Utah DWS Form 630, titled Employment Information, is the one-page form an employer completes whenever someone connected to an open Department of Workforce Services case starts a new job, returns from a leave of absence, or has a change in their employment terms. The employer fills in the whole form in black pen, both the employer and the customer sign it, and it goes to DWS by fax at 801-526-9500 or by mail to P.O. Box 143245, Salt Lake City, UT 84114-3245.
When You Need to Submit Form 630
Form 630 attaches to an active DWS case, which may involve unemployment insurance, public assistance, or another workforce services program. The form itself states that “for new, changes, and returning employment, the entire form must be completed and signed by the employer.” Three situations trigger it:
- A person on a DWS case starts a new job.
- An existing job’s terms change, such as a raise, a shift in hours, or a move from temporary to permanent.
- Someone returns to work after a leave of absence.
DWS uses the wage and schedule information on the form to adjust benefits, confirm eligibility, or close the case.
Completing the Employer Section
The top of the form captures the case name, case number, the employed person’s name, and their Social Security number. If your caseworker gave you a partially completed copy, those fields may already be filled in.
Below that, the employer provides:
- Company name.
- Corporate name, only if different from the company name (for example, a franchise under a parent corporation).
- Payroll company, if a third-party service handles wages; otherwise blank.
- Company address.
- A supervisor or HR contact with a phone number.
Make the contact information accurate. If DWS has a question about the form, they call the person listed here, and a bad number delays case processing.
The 14 Employee Questions
The 14 questions in the middle of the form are where accuracy matters most. Each one feeds into how DWS calculates benefits or determines eligibility.
Dates and Status
Question 1 asks for the date employment began, changed, or the employee returned to work. This is the single most important date on the form because it tells DWS when to start adjusting the case. Question 2 asks whether the position is temporary and, if so, the expected end date. Question 3 asks whether the job is educational work-study, which gets separate treatment under benefit calculations.
Wages and Hours
Question 4 asks for the pay rate, either an hourly wage or a salary with a checkbox for monthly or yearly. Question 5 asks whether weekly hours vary. If they do, enter the minimum and maximum hours per week; if hours are consistent, enter the fixed weekly total. Question 6 covers seasonal variation. If the employee works different hours in certain months (the form’s own example is a teacher who doesn’t work during summer), identify which months and the weekly hours during those periods. Question 7 covers overtime: whether it is offered regularly, typical weekly overtime hours, and the overtime rate.
Pay Schedule and First Paycheck
Question 8 asks how often the employee is paid: every two weeks, twice per month, weekly, monthly, or a custom schedule. For biweekly and semi-monthly pay, specify which days. Question 9 asks for the date of the first paycheck (received or expected), the estimated gross amount before taxes, and the hours covered by that check. Question 10 asks when pay periods end. Together these let DWS match reported earnings to the correct benefit weeks.
Extra Compensation and Benefits
Question 11 asks whether the job includes tips, commissions, a health savings account contribution, or shift differentials, with the amount and frequency. Question 12 covers bonuses, including holiday, profit-sharing, and performance bonuses, again with amount and frequency. Question 13 asks whether the employer offers health insurance and whether this employee is eligible to enroll; if not eligible, the employer explains why. Health insurance availability can affect eligibility for certain public assistance programs.
Termination
Question 14 applies only if the employee has already been terminated. It asks for the termination date and the date of the final paycheck. If the person is still employed, leave it blank.
Signatures
Both the employer and the customer sign and date the form. The employer’s signature carries real weight: the form warns that “additional verification will be required if employer does not sign form.” A missing employer signature won’t automatically reject the submission, but it will trigger extra steps that slow processing. If you’re the employee passing this form to your employer, make sure they sign before you return it.
Submitting the Form
The form offers two submission paths:
- By mail: Department of Workforce Services, Imaging Operations, P.O. Box 143245, Salt Lake City, UT 84114-3245.
- By fax: 801-526-9500 in the Salt Lake City area, or toll-free at 1-877-313-4717.
The employer can send it directly, or hand it back to the employee to deliver. Faxing tends to be faster because mailed documents are processed in batches at the imaging center. Keep a copy whichever way you send it.
Why the Details Matter
For employers, Utah Code 35A-4-204 requires that each employer furnish a report of an individual’s earnings within 48 hours of receiving a request from the division, on the form the division prescribes. Failure to comply can result in a penalty, collected the same way as unpaid unemployment insurance contributions. The information employers provide also feeds into their own experience rating, so inaccurate or late reporting can affect their contribution rate.
For employees, the numbers on Form 630 drive the benefit calculation. If you start new employment while receiving unemployment, DWS applies a 30 percent earnings allowance: you can earn up to 30 percent of your weekly benefit amount without reducing that week’s payment. Earnings above the allowance reduce benefits dollar for dollar, and working 40 or more hours in a week eliminates payment for that week entirely. Reporting hours and wages precisely is what keeps the calculation right.
Where to Get the Form
The current version, revised April 2020, is available as a PDF on the DWS forms page at jobs.utah.gov/customereducation/forms, listed as “Employment Information (630).” You can print it and fill it out by hand in black pen as the form directs, or your DWS caseworker may give you a copy with the case name and number already entered.