NY Form IA 12.3 Record of Employment: How to Complete and Provide It

New York Form IA 12.3, the Record of Employment, is a one-page certificate that every New York employer must complete and hand to a worker at the moment employment ends or hours are cut. The worker keeps it and brings it along when filing for unemployment insurance. Nothing about this particular form is mailed back to the Department of Labor — it travels with the employee.¹

The form itself is short. Getting it right still matters, because the identifying numbers on it are what link the claim the worker files to your account at the Department of Labor, and the benefits eventually charged against that account feed into your future unemployment insurance tax rate.²

When You Have to Give the Form

The Department of Labor requires an IA 12.3 whenever employment is interrupted in a way that could make the worker eligible for full or partial benefits.³ In practice that covers:

Layoffs, position eliminations, and terminations, whether permanent or indefinite.
Voluntary resignations, regardless of the reason the worker gives.
Furloughs and temporary layoffs with no set return date.
Reductions in hours that could qualify the worker for partial unemployment benefits.
Any other break in continuous employment.

Hand the completed certificate to the worker at the time of separation. Some employers keep a stack of blank copies at the ready so a supervisor can fill one out during the exit meeting rather than trying to mail it after the fact. The form is available as a downloadable document from the Department of Labor.⁴

A note printed on the certificate itself tells the worker that holding an IA 12.3 does not guarantee they will receive benefits; the UI Claims Center makes that determination separately.¹

How to Fill Out Each Field

The employer completes the top of the form. The worker fills in their own name and Social Security number. Each field on the certificate asks for the following:¹

Date given to the employee — the calendar date you hand over the form.
NYS Employer Registration Number — your eight-digit state registration number, the same one that appears on all of your correspondence with the Department of Labor.⁵
Federal Employer Identification Number — your IRS-issued FEIN.
Employer name and address — the legal business name and mailing address.
Payroll records location — the physical address where payroll records are kept, if different from the main business address.
Payroll or clock number — your internal identifier for the worker, such as a payroll ID or time-clock number.
Location of employment or code — the worksite the employee was assigned to, or an internal location code for it.
Employee name and Social Security number — completed by the worker.

The identifying numbers are the fields to double-check. If the state registration number or FEIN is wrong, the Claims Center may struggle to match the certificate to your account, which delays the worker’s claim and complicates the response you will eventually be asked to give.

What Happens After You Hand the Form Over

The IA 12.3 stays with the employee. When they file a claim, the Department of Labor opens a separate inquiry with you and sends a request for information to the employer address on its file. That request covers wages, dates of employment, and the circumstances of the separation. It is a different document from the IA 12.3 and carries its own deadline: you have 10 days from the mailing date on the DOL request to respond. Miss it and the state can issue a determination based only on what the claimant reported.

Employers registered on the state’s Online Services for Employers portal can respond to these inquiries electronically, which is faster than paper and creates a timestamped record that you met the deadline.⁶

The DOL’s follow-up inquiry is also where the separation reason is captured — lack of work, discharge, or voluntary quit. The IA 12.3 itself does not include checkboxes for these categories; it is purely an identifying record. The characterization of the separation happens on the state’s inquiry form, and it is what drives the eligibility decision. If a claim is approved, you will later receive a Notice of Experience Rating Charge showing how benefits paid to the former worker affect your UI tax rate.²

Why Accuracy on the Form Matters

New York operates an experience-rated unemployment insurance system, meaning every dollar of benefits charged to your account feeds into next year’s contribution rate.⁷ The IA 12.3 is what connects a claim to the right account. A missing form, a wrong registration number, or a garbled FEIN can push a claim into a slower manual review, and slower reviews leave less time for the employer to respond with the information that would have supported a denial.

Two habits pay off. Fill out the form in front of the worker, not after they leave the building, so the numbers can be verified against your payroll system while there is still time to correct a typo. Keep a copy for your records before you hand the original over. If a claim later goes to a hearing, the copy in your file is the cleanest proof that you complied with the notice requirement at separation.

Keeping a Copy on File

New York Labor Law Section 575 requires every employer to maintain accurate records of each worker, including name, Social Security number, and pay for each period, and to make those records available for inspection by the Department of Labor. Regulations set a three-year retention minimum for those records. Willfully filing false records under Section 575 is a misdemeanor.⁸

Keeping the IA 12.3 copy longer than three years is worth doing. Unemployment claims, audits, and appeals can surface well after a worker leaves, and the employer who can produce the signed form, the payroll history, and any relevant policy acknowledgments is in a much stronger position than one reconstructing the file from memory. Organize the copies so a specific worker’s file can be pulled quickly; the timelines on DOL inquiries and hearing notices do not leave room for a long search.

1
New York State Department of Labor. IA 12.3 Record of Employment
2
Department of Labor. Your Notice of Experience Rating Charges
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New York State Department of Labor. Notice of Eligibility for UI Benefits
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New York State Department of Labor. Record of Employment
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New York State Department of Labor. Register for Unemployment Insurance
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New York State Department of Labor. Online Services for Employers
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Department of Labor. Unemployment Insurance Rate Information
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New York State Senate. New York Labor Code 575 – Maintenance, Audit, and Report of Remuneration and Employment Records