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Click ‘Get Form’ to open the UI-28 Refund Request Form in the editor.
Begin by entering your name and account number exactly as they appear on your contribution report. Ensure your current address is accurate, but remember that any address change must be updated separately.
In Item A, provide a detailed explanation of the overpayment. Include all relevant facts that support your request for an adjustment or refund. If more space is needed, attach additional sheets.
For Item B, enter the year applicable to your claim. Each calendar year requires a separate UI-28 form.
In Item C, list each payment for which you are requesting a refund. Fill in the date of payment, original amount, and amount to be refunded for each quarter.
Calculate and enter the total amount of your claim at the bottom of Item C. This should match the sum of amounts listed in the refund column.
Finally, sign and date the form where indicated. Ensure it is signed by an authorized individual from your organization.
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