpage: Employer or authorized representative review and verification. ________________________ employer mmis (or sfs) number: Web you, the employee, must complete each field in section 1 as described below. An employee is not able to claim bonuses independently.
Employer attestation form (pdf) employee attestation form (pdf) Newly hired employees must complete and sign section 1 no later than the first day of employment. Web eligible employees must complete this employee attestation form in order to receive a bonus. Web qualified employers are required to claim the bonus on behalf of their employees. Employer or authorized representative review and verification. Web completing section 1, employee information and attestation. Web 3.0 completing section 1: Have the employee complete section 1 at the time of hire (by the first day the employee starts work for pay or other remuneration) by entering the correct information and signing and dating the form. Employer attestation form (pdf) employee attestation form (pdf) Web worker bonus (“hwb”) for the employer. The employer must maintain contemporaneous records for all claims related information and any other data or documents used to demonstrate that an employee was eligible to receive such bonus, including but not limited to employee attestations.
