What Form IA 12.3 Is For
Form IA 12.3, Record of Employment, is an official separation notice issued by the New York State Department of Labor (NYS DOL) that employers must provide to workers who leave their payroll. This mandatory form serves as written proof that an employee's job was covered by New York State Unemployment Insurance (UI) and provides essential information the worker needs to file a claim for unemployment benefits.
The form documents the employment relationship and gives separated employees critical details about their former employer, including the company name, New York State Employer Registration Number, Federal Employer Identification Number (FEIN), and the address where payroll records are maintained. While receiving this form does not automatically qualify a worker for benefits—the UI Claims Center makes that determination—it significantly streamlines the claims process by ensuring the employee has accurate employer information readily available.
Under New York State Labor Law regulations, employers have a legal obligation to provide this notice regardless of the reason for separation. Whether an employee quits voluntarily, is laid off temporarily or permanently, is discharged for cause, or has their hours reduced to 30 or fewer per week, they must receive Form IA 12.3. The requirement applies to all types of separations and work reductions that may trigger eligibility for full or partial unemployment benefits.
When You’d Use Form IA 12.3
Standard Separation Scenarios
Employers must provide Form IA 12.3 at the time of separation—meaning when the employee goes off the payroll. Timing is critical: the form should be given on the employee's last day of work or mailed immediately if the separation occurs remotely.
The requirement applies to:
- Permanent terminations
- Indefinite layoffs
- Temporary separations lasting seven days or more
- Voluntary resignations
- Discharges
- Reductions in hours to 30 or fewer per week
Partial Unemployment Situations (2023 Update)
The 2023 amendments expanded the requirement to include workers whose hours are reduced below 30 per week.
Special Employer Situations
- Seasonal employers must provide the form unless “reasonable assurance” exists
- Educational institutions may be exempt under academic assurance rules
- Temporary help firms must provide notice when gaps between assignments occur
Late or Corrected Forms
If an employer fails to provide Form IA 12.3 at the time of separation:
- Provide it immediately once discovered
- Issue corrected versions if errors exist
Key Rules or Details for 2013–2025
Mandatory Compliance
Providing Form IA 12.3 is required under Article 18 of New York State Labor Law.
Required Information Elements
The form must include:
- Employer’s legal name
- NY Employer Registration Number
- Payroll records address
- Instructions for filing UI claims
Distribution Requirements
The form must be:
- Handed directly
- Mailed
- Provided electronically (if applicable)
Employee Information Section
The employee completes:
- Name
- Social Security number
Universal Application
Applies to:
- Private businesses
- Nonprofits
- Government entities
- Agricultural and household employers
Record-Keeping
Employers should retain:
- Copies of forms
- Proof of delivery
- Records for at least four years
Step-by-Step (High Level)
Step 1: Obtain Official Forms
Request from NYS DOL via:
- Hotline
- Website
- Order system
Step 2: Identify Triggering Events
Monitor:
- Terminations
- Resignations
- Hour reductions
- Wage reductions
Step 3: Complete the Employer Section
Include:
- Legal name
- Registration number
- Payroll address
- FEIN
Step 4: Provide the Form to the Employee
- Deliver on last day or mail immediately
- Ensure employee understands its purpose
Step 5: Document Compliance
Maintain:
- Copy of form
- Delivery method record
Step 6: Respond to UI Inquiries
- Respond to DOL requests promptly
- Consider SIDES E-Response
Common Mistakes and How to Avoid Them
Mistake #1: Not Providing the Form for Voluntary Quits
How to Avoid: Train staff that all separations require the form.
Mistake #2: Forgetting About Partial Unemployment
How to Avoid: Provide the form when hours drop below 30.
Mistake #3: Using Unapproved or Outdated Forms
How to Avoid: Use current DOL-approved versions only.
Mistake #4: Providing Incomplete Employer Information
How to Avoid: Pre-fill templates and double-check entries.
Mistake #5: Delaying Distribution
How to Avoid: Make the form part of your separation checklist.
Mistake #6: Assuming Small Employers Are Exempt
How to Avoid: Understand all covered employers must comply.
Mistake #7: Poor Record-Keeping
How to Avoid: Maintain copies and delivery logs.
What Happens After You File
Immediate Employee Actions
Employees:
- Complete their portion
- File claims online or by phone
Department of Labor Processing
The DOL:
- Verifies employment
- Matches wage records
Employer Notification and Response
Employers receive:
- Request for Separation Information
- Typically must respond within 10 days
Benefit Determination
Eligibility depends on:
- Separation reason
- Work history
- Earnings
Charging Your Account
Approved benefits may:
- Affect your UI tax rate
- Be excluded in certain cases
Appeal Rights
Employers can:
- Request hearings
- Challenge determinations
Ongoing Obligations
Continue:
- Responding to DOL requests
- Maintaining accurate records
FAQs
Is this form required for employees who quit or resign voluntarily?
Yes, absolutely. New York law requires employers to provide Form IA 12.3 to every employee who separates from employment, regardless of whether the separation was employer-initiated or employee-initiated. Even when an employee voluntarily resigns, quits, or retires, you must give them the completed form.
What if an employee only has their hours reduced but doesn't actually leave the job entirely?
You must still provide Form IA 12.3 if the hour reduction drops the employee below 30 hours per week or reduces their weekly earnings below the state's maximum benefit rate.
Can I create my own version of this form or use a general separation letter instead?
No, unless you have obtained written approval from the New York State Department of Labor.
What happens if I forget to give an employee Form IA 12.3 when they separate?
Provide it immediately once you realize the oversight. Delays can create compliance and employee claim issues.
Are there any employers exempt from this requirement?
No. There is no small business exemption if you are subject to NY UI law.
Do I need to provide this form to seasonal employees?
Yes, unless reasonable assurance of re-employment exists.
Do staffing agencies need to provide this form between assignments?
Yes, if there is a gap that results in unemployment.
