Form Ui-40c - Employer'S Correction Report For The Quarter Ending

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UI-40C (Rev. 02/17)
IL 427-0406
Stock No. 7192
EMPLOYER'S CORRECTION REPORT FOR THE QUARTER ENDING
SPECIAL INSTRUCTIONS
ACCOUNT NUMBER:
1. Prepare a separate correction report for each quarter. Retain a copy for your files.
2. Give complete explanation.
3. Always complete Schedule A.
4. Be sure to complete Schedule B if you are correcting wages reported for individual
workers.
Enter complete account number, name and address in the space above.
SCHEDULE A - QUARTERLY WAGE INFORMATION
EXPLANATION
As Reported on UI-3/40
Should Be
Line 2. Total Wages Paid
Line 3. Less: Excess Wages
Line 4. Taxable Wages
Line 5. Contribution Due
,
and 2017 the taxable wages of $12,9 0 of wages paid to each worker for the calendar year. For
NOTE: For calendar year 201
the calendar year
SCHEDULE B - INDIVIDUAL WAGE CORRECTIONS
LIST ONLY THOSE WORKERS WHOSE WAGES ARE TO BE CORRECTED
Worker's Social Security
W A G E S
UI-3/40
Account Number
Worker's Name (Type or Print)
As Reported
Should Be
Page #
TOTAL
I certify that the information in the foregoing report is true and correct to the best of my knowledge and belief.
Date ________________________________________
Signed ___________________________________________________
This report MUST be signed by owner, partner, officer, or authorized
Title ______________________________________________________
agent within the employing enterprise. If signed by any other person,
a Power of Attorney must be on file.

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