Designation of Authorized Agent
for
Unemployment Insurance Tax and Benefits
This form must be completed, signed and returned to Idaho Department of Labor to get access to Employer
Account information for the Account listed below. This completed Authorization Form may be returned as an
attachment using the Employer Portal messaging system or FAXED to 208-334-6301.
Employer Information
State Employer Account # ___________________________________
Federal Employer Identification #_____________________________
Legal Business Name: _______________________________________________________________________
Doing Business As: __________________________________________________________________________
Employer Portal User Information
User’s email: ____________________________________ Name: ___________________________________
Address & Phone # __________________________________________________________________________
User’s Signature ____________________________________________________________
Check all that apply:
____Administrator – Controls user access to the employer account and has all the permissions listed below.
____Manage UI Tax Filing – Report and pay UI taxes on line.
____Manage Tax Addresses – Maintains the address for tax notices.
____Manage Benefit Addresses – Maintains benefit addresses for separation statements.
____Manage Also Known As – Maintains employer names for use with benefit claims.
____Manage Separations – Reports employee separations to the department.
____View Benefit Charge Statements – View current and past Benefit Charge Statements.
____Manage Contacts – Keep Tax and Benefit contacts current.
_______________________________________ __________________ ________________
Signature of Employer Title Phone
208-332-3576 or 800-448-2977
