Fillable Form PA-100 must be completed to obtain a (Pennsylvania)

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Form PA-100 must be completed to obtain a (Pennsylvania)

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The Form PA-100 must be completed to obtain a (Pennsylvania) form is 1 page long and contains:

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  • 2 check-boxes
  • 51 other fields

Country of origin: US
File type: PDF

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PA Form UC-2B REV 07-21, Employer’s Report of Employment and Business Changes
Complete this form to report any new or changed informaon about your business. Photocopy
this form or aach addional sheets if more space is needed.
1. Enter the PA UC account number from Form UC-2.
2. Use the following chart to change any of the indicated items of informaon. Complete all secons of the chart that apply.
Form PA-100 must be completed to obtain a new account number if there has been a change in enty 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 locaon, provide the new address here:
4. Date wages last paid in PA. . If a date is entered in this eld, the PA UC account listed above will be closed.
5. Date business disconnued 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 queson in items 6 through 11 is ‘Yes’, complete the following for the other enty involved in the transacon.
Legal Name: Trade Name: Telephone #:
Successor’s PA UC account number (If known):
Successor’s FEIN (If known):
Street Address: City: Zip Code:
State: If other than PA, provide the primary locaon in PA.:
13. Authorized signature for the enty listed in item 1 above: Date:
Print Name: Title: Telephone #:
Auxiliary aids and services are available upon request to individuals with disabilies.
Equal Opportunity Employer/Program
UC-2B REV 07-21
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Form PA-100 must be completed to obtain a (Pennsylvania)

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Completed 4 January 2022

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