Request for Payroll Information Forms

The Employment Insurance (EI) program provides temporary income support to unemployed people, and ensures that the premiums employers and employees pay are spent according to the requirements of the law.

As an employer, Service Canada may occasionally ask you to complete a Request for Payroll Information form. For some companies, this occurs several times a month. In these cases, completing several of these forms can be a very demanding manual task.

How to complete the Request for Payroll Information form (INS5097)

Section 126(14) of the Employment Insurance Act, gives Employment and Social Development Canada (ESDC) the authority to request information on named individuals from employers.

ESDC and Service Canada have created two programs that may reduce the number of Request for Payroll Information forms you receive, or help reduce the burden associated with completing them. If you are interested in finding out more, please visit the Automated Earnings Reporting System and the Report on Hirings program.

Please read through the instructions and guidelines below to ensure your Request for Payroll Information forms are completed as accurately as possible.

Side 1 - Block descriptions

Payroll Information form - Side 1 - Block descriptions
Image of front of form INS5097: description follows

Information block

The top of the Request for Payroll Information form 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.

Address block

The left-hand side of the address block displays your business address, and the right-hand side displays the address of the Service Canada Centre where the form is to be returned.

Once you have completed the form, please return it in the envelope provided, with the Service Canada Centre address displayed in the envelope window.

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 explain in the "Additional Information" section on side 2 of the form (for example, 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. You may have to obtain information from your time records.

Please return the form by the date requested. If you do not return it by that date, you could receive a second request.

Payroll data block

There are three sections in the payroll data block, and each section has three columns:

  • the first column is for office use only;
  • the second column shows the date of the Sunday of the week for which information is being requested (Please make sure that all earnings are reported on a calendar-week basis from Sunday to Saturday); and
  • you complete the third column by reporting all gross earnings, even if they are not insurable.

Note: The weeks requested are listed horizontally across the page - not vertically.

Message block

This block is used to ask you for more details or for an explanation about specific information. For example, if you issued a Record of Employment indicating the reason for separation as “Other,” we may ask you to provide an explanation in the Additional Information section on side 2 of the 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

Payroll Information form - Side 1 - Block descriptions
Image of back of form INS5097: description follows

Other monies paid block

Use this block to provide details about other monies that may have been paid to the employee during any of the weeks listed in the payroll data block. Other monies we ask you to report are listed on side 2 of the form.

Also 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, as they may be considered earnings for EI purposes.

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.

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.

Certification block

It is extremely important that you complete the certification block. This certifies that the information you have provided is correct, and it provides us with a contact person if we need additional information. Please make sure you sign the form and include your telephone number.

Available assistance

Two options are available to help reduce the burden associated with Request for Payroll Information forms.

The Automated Earnings Reporting System

If you have a Sunday-to-Saturday pay period or can report payroll data in this format, you can participate in the Automated Earnings Reporting by submitting your payroll information to Service Canada.

The Report on Hirings program

Regardless of pay period schedule, any business can participate in the Report on Hirings program by providing Service Canada with the Social Insurance Number and first day of work for new and recalled employees.

If you are already a registered user of one of the programs and are looking for assistance or technical support, please call the employer support team at 1-800-367-5693.

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