establishing a benefit year and authorizing payment of UCX benefits under its UI law.

(o) Items 22-23. Complete items 22-23 based on the information contained in items 6 through 15 of this form. This information defines the service and wages assignable for the base and lag periods, as appropriate. When weeks of employment, or other employment information is necessary to a monetary determination, the State agency should adapt items 22-23 to record the necessary information.

Posting of the period of service and wages in these items is optional, if this information is included on the State agency’s monetary determination.

(p) Item 22. Enter the claimant’s monthly and daily wage rate. Calculate this information based on the claimant’s pay grade at the time of separation from the latest period of Federal military service. This rate applies to the calculation of all military wages to be recorded in item 23 even if the claimant held other pay grades during the period of military service recorded.

(q) Items 23a and 23b. Enter the quarter ending dates, number of months and days of military service and total UCX wages during each such quarter applicable to the first claim. A State may wish to preprint the month and month-ending date of the last month of each calendar quarter, omitting the year, in the space provided.

Calculate the claimant’s number of months and days of military service based on the information recorded in item 9 through 13 and total UCX wages based on the monthly and daily wage rate shown in item 22. (Employment and wages recorded for the lag period should be maintained for future use in determining base period employment and wages available for a subsequent benefit year.)

(r) Items 24a and 24b. Items 24a and b are for official use only and should only be completed on the State agency copies of this form. No entries will be made on the copy given to the claimant.

State agencies may use item 24a to record the claimant’s ethnic group by entering the appropriate code number shown below:


May 2003