How to Fill Out and Submit Utah Form 631: Employer’s DWS Response

Utah Form 631 is a Department of Workforce Services (DWS) document called “Employment Termination/Leave of Absence” that an employer fills out to confirm you have lost your job or had your work hours reduced. DWS uses it to update an existing public benefits case, not to decide unemployment insurance claims.¹ The form captures your final pay, whether continued insurance is available, and any retirement benefits, so your eligibility worker can reassess the case.²

When DWS Asks for Form 631

Two events trigger the form: you lost your job (quit, fired, or laid off), or your hours were cut. If you already have a DWS benefits case and you report either change, expect to be asked for a completed 631.²

The form is tied to an existing case. You will need your case name and case number before you start, and if you do not have a DWS case, Form 631 is probably not what you are looking for. Filing an unemployment insurance claim in Utah is a separate process handled through the myCase portal.³

Where to Get the Form

The current PDF is a free download from the DWS forms page at jobs.utah.gov/forms/631.pdf.⁴ Print it and complete it by hand. Your DWS eligibility worker can also hand you a copy if the office asks for one.

How to Fill Out Form 631

The form runs one page and has three parts: case identification at the top, employer and employment details in the middle, and signatures at the bottom. Both you (the “customer” on the form) and your employer have to sign it. The usual sequence is to fill in the case information yourself, take the form to your employer or HR department to complete the employment details, then both sign.¹

Case Information

Four fields identify the case:

Case name — the name on your DWS case, usually yours or a household member’s.
Case number — assigned by DWS when the case was opened.
Employed person — the name of the person whose job or hours changed, which may not be the case name if the case belongs to a spouse or parent.
SSN — the Social Security number of the employed person.

Employer Information

Your employer fills in the company name, a separate corporate name if the business operates under a parent corporation, a payroll company name if a third-party service handles wages, the full company address, and a supervisor or HR contact name and phone number DWS can call to verify anything.

Employment and Pay (Lines 1–6)

Lines 1 through 6 lay out the financial picture:

Line 1 — average hours worked per week and the hourly wage.
Line 2 — date of hire and last day worked.
Line 3 — the date the final paycheck is available.
Line 4 — the gross amount of the final paycheck, before taxes.
Line 5 — total gross pay for the entire month the final check was received. This is the full month’s earnings, not the last check alone.
Line 6 — any severance or vacation pay paid separately from the final check, with the dollar amount and date received.

These numbers should come from payroll records. DWS relies on them to assess income during the transition, and estimates can create problems for the case.

Reason for Leaving and Leave Details (Lines 7–8)

Line 7 asks the employer to check one reason and give a short explanation: quit (with the reason you gave), laid off (with the date), fired (with the reason), leave of absence (with expected length), or other. Line 8 asks whether the separation is temporary. If it is, the employer notes when you are expected to return and whether you will receive any pay during the leave. A temporary separation with continuing pay is treated differently from a permanent job loss.

Insurance and Retirement (Lines 9–10)

Line 9 asks whether continued medical insurance is available. If COBRA or another continuation option is offered, the employer enters the insurance carrier, group number, policy number, and COBRA premium. DWS uses this to decide whether you need coverage through a public program. Line 10 asks whether you have retirement or 401(k) benefits and, if so, the dollar value. Account numbers are not required.

Comments and Signatures (Line 11)

Line 11 is an open field for anything that does not fit the other boxes, such as eligibility for rehire, a pending dispute, or a reduction in hours rather than full termination. Both employer and customer sign and date at the bottom. The form warns that additional verification will be required if the employer does not sign, so getting the signature before submitting avoids follow-up requests.¹

Where to Submit It

Once both parties have signed, send the form to DWS Eligibility Services one of three ways:⁵

Mail — Imaging Operations, P.O. Box 143245, Salt Lake City, UT 84114-3245.
Fax in the Salt Lake area — 801-526-9500.
Toll-free fax — 1-877-313-4717.

Faxing is faster and gives you a transmission confirmation. If you mail it and a benefits deadline is close, use a trackable method so you have proof of the send date.

What Happens Next

DWS reviews the form as part of your case. The reason for separation, final pay, and insurance continuation drive the eligibility determination for whichever program your case covers. If a field is blank or the employer’s signature is missing, expect DWS to contact you or the employer before the case moves forward. To check on a pending case or confirm the form arrived, call Eligibility Services at 801-526-0950 in the Salt Lake area or 1-866-435-7414 toll-free.⁵

Mistakes That Slow the Case

A few errors come up repeatedly:

Missing case number. Without it, DWS cannot match the form to your file. Call Eligibility Services first if you don’t know it.
Putting the same figure on Line 4 and Line 5. Line 4 is the final paycheck only; Line 5 is total gross pay for the whole month that check landed in. Matching numbers usually triggers a follow-up.
Leaving Line 9 blank when insurance continuation exists. Even if you know you cannot afford COBRA, the employer should still fill in the carrier, group and policy numbers, and premium. A blank forces DWS to investigate on its own.
No employer signature. The form itself warns that additional verification kicks in without it. Get the signature before you submit.

Form 631 Is Not an Unemployment Claim

The form states on its face that it is not used to determine unemployment insurance eligibility.¹ If you want to file for unemployment in Utah, that goes through the DWS myCase portal or the unemployment insurance division directly. Employers report wages and separation reasons to the UI system as part of that claim, not through Form 631.³ If DWS needs a 631 for your benefits case and you also want unemployment, you have to do both.

1
Utah Department of Workforce Services. Utah Department of Workforce Services Form 631 – Employment Termination/Leave of Absence
2
Brigham Young University Human Resources. Department of Workforce Services Employment Termination
3
Utah Department of Workforce Services. UI Claimant Guide
4
Utah Department of Workforce Services. Forms – Workforce Services
5
Utah Department of Workforce Services. Eligibility Services – Workforce Services