Form J-3 Instructions

Unemployment Insurance Management System (K–12)

California Education Code Section 1330 requires the Superintendent of Public Instruction to apportion $2.00 per covered employee, less actual state administrative costs not to exceed $0.05 per covered employee, to the County Superintendents of Schools to cover costs of administering the Unemployment Insurance Management System. The Form J-3 and these instructions can be found on the California Department of Education web page at https://www.cde.ca.gov/fg/fo/r14/uims19rfa.asp.

Instructions

1. Fill in the county name and provide the County-District code numbers. Complete one form per county.
2. Report on Line 1 the total number of covered employees who worked during October 2019 for the county office and for any district (K–12) or charter school within the county participating in the School Employees Fund.
3. Counties that have prior year, October 2018, revisions should complete Lines 2a, 2b, and 2c.
4. Count each employee only once.
5. Do not count the following employees unless districts or counties have met requirements to cover them (refer to Unemployment Insurance Code Section 634.5 for further exclusions):
   • Students who are employed in schools and who are regularly attending classes at such schools.
   • Employees receiving work relief or work training.
   • Employees who are elected officials.
6. Do not include employees in Community College Districts. These employees should be reported on Form CCAF-351, which can be obtained from the Community College Chancellor’s Office by contacting April Lován-Martinez by phone at
   916-327-5355.
7. After County Superintendent’s review and approval, submit your signed Form J-3 on or before November 1, 2019, as outlined below:

Email Form J-3:
Scan your signed Form J-3 and email it to Tonya Holmes at tholmes@cde.ca.gov.

OR (Please submit only once.)

Mail Form J-3 to:

Tonya Holmes, Analyst
School Fiscal Services Division
Categorical Allocations and Management Assistance Office
California Department of Education
1430 N Street, Suite 3800
Sacramento, CA 95814