Employment Insurance (EI) and How to complete the Request for Payroll Information form (INS5097)

As per Section 126(14) of the Employment Insurance Act, Human Resources and Skills Development Canada (HRSDC) has the authority to request information on named individuals.

This document has been created to assist employers with the completion of "Request for Payroll Information" forms sent by Human Resources and Skills Development Canada (HRSDC).

Instructions: A hand-shaped pointer shows up in each block of the form allowing you to click to access the detailed description at the bottom of the form.

INS 5097 - Side 1

INS 5097 - Side 2

Side 1 - Block descriptions

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1) The header information Block on the "Request for Payroll Information" — INS 5097 — provides you with:

The Program type;
The name of the employee/claimant;
The Badge or Payroll number of the employee;
The employee/claimant Social Insurance Number — SIN;
The date the form was prepared;
The date we expect your reply — BF;
The Benefit Period Commencement — BPC — date of the claim for EI Benefits in question;
A telephone number that you may call for assistance, usually of the person who sent you the form.

2) Address Block

On the left hand side of the address block, your address as employer should appear. On the right, the address of the local office where the form is to be returned will appear. With the form, you should have received a return envelope. Please ensure that the address of the local office appears in the return envelope window when returning the completed form.

3) Text Block

Please read the text very carefully. First you are asked to check the box YES or NO to the question "Did this person work and/or have earnings for the week(s) shown below?"

If the person worked during a period in which no earnings were paid, please enter a comment to clarify in the "Additional information" section on side 2 of the form, ie: salesperson. It is essential that you report all GROSS earnings on a CALENDAR WEEK basis — SUNDAY to SATURDAY. This is extremely important as EI Benefits are paid from Sunday to Saturday. This may necessitate that you obtain information from your time records.

Please, return the form by the date requested. If it is not returned by this date it could result in a second request being sent to you.

4) Payroll Data Block

There are 3 sections in the «Payroll Data» block, each with 3 columns:

1^st column is for office use only;
2^nd column shows the Sunday date of the week for which information is being requested. Please ensure that all earnings are reported on a calendar week basis from Sunday to Saturday;
3^rd column is to be completed by you. All gross earnings must be reported, even though they may not be insurable.

You will note that the weeks requested are listed horizontally across the page and not vertically.

5) Message Block

This block used to provide you with messages concerning specific information on which Human Resources and Skills Development Canada (HRSDC) needs clarification. Example: You issued a Record of Employment indicating that the reason for separation was «Other». Please provide an explanation in section 7 — Additional information — on side 2 of this form.

In cases where the reason for separation may be an issue, it is important that you provide all information leading to the employee’s termination.

Side 2 - Block descriptions

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6) Block on other Monies Paid

On side 2 of this form we are requesting that you provide details concerning "Other Monies" that may have been paid to the employee during any of the weeks listed in the "Payroll Data Blocks". A list of "Other Monies" types we ask you to report are also listed on side 2 of this form.

You are also asked to indicate whether any of those "Other Monies" were included in the gross earnings that you reported in the "Payroll Data Block".

It is important that you take the time to list and describe any additional monies paid; they may be considered earnings for the Employment Insurance purposes.

7) Additional Information Block

This space is reserved for you to report any information concerning the employee’s reason for separation. It should also be used to explain any additional earnings that may have been paid or to provide any other information that may assist us in protecting the integrity of the Employment Insurance Fund.

8) Privacy/Confidentiality of Information Block

This block provides you with information concerning the claimant’s right to access the information you are providing.

The information you provide is confidential. Its use is restricted to the administration of the Employment Insurance Act.

Your co-operation is essential in protecting the integrity of the Employment Insurance fund to which you are a contributor.

9) Certification Block

It is extremely important that you complete the certification block.

It not only provides us with the necessary certification that the information provided is correct, but provides us with a contact person should additional information be required. Please ensure that you sign the form and include your telephone number.

This is important, not only for Human Resources and Skills Development Canada (HRSDC), but for you, as it saves time, a valuable commodity in today’s limited resource environment.