How to Fill Out the Tennessee Separation Notice (Form LB-0489)

Tennessee employers fill out the separation notice LB-0489 for every worker whose employment ends indefinitely or for seven days or more, and they must deliver the completed form to that worker within 24 hours of the separation.¹ The form feeds the facts the Tennessee Department of Labor and Workforce Development uses to decide whether the person qualifies for unemployment insurance benefits, so the details you write on it matter well beyond the paperwork itself.

When You Have to Issue One

The 24-hour clock starts at any separation that is indefinite or expected to last seven days or more.¹ Layoffs, firings, and resignations all qualify. Every Tennessee employer is covered; there is no small-business carve-out.

Two narrow exceptions. You do not need to issue a notice for a worker who was employed less than one week and is being separated for lack of work, unless the Department specifically asks for one.¹ And employers with a prior arrangement to submit separation data electronically, through a Mass Separation Notice, or through a Mail-in Claim can skip individual LB-0489s. Employers running frequent separations can contact the Department to set one of these up.

Getting the Form

LB-0489 is a fillable PDF on the Tennessee Department of Labor and Workforce Development site at tn.gov/workforce.² Type into the PDF before printing so everything is legible. The rule requires the Department’s own form; a substitute you built in-house is not compliant.

Employer Information

The bottom of the form is for the company. You will fill in:

The employer’s legal name as registered with the state.
An address the Department can use for follow-up.
Telephone number and email address.
Your eight-digit state employer account number (sometimes called the SEIN), which appears on your State Quarterly Wage Report (LB-0851) and Premium Report (LB-0456). If you cannot locate it, look for the correspondence the state sent when it first assigned your unemployment insurance account.³

Employee and Separation Details

The top of the form is where most of the work happens. Go in field order.

Field 1: employee’s first name, middle initial, and last name.
Field 2: Social Security Number.
Field 3: dates of employment. Enter the start date under “From” and the last day worked under “To,” both in mm/dd/yyyy format, plus the worker’s occupation or job title.
Field 4: where the work was performed. This is the physical location the employee worked at, not necessarily your headquarters.
Field 5: reason for separation. Check one box, Lack of Work, Discharge, or Quit. For Lack of Work, say whether the layoff is permanent or temporary and give a recall date if one exists. For a discharge or quit, describe the circumstances in the space provided.

Field 5 is the single most important entry on the form. The Department treats it as the starting point for the unemployment eligibility decision. Vague phrasing like “not a good fit” invites follow-up questions and delays. Write concrete facts instead: “position eliminated due to reduction in force,” “failed to report for three consecutive scheduled shifts,” “submitted written resignation effective June 15.” Say what happened. Skip commentary.

Wages in Lieu of Notice and Severance

Field 6 asks whether the employee received wages in lieu of notice or severance pay. Enter the dollar amount and the period each covers. These numbers matter because Tennessee law denies unemployment benefits for any week in which the claimant receives wages in lieu of notice equal to what they would have earned by staying on through a notice period.² The same rule reaches severance packages that include salary the employee would have received if still working. Leaving these fields blank when payment was actually made can create an overpayment the state later recovers from the worker.

Signing and Delivering the Form

The person who signs LB-0489 must be a company official or representative with firsthand knowledge of the separation.² In practice that is usually the direct supervisor or the HR representative involved in the decision, not a receptionist or a payroll clerk relaying the news secondhand. The signer certifies the information is true and correct, then adds a title and the date the form is released to the employee.

Delivery has to happen within 24 hours of the separation. The form’s certification language contemplates two methods: handing the notice directly to the worker or mailing it.² Hand delivery on the employee’s last day is safest because it removes any question about whether you met the deadline. If you mail it, use a service with tracking so you have a record.

What Happens After You Give the Form Out

You do not file the LB-0489 with the state. The employee keeps the completed form and presents it when they file for unemployment benefits. Claims are filed online at jobs4tn.gov, and the claimant may be asked to mail or fax the notice to Tennessee Claims Operations as part of processing.²

Once the claim is filed, the Department sends the employer a separate Request for Separation Information. That request is handled through the SIDES (State Information Data Exchange System) portal, not through the LB-0489.⁴ Employers or their third-party administrators log in with their FEIN, SEIN, and a four-digit PIN printed on the request letter.

You have seven days from the date the SIDES request is mailed to respond. If you miss the window and the Department later reverses an initial approval, the state will not require the claimant to pay back benefits already received. Those costs get charged to your employer account instead, which can raise your unemployment insurance tax rate.⁵ This is where a carefully filled-out LB-0489 pays off: the details you recorded on the form become your ready-made SIDES answer.

Keep a Copy

Tennessee requires employers to keep employment records, including separation notices, for at least seven years.⁶ File a copy of each LB-0489 in the employee’s personnel file along with their final payroll records.

1
Cornell Law – Legal Information Institute. Tennessee Comp R Regs 0800-09-01-.02 – Separation Notices To Be Furnished by the Employers
2
Tennessee Department of Labor and Workforce Development. LB-0489 Tennessee Separation Notice Form
3
Tennessee Department of Labor and Workforce Development. Tax and Insurance
4
Tennessee Department of Labor and Workforce Development. SIDES and SIDES E-Response
5
FindLaw. Tennessee Code Title 50 Employer and Employee 50-7-304
6
Cornell Law – Legal Information Institute. Tennessee Comp R Regs 0800-10-03-.10 – Records To Be Kept