Employer Forms

Request for Disclosure of Tax/Benefit Information (K-RM 002): Form used by employers or claimants to obtain information in their record with KDOL. Requires a signature and notarization.

Status Report (K-CNS 010): Regulations issued under the Kansas Employment Security Law provide, "Every employing unit for which services are performed in employment shall file a report to determine status within 15 days after such first employment." The purpose of the Status Report is to provide information for this agency to determine liability/non-liability under the statutes of the law. Complete in accordance with instructions. Be sure to include the Federal Identification Number and Social Security number of the owner, all partners or corporate officers. The form must be signed and dated on the back side.

Employer Account Record Change (K-CNS 0103): This form is used to notify the department when business operations change, such as selling all or part of the business or discontinuing business for any reason.

Employer Representation Authorization (K-CNS 032): If you are an accountant filing for an employer, also see the information found in How to File Unemployment Taxes Online: A guide for accountants filing for clients (K-CNS-P 104), which was designed to assist accountants and other third party administrators (TPAs) who wish to file quarterly unemployment wage reports for their clients.

Quarterly Wage Report and Unemployment Tax Return (K-CNS 100): At the end of each calendar quarter, the department mails a Quarterly Wage Report to every registered Kansas employer. The form is imprinted with the employer’s name, address, account number, tax rate, period involved and due date of the report. The form should be completed in accordance with instructions included in the packet. Be sure to include remittance for the full amount of monies due when filing our report. You may file this report online and submit payment electronically. Certain employers are required to file electronically.

Adjustment to Employer's Wage Report (K-CNS 111): Use this form to make an adjustment to a Quarterly Wage Report. 

Back Pay Award (K-BEN 3112): This form is used to notify the department if a claimant was awarded back pay.

Job Refusal Form – Employer (K-BEN 3119): This form is used to notify the department if a claimant was offered a job but the offer was turned down.

Drug and Alcohol Statement - Employer (K-BEN 319): This form is used to inform the department if a drug test was given to a claimant.

Reasonable Assurance Statement (K-BEN 3211): May be required if an unemployment claimant was employed by a school and has a "reasonable assurance" of returning to that employment in the next term.

New Hire Report (K-CNS 436): This form may be used to report required information about new hires at a Kansas business within 20 days of the hiring.


The following forms are mailed to employers and are not available for online download.

Notice of Benefit Charges (K-CNS 403): Each September, a Notice of Benefit Charges is mailed to all subject contributing employers. This is a statement of the pro rata share of benefit payments charged to an account during the fiscal year ended June 30. These benefit charges will be used in the computation of the contribution rate for the next calendar year.

Experience Rating Notice (K-CNS 404): Each December, an Experience Rating Notice is mailed to all subject contributing employers. This notice provides the experience rating computation and the resulting tax rate for the upcoming calendar year. A voluntary contribution computation is a part of the Experience Rating Notice. If you wish to make a voluntary contribution, return the lower portion to the administrative office along with the proper remittance for the option you select.

Nonmonetary Determination (K-BEN 4211): A Nonmonetary Determination is issued when there is a separation issue from the claimant's last employment, or if there is a current eligibility issue which affects benefit payments. The determination informs the claimant and the employer of a disqualification or clearance for benefit payments. Either party has 16 days to appeal the determination if they disagree. In addition, the charge or non-charge determination will appear at the bottom of a separation determination if the last employer is also a base period employer.

Employer Notice (K-BEN 44/45): When an unemployment claim is filed, an Employer Notice is mailed to all contributing and rated governmental base period employers and to the last employing unit that is an interested party to the claim. Complete and return the notice within 10 days, supplying the requested information, or to protest a claim or a potential charge as shown on the form.

Reconsidered Base Period Employer Determination (K-BEN 452): The Reconsidered Base Period Employer Notice is issued as a result of an employer requesting reconsideration on a K-BEN 44/45. This notice informs the employer of a reconsidered charge or non-charge. Once determined, the charge or non-charge remains in effect the entire benefit year unless appealed within 16 days.

Reimbursing Employer Notice (K-BEN 46): A Reimbursing Employer Notice is mailed to all base period reimbursing employers who are interested parties to an unemployment claim. Complete and return this notice within 10 days, supplying the requested information to protest the claim. Reimbursing employers are not eligible for a non-charge to their account.