Unemployment Insurance - Printable Forms
The following Unemployment Insurance forms are available in Adobe .pdf format*. The .pdf format will allow you to print the forms, fill them out and mail them back to the UI Division. Please note that printing and mailing claim forms will not establish a claim for Unemployment Insurance benefits. In order to file a claim for Unemployment Insurance benefits, you must call Telephone Claims at 605.626.3179.
UI Benefits Forms
UI Tax Forms
New Hire Forms
UI Overpayments (Benefit Payment Control) Forms
UI Appeals Forms
| UI Benefits Forms (in Adobe .pdf format* unless otherwise noted) | |
| Form 203M | Medical Statement of Ability to Work |
| Form 203MP | Medical Statement of Ability to Work, Pregnancy |
| Weekly Certification Payment Form | |
| The following forms can also be found in the back of the Facts About Unemployment Insurance (PAM247) booklet: | |
| Claimant Change of Name and Address Form | |
| Employer Contacts Form | |
| UI Tax Forms & Other Documents (in online-fillable Adobe .pdf format* unless otherwise noted) | |
| Form 1 (online-fillable) | Employer's Report to Determine Liability |
| Form 1 (print, then complete) | |
Form 1NP (online-fillable) |
Registration Report to Determine Liability for Nonprofit Organizations |
| Form 1NP (print, then complete) | |
| Form 1PS (online-fillable) | Registration Report to Determine Liability for Political Subdivisions |
| Form 1PS (print, then complete) | |
| Form 10 (Excel format) | Proposal for Payment |
| Form 10 (print, then complete) | |
| Form 21 (Excel format) |
Employer's Quarterly Contribution, Investment Fee and Wage Report |
| Form 21 (Adobe .pdf format) | |
| Form 21C (Excel format) | Statement to Correct Information Previously Submitted |
| Form 21C (Adobe .pdf format) | |
| Form 21D & E (Excel format) | Annual Employer's Contribution, Investment Fee and Wage Report |
| Form 21D & E (print, then complete) | |
| Form 23 (online-fillable) | Worker Relationship Questionnaire |
| Form 23 (print, then complete) | |
| Form 26 (online-fillable) | Application for Seasonal Designation |
| Form 26 (print, then complete) | |
| Form 49 (online-fillable) | Employers Report on Acquiring a Business |
| Form 49 (print, then complete) | |
| Form 55 (online-fillable) | Application for Exemption or Transfer of Liability |
| Form 55 (print, then complete) | |
| Form POA (online-fillable) | Power of Attorney/Authorization of Agent |
| Form POA (print, then complete) | |
| SIDES E-Response Registration Form | Register to participate in the State Information Data Exchange System (SIDES) E-Response |
| New Hire Division Forms (in Adobe .pdf format* unless otherwise noted) | |
| New Hire Reporting Form | New Hire Reporting Form (Can be filled in online, then printed and mailed or faxed in) |
| Multistate New Hire Reporting Form | Multistate Employer Application |
| UI Overpayments (Benefit Payment Control) Forms (in Adobe .pdf format* unless otherwise noted) | |
| Form NH-1 | New Hire Crossmatch |
| Form 222 | Quarterly Audit of Wages and Benefits Paid |
| Form 278 (online fillable) | Repayment Agreement |
| Form BPC-UID | Credit Card Authorization |
| Appeals Forms (in Adobe .pdf format* unless otherwise noted) | |
| Form UID-A1 | Appeal a UI Department Decision |
*Opening and printing Adobe .pdf files requires Adobe Acrobat Reader. Click here as needed to download the free Adobe Acrobat Reader.
700 Governors Drive
Pierre, SD 57501-2291
Tel. 605.773.3101
Fax. 605.773.6184
