FORM 132 Domestic                                *F132D0121*
EMPLOYER NAME:
                                   EMPLOYEE DETAIL REPORT                                       F132D0121
                                   ENCLOSE WITH FORM OA
                                                                                   Business                        Qtr/YrIdentification Number 

1. TOTAL UI SUBJECT WAGES                                                          Date Received

         2. Social  First          3. Employee Last 4. Whole Hours    5. Total UI               6. State Withholding
   Security Number Initial         Name                Worked         Subject  Wages            Taxes
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

                                   7. Column Totals

  NOTE:  All employers who pay Unemployment Insurance tax or reimburse the Employment Department for 
  unemployment benefits paid and/or withhold State taxes must complete this form.  Pursuant to ORS 657.571, 
  failure to report all employees with correct Social Security numbers, failure to accurately report whole hours 
  worked (no fractions or decimals), failure to report UI subject wages, and/or State Withholding taxes may result 
  in penalties.           DO NOT SUBMIT PHOTOCOPIED FORMS
                                                                                                012021

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