Note: Address change requests must be received in writing by IWD if form 68-0092 is submitted by email or mail.
Who Must Sign the Declaration?
1. Sole Proprietor
Must be signed by individual owner
2. Corporation or Association
Must be signed by an officer of the corporation or
association having authority to legally bind the
corporation or association. The corporation or
association must certify that the officer has such
authority.
3. Trust or Conservator
Must be signed by fiduciary authority
4. Partnership
Must be signed by all partners, or if executed in the
name of the partnership, by the partner or partners
duly authorized to act for the partnership, who must
certify that the partner(s) has such authority.
5. Limited Liability Corporation
Must be signed by a member of the LLC
Duration of Authority, Canceling or Withdrawing a
Declaration
The Declaration will remain in effect until revoked. The
employer can do this by logging into their account on
www.
myiowaui.org, select assign agent option, select the agent
you want to revoke and enter an end date. The employer,
Power of Attorney, or Authorized Representative can also
revoke the Declaration by notifying IWD in writing.
Submitting a New Declaration
A new Declaration revokes a prior Declaration for the
specified transactions. The Declaration becomes effective
the date it is received by IWD.
Submission Options:
• Online: www.myiowaui.org − Log into account,
select assign agent option, enter agent R number,
assign roles
• Email completed form:
IWDUITAX@IWD.IOWA.GOV
• Mail completed form: Iowa Workforce Development
UI Tax Bureau
1000 E Grand Ave
Des Moines IA 50319-0209
Iowa Workforce Development (IWD) will only discuss
confidential Unemployment Insurance (UI) information with
authorized parties. An employer must have a signed
Declaration of Power of Attorney or Authorized
Representative (herein after called Declaration) on file with
IWD.
Purpose of Declaration
A Declaration is a legal document authorizing someone else
to act on an employer's behalf.
Who Can Be Declared a Power of Attorney or
Authorized Representative?
•Attorney
•Accountant, Firm
•Tax preparer or
•Any individual acting on behalf of an employer.
Privileges of Both Power of Attorney and Authorized
Rep
Both are allowed to perform one or more of the following on
behalf of any employer:
•Sign and file reports for UI matters
•Make deposits and payments for UI
•Receive UI information, notices and other
communication regarding authorization granted
•Access electronic records specific to the employer
•Represent the employer in any formal or informal
meeting, hearing, decision or appeal, final or
otherwise.
Additional Privileges for Power of Attorney Only
The Authorized Representative cannot be granted the
following privileges:
•Enter into any compromise with IWD
•Execute any release from liability required by IWD as
a prerequisite to divulge otherwise confidential
information concerning the employer
•Other acts as expressly stipulated in writing by the
employer
Assign Agent Roles
As the true and lawful agent, you are able to represent the
employer in all roles or only the specific roles selected in
this section. See page 2 for description of roles.
Instructions
Power of Attorney or Authorized Representation may be assigned online at: www.myiowaui.org
Declaration of Power of Attorney or Authorized Representative
68-0092 (04-15)
