Example: tourism industry

Instructions for the Information CLE Address/Phone Change …

New OLTL Employer Informational Packet Page 17 Version The Common Law Employer (CLE) must complete and submit the Address/Phone Change Form, to Public Partnerships, LLC (PPL) when a CLE address and phone contact Information has changed UPDATE QUALIFIED DCW Information 1. Select the Common Law Employer: Check the appropriate box to identify Who is acting as the CLE. 2. Select the Type of Change : Check all changes to either the CLE address , or phone number. 3. Participant PPL ID: Print or type the Participant PPL ID number to specifically identify the appropriate record to Change . 4. Common Law Employer address : Print or type the old and new address of the CLE in the space provided. 5. Common Law Employer Township/Borough/School District: Print or type the current township, borough, or school district in the space provided. 6. Common Law Employer phone Number: Print or type the old and new phone number of the in the space provided.

New OLTL Employer Informational Packet Page 18 Version 1.2 As a Common Law Employer in the Pennsylvania OLTL program, please complete this form when there is a change in your personal information.

Tags:

  Information, Change, Complete, Address, Phone, Address phone change

Information

Domain:

Source:

Link to this page:

Please notify us if you found a problem with this document:

Other abuse

Transcription of Instructions for the Information CLE Address/Phone Change …

1 New OLTL Employer Informational Packet Page 17 Version The Common Law Employer (CLE) must complete and submit the Address/Phone Change Form, to Public Partnerships, LLC (PPL) when a CLE address and phone contact Information has changed UPDATE QUALIFIED DCW Information 1. Select the Common Law Employer: Check the appropriate box to identify Who is acting as the CLE. 2. Select the Type of Change : Check all changes to either the CLE address , or phone number. 3. Participant PPL ID: Print or type the Participant PPL ID number to specifically identify the appropriate record to Change . 4. Common Law Employer address : Print or type the old and new address of the CLE in the space provided. 5. Common Law Employer Township/Borough/School District: Print or type the current township, borough, or school district in the space provided. 6. Common Law Employer phone Number: Print or type the old and new phone number of the in the space provided.

2 7. Common Law Employer Signature and Date: The CLE whose Information has changed must verify the new Information reported on the form by signing and dating the form in the space provided. Next Steps: Once the CLE has completed the form, signed and dated the form, as appropriate, it should be submitted to PPL within two (2) business day of the CLE being informed of any changes. If you have any questions, please contact one of our Customer Service Representatives at 1-877-908-1750. IInnssttrruuccttiioonnss ffoorr tthhee IInnffoorrmmaattiioonn CCLLEE AAddddrreessss//PPhhoonnee CChhaannggee FFoorrmm MAIL FORMS TO: PA OLTL PUBLIC PARTNERSHIPS, LLC BOX 1108 WILKES-BARRE, PA 18773-9905 New OLTL Employer Informational Packet Page 18 Version As a Common Law Employer in the Pennsylvania OLTL program, please complete this form when there is a Change in your personal Information . UPDATE COMMON LAW EMPLOYER (CLE) Information ( complete this section when there is a Change in the CLE s Information .)

3 Select the Common Law Employer: (check one box) Participant Designated Common Law Employer Check All Boxes for Changes that Apply: Change in address Change in phone Number Participant PPL ID: C_____ Previous address : _____ Previous City/State/Zip: _____ New address : _____ New City/State/Zip: _____ Previous TWP/Borough/School District: _____ New TWP/Borough/School District: _____ Previous phone Number: _____ New phone Number: _____ Common Law Employer Name (Print): _____ Common Law Employer Signature: _____ Date: _____ If you have any questions, please call PPL at 1-877-908-1750. CCoommmmoonn LLaaww EEmmppllooyyeerr AAddddrreessss//PPhhoonnee CChhaannggee FFoorrmm MAIL FORM TO: PA OLTL PUBLIC PARTNERSHIPS, LLC BOX 1108 WILKES-BARRE, PA 18773-9905


Related search queries