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Unemployment Insurance (UI)
Forms
RA Benefits Forms
The RA Benefits forms available below are in Adobe PDF format.
| Direct Deposit Form |
| Medical Statement of Ability to Work |
| Weekly Request for Payment |
| Claimant Change of Name and Address Form Name and address may also be updated online at raclaims.sd.gov or by calling 605.626.2452. |
| Employer Contacts Form (Job Search Tracking Sheet) This form also in the back of the Facts About Reemployment Assistance (PAM247) booklet |
RA Tax Forms
You can complete most RA Tax forms online, then print and mail or fax.
Register Your Business |
TWO WAYS TO REGISTERRegister your business online and receive your account number and assigned rates immediately. Complete, print and mail |
Employer's Quarterly Report/Annual Contribution and Wage Report Forms |
| Online Employer’s Reemployment Assistance Quarterly Report Log in to File a Quarterly Report OR Print, complete and mail (Adobe PDF): |
| Correct Information Previously Submitted (Form 21C) Excel format | PDF format (print, then complete) |
| Employer’s Annual Contribution, Investment Fee and Wage Report (Form 21D and Form 21E):
Excel format | PDF Format (print, then complete) |
Additional RA Tax Forms |
| Application For Designation as Seasonal Employer (Form 26) |
| Application for Exemption or Transfer of Liability (Form 55) |
| Domestic Employer Application to Withdraw from Annual Wage and Contribution Reporting (Form WDE) |
| Domestic Employer Election to Report Quarterly Wages and Pay Contributions Annually (Form DE) |
| Employer's Report on Acquiring a Business (Form 49) |
| Payment Agreement (Form 10) |
| Power of Attorney/Authorization of Agent (Form POA) |
| Registration for State Information Data Exchange System (SIDES) E-Response (SIDES E-Response Registration Form) |
| Worker Relationship Questionnaire (Form 23) |
Overpayments Forms
| Credit Card Authorization Form (Adobe PDF - Print and mail or fax) |
| Report Fraud (Complete online and submit or print and mail or fax) |
Appeals Forms
Complete online, then print and mail or fax.
| Appeal of and Request for Hearing on Determination or Request for Waiver of Overpayment (Form UID-A1) |