(b) Each covered employer whose provision for disability benefits utilizes the allocation clause set forth in the last sentence of subdivision 2 of section 204 (of the Workers' Compensation Law) shall, through appropriate means, advise his employees as to which of the following alternative methods of adjustment such employer has elected to follow:

1. (1) The contributions of employees engaged in concurrent employment may be currently adjusted with respect to deduction for each payroll period as follows:

   1. (i) Each employee engaged in concurrent employment shall furnish his employer with a statement of his concurrent employment and of his approximate earnings with each employer for whom he is concurrently performing services. The employee shall file a new statement within one month after any significant change in his earnings with one or more of the employers, and any employer to whom such a statement has once been furnished may subsequently require the employee to file a new statement not more frequently than once a month.

   2. (ii) Each covered employer (hereinafter referred to as the adjusting employer) whose provision for disability benefits utilizes the allocation clause set forth in the last sentence of subdivision 2 of section 204 (of the Workers' Compensation Law) shall, upon receipt of such a statement, adjust the maximum contributions required of the employee by such employer with respect to pay periods beginning thereafter in accordance with the following schedule:

      The adjusted maximum contribution required of an employee by the adjusting employer shall not exceed the appropriate amount set forth in column B following on the same horizontal line on which in column A there appears the adjusting employer's percentage. The adjusting employer's percentage shall be computed by dividing the employee's average weekly wages or normal earnings with such employer by the total of the employee's average weekly wages or normal earnings in respect to all covered employers.

      A	B
      Adjusting Employer's percentage	Employee's adjusted maximum contribution for employees paid
      	Weekly	Biweekly	Semimonthly	Monthly
      Less than 5%	No contributions to be deducted
      5% but less than 15%	$.03	$.06	$.07	$.13
      15% but less than 25%	.06	.12	.13	.26
      25% but less than 35%	.09	.18	.20	.39
      35% but less than 45%	.12	.24	.26	.52
      45% but less than 55%	.15	.30	.33	.65
      55% but less than 65%	.18	.36	.39	.78
      65% but less than 75%	.21	.42	.46	.91
      75% but less than 85%	.24	.48	.52	1.04
      85% but less than 95%	.27	.54	.59	1.17
      95% or more	.30	.60	.65	1.30

   3. (iii) The adjustment of the employee's contribution shall be discontinued with respect to pay periods beginning after termination of concurrent employment, and the employee shall promptly give notice of such termination to his employer.

2. (2) The contributions of employees engaged in concurrent employment may be adjusted on the basis of claims for refund filed with the employer in accordance with the following:

   1. (i) Each employee who has been engaged in concurrent employment during a period of at least one month within the calendar year may apply to such employers for a proportionate refund of the contributions paid within 60 days following the end of the calendar year.
   2. (ii) In filing such claims for refund, the employee shall furnish a statement to each such employer concerning the periods in which he was engaged in concurrent employment and the amount of wages received from each such employer during the period of concurrent employment. Such claims for refund shall be supported by suitable evidence of the wage payments made to the employee, including without limitation pay envelopes or check stubs, duplicate copies of income tax form W-2, statements of social security taxes withheld and/or similar data.
   3. (iii) Each covered employer whose provision for disability benefits utilizes the allocation clause set forth in the last sentence of section 204(2) of the Workers' Compensation Law shall, upon receipt of such a claim for refund, determine the adjusting employer's percentage and on the basis of the table set forth in paragraph (1)(ii) of this subdivision, compute the amount of refund of contributions to which the employee is entitled.
3. (3) Where an employee has complied with the provisions of paragraphs (1) or (2) of this subdivision (depending on the alternative method of adjustment selected), such employee shall have the right to apply to the chairman for a review of the adjustment in his contributions made by his employer if he feels that such adjustment has not been properly made.