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Reemployment Assistance (RA)
RA Benefits Forms
The RA Benefits forms available below are in Adobe PDF format.
Employee/Claimant Benefit Forms
Weekly Request for Payment for Regular RA and PEUC Claimants (Print and fill out) — Preferred and faster methods for submitting weekly requests: online at RAClaims.sd.gov or through the automated phone system at 605.626.3212.
(PUA Claimants, use the PUA form below)
You may use this form for backdate and late payment requests as well for regular RA benefits and PEUC. Complete one form for each week you are requesting back pay and the RA Division will review to determine eligibility. Back date and late payment requests cannot be done online or through the automated phone system.
| PUA Weekly Request for Payment (Print and fill out) — File online at RAClaims.sd.gov for preferred and faster method of submitting weekly requests. The automated phone system is not available for PUA Weekly Requests for Payment; If unable to file online, fill out this form.
(PUA claimants who submitted the regular RA claimant form prior to June 6, 2020, do not need to resubmit this form for those weeks.)
|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.
|Direct Deposit Form|
|Employer Contacts Form (Job Search Tracking Sheet)
This form also in the back of the Facts About Reemployment Assistance (PAM247) booklet
|Medical Statement of Ability to Work|
|Overpayments and Appeals forms|
|Employee Recall Date Form
Employers who have furloughed employees and will be recalling them, please provide recall dates if you have not already done so. You may also call 605.626.2452 with this information.
|Employer Reporting Refusal of Suitable Work (Open this form in an Adobe reader program to complete. Changes made in your internet browser will not save.)|
RA Tax Forms
You can complete most RA Tax forms online, then print and mail or fax.
Register Your Business
TWO WAYS TO REGISTER
Register 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
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)|
See Appeals and Waiver section to request an appeal of an overpayment determination or if you've been determined not at fault and wish to request a financial waiver.
|Credit Card Authorization Form (Adobe PDF — Print and mail or fax)|
|Report Fraud (Complete online and submit or print and mail or fax)|
Appeals and Waiver Forms
Open forms in an Adobe reader program to complete. Changes made in your internet browser may not save. Then print, sign, and mail, fax or drop off at your Job Service office. We cannot accept appeals or waiver requests over the phone or by email.
|Appeal Request (Adobe PDF — Print and mail or fax)
Complete this form if you disagree with a determination made by the Division and are requesting a hearing or have an overpayment determination that puts you at fault, and you would like to request a review of that determination. You may also request a financial waiver.
|Request for Financial Waiver of Overpayment (Adobe PDF — Print and mail or fax)
Complete this form if you have an overpayment and it has been determined you are not at fault, and you would like to request a financial waiver.
View Family Income Table for Overpayment Waiver Provision
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