There is no need to return this form to the department if the claimant was separated due to a lack of work, did not receive any separation pay at the time of separation (vacation/wages in lieu of notice or severance pay), and the return to work date the claimant provided to us is correct according to your records. If you have any questions about completing the Request for Separation Information, you can call us toll free at 877-214-3331.

Section A

This section should be completed on all forms that are returned to us. Start and End dates of employment help us to gauge a claimant's experience in this position, which can be relevant in a separation determination. It also helps with the separation pay. On occasion we do find employer's who report all wages paid to date as "Wages in Lieu of Notice". "Wages in Lieu of Notice" is a payment an employer may make to compensate a worker when it has not been able to provide advance notice of a separation.

Hours worked, with an hours per day times the number of days per week, are needed for a correct allocation of separation pay. We have to allocate based on the customary work schedule, not just the total hours usually worked per week.

Pay Rate is needed for allocation of separation pay as well as determining the suitability of the work. Occupation is needed for suitable work as well as simply having a better understanding of what a person's job duties were in order to more accurately determine eligibility due to an adverse separation. Location is needed to determine commuting distance for suitable work.

Separation reason - vital on all claims. Most circumstances will match one of the choices on the form. If the "Other" box is marked a narrative is required. Please do not use "Other" if the separation is due to a "reorganization", "down sizing", "position elimination" or any of the other ways employer may indicate that it is a lack of work separation. These responses frequently result in the unnecessary delay of payments to claimants who are eligible. If "Still working Part-time or Hours Reduced" you must complete section E so we can determine the cause of the part-time status to evaluate for an availability issue or charge relief if appropriate.

Section B

Payment information is only necessary if the claimant has received any vacation pay, wages in lieu of notice, severance pay or is currently receiving a pension from the employer. These payments would be made at the time of separation, or if vacation pay was paid, but not used, within 4 weeks prior to the date of separation. We are asking for the gross dollar amount of each type of payment as well as the number of hours/weeks/etc that was paid.

Under Vermont Law, Severance pay is disqualifying unless the employer chooses to designate it as nondisqualifying remuneration. Please mark the appropriate box. Also, Combined Time Off (CTO) or

Earned Time Off (ETO) should be reported as vacation pay. Sick pay and holiday pay is not disqualifying under Vermont Law, so please do not include those figures.

Section C

If you have indicated in section A that the separation was due to a discharge, a specific statement regarding the cause of separation is required. Vague statements such as "Job Performance" will require us to do follow up contacts as we need to know the exact circumstances or failures in performance that lead to discharge. If there is supporting documentation, please provide it up front. Supporting documentation should include copies of written warnings, policies that the claimant is accused of violating, attendance records as appropriate and anything else the employer feels would support their decision to terminate employment. If the employer prefers not to provide information due to what it believes is in its best interest, please simply write, "Employer declines to provide specifics". That response is more accurate than "no protest". Please note that if you do that, however, we are likely to pay benefits.

Section D

If you have indicated in section A that the claimant has resigned, please provide whatever information you have available. If it was personal, indicate that. If it was a choice to resign or be discharged, Vermont considers this to be a discharge circumstance and would ask that you complete section C.

Section E

Under Vermont Law, we can evaluate the potential of charge relief for employers who have part-time employees who are filing for benefits. Section E helps us to understand what the hiring agreement was, if there has been any change in that agreement, and if there has been, what caused the change. We use this information to determine if availability issues need to be explored or if the employer would be entitled to relief. Completing all questions asked with specific information will help us to determine eligibility for the claimant as well as potential charge relief for the employer.