The Power of Attorney (Form MODES-4444) is the Wyoming Department of Workforce Services (DWS) form that lets a business appoint a representative to act for it before the Unemployment Tax Division. It covers unemployment insurance matters such as claims for adjustment of account and employer protests of benefit claims. Employers and the CPAs, payroll providers or other third parties who work for them use it. On FillingPDF you can fill out the form online and download or print the completed PDF; the original is published by the Wyoming DWS at the official source link.
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What is MODES-4444?
The Power of Attorney (Form MODES-4444) is a one-document appointment, issued by the Unemployment Tax Division of the Wyoming Department of Workforce Services, in which a business names a representative as its attorney(s)-in-fact for specific unemployment insurance matters.
The form has the business (taxpayer) identify itself with its FEIN, UI Tax Number and WC Account Number, then name the appointed representative. The appointment covers three things printed on the form:
- presenting completed forms, including claims for adjustment of account, employer's protest of benefit claims and related information;
- all matters affecting merit rating, contributions and/or direct reimbursements;
- personal discussion of those matters with proper officials of the Wyoming Unemployment Tax Division, Unemployment Insurance Division and the Workers' Safety and Compensation Division.
The form also states that the appointment supersedes and replaces any prior authorization the company filed with the agency. The business then initials one access level, which decides whether the representative receives tax mail, benefits mail, both, or has information-only access. Both the business and the appointed representative sign. This is a Wyoming agency form for unemployment insurance matters only; it is not a general-purpose power of attorney.
Who needs to file MODES-4444?
Wyoming employers (the "Business/Taxpayer" in Section I) that want someone else to handle their unemployment insurance matters with the Unemployment Tax Division complete this form and sign it through a business representative, with a printed name and title.
The appointed representative, such as a CPA, payroll provider or other third party, also takes part. Section IV requires the representative to sign a certification that they will represent the employer as a Third Party only, that the employer has established its own account in WYUI and requested an Association, and that the representative will access the employer's WYUI information and file quarterly reports only through their Third Party login.
The agency's Third Party and Payroll Provider FAQ adds that a third party servicing an employer account who wants to discuss that account with the Unemployment Tax Division needs a Power of Attorney on file. The FAQ also says CPAs sign up on the WYUI site as a Third Party, and that bulk upload requires registering as a Payroll Service; those are separate steps from this form.
When to file MODES-4444
Complete the form when you appoint a representative to act for the business before the Unemployment Tax Division. The Division's Third Party FAQ says a third party needs a Power of Attorney on file before discussing an employer account with the Division, so it should be submitted before the representative contacts the Division about that account.
The form prints no due date. Because it states that it supersedes and replaces any prior authorization the company filed with the agency, submit a new one whenever you want to change the representative or the access level you initialed, rather than relying on an earlier appointment.
How to fill out MODES-4444
Enter the business name and address
In Section I, Business/Taxpayer, enter the business Name, then the Address, City, State and ZIP Code.
Add the business identification numbers
Still in Section I, enter the Phone Number, FEIN, UI Tax Number and WC Account Number for the business.
Identify the appointed representative
In Section II, Does Hereby Appoint, enter the Name of Appointed Representative and Phone Number, then the representative's Address, City, State and ZIP Code.
Review the matters covered
Read the printed list of unemployment insurance matters the appointment covers. It also states that it supersedes and replaces any prior authorization your company filed with the agency.
Initial one access option
In Section III, Authorize Access, initial your choice: Tax Mailing Address, Benefits Mailing Address, Both, or Information Only. Under the first three, no correspondence of that type is mailed to you; under Information Only, all mail goes to your address.
Sign for the business
In the Signature of Business Representative/Taxpayer block, enter the printed name and title, then sign and date.
Have the representative complete Section IV
The appointed representative reads the Third Party certification, then enters a printed name and title, signs and dates.
Review and download the completed PDF
Check that every section is filled, one access option is initialed and both signature blocks are complete. Download or print the completed PDF from FillingPDF, then send it as described under How to submit.
How to submit MODES-4444
You return the completed form to the Unemployment Tax Division by mail or by fax. Section V of the form gives both:
- Mail: Unemployment Tax Division, PO Box 2760, Casper, Wyoming 82602.
- Fax: 307-235-3278.
The form's letterhead lists the Division's phone number as 307-235-3217. Before sending, make sure both signature blocks are complete: the business representative or taxpayer signs in the section for the business, and the appointed representative signs Section IV. The form names no online submission channel. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Not initialing any of the four access options in Section III (Tax Mailing Address, Benefits Mailing Address, Both, Information Only), when the form asks you to initial your choice.
- Choosing Tax Mailing Address, Benefits Mailing Address or Both without realizing that no correspondence of that type will then be mailed to the business.
- Choosing Information Only and expecting the representative to receive the mail; with that option all mail goes to the business address.
- Leaving Section IV unsigned. The appointed representative must sign the Third Party certification.
- Omitting the printed name, title, signature or date in the business representative's signature block.
- Having the representative access the employer's information any way other than their Third Party login, which Section IV says they will not do.
- Mailing or faxing the form somewhere other than the Unemployment Tax Division address or fax number printed in Section V.
- Assuming a new form is unnecessary when changing representatives, although the form states it replaces any prior authorization the company filed.
Frequently asked questions
What is the Wyoming Power of Attorney form MODES-4444?
Form MODES-4444 is the Wyoming Department of Workforce Services form that appoints a representative to act for a business before the Unemployment Tax Division on unemployment insurance matters, such as claims for adjustment of account, protests of benefit claims, merit rating and contributions.
Does a third party need a power of attorney to call the Unemployment Tax Division?
Yes. The DWS Third Party and Payroll Provider FAQ says a third party servicing an employer account must have a Power of Attorney on file to discuss that account with the Unemployment Tax Division.
What do the access options on the form mean?
Tax Mailing Address sends all Unemployment Tax account correspondence to your representative, and Benefits Mailing Address does the same for unemployment claims. Both covers each. With Information Only, all mail goes to you, and your representative can still view the account and file reports.
Where do I send Form MODES-4444?
Mail it to Unemployment Tax Division, PO Box 2760, Casper, Wyoming 82602, or fax it to 307-235-3278. These are the two channels printed in Section V of the form.
Who signs the Power of Attorney form?
Two people sign. A business representative signs for the taxpayer, with printed name and title. The appointed representative then signs Section IV, certifying they will act as a Third Party only and use their Third Party login in WYUI.
Does this form replace a previous authorization?
Yes. The form states that the appointment supersedes and replaces any prior authorization the company may have filed with the agency, so a new form is how you change your representative.
Do CPAs need anything besides this form to file for clients?
Yes. The agency's FAQ says a CPA should sign up on the WYUI site as a Third Party and will then be contacted about accessing client accounts. Section IV also says the employer must have its own WYUI account and have requested an Association.
Can I fill out the Wyoming power of attorney online on FillingPDF?
Yes. You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service, not affiliated with Wyoming DWS, and does not file the form; you mail or fax it to the Unemployment Tax Division.
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