NOTE: You must be pre-approved to file this report annually. Refer to the Registration Form for Domestic Wages (PDF) in the forms index.
Enter the number of domestic/household employees that received pay in each quarter of this year. (Quarters: January to March; April to June; July to September; October to December)
Enter the due date. If the calendar year end date is 12/31/___, the due date is 01/31/__. (If this account is inactive prior to the last quarter of the year, enter the due date for the last quarter wages were paid.)
Enter the calendar year being reported.
Enter the Federal Identification Number.
Enter the State Unemployment Tax Identification Number.
Enter the employer's experience rate. (Enter .16% as .0016; 1.33% as .0133)
Enter the worker's social security number.
Enter the worker's first initial and last name.
Enter in columns a, b, c and d the wages paid in each quarter of the year. Round wages to the nearest whole dollar amount.
This line will automatically update the total amount of wages paid for the year.
NOTE: Items 1-8 will be pre-filled per the information entered on the Employer's Annual Wage Report.
Assume the report is 15 days past the due date for the 4th quarter
of 2001 (due 01/31/2002). The contributions due = $100.25. Interest
is calculated at 1% per month or portion thereof. In this case,
interest equals $0.49. Penalty accrues at 5% per month not to exceed
25% on the first day. The penalty calculation is 5% of the contributions
due plus interest due. In this case, penalty equals $5.04.
The total remittance for line 14 will equal $105.78.
REMINDER: Signature is required on both portions of this form.
Click here (PDF) to download the Annual Report of Wages form.
This page was last updated on July 17, 2007.