Form De 938sef - Quarterly Return Adjustment Form For School Employers - 2014

Download a blank fillable Form De 938sef - Quarterly Return Adjustment Form For School Employers - 2014 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form De 938sef - Quarterly Return Adjustment Form For School Employers - 2014 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

For Quarter Ended

Employer Account No.

MO. DAY YR.

942 –

–

QUARTERLY RETURN

ADJUSTMENT FORM

FOR SCHOOL EMPLOYERS

STATUTE OF LIMITATIONS

A claim for refund or credit

Please Follow Instructions on Reverse Side

For Department Use Only

must be filed within three

MO. DAY YR.

years of the last timely

EFFECTIVE

filing date of the

Name

DATE

quarter being adjusted.

Address

(1)

(2)

(3)

DIFFERENCES

I. COMPUTATION OF ADJUSTMENT IN CONTRIBUTIONS

Previously reported

Should have reported

Debit/(Credit)

B. TOTAL WAGES IN SUBJECT EMPLOYMENT

C. EMPLOYER CONTRIBUTIONS (Employer Rate times B)

I. Penalty (Refer to instructions on reverse side) .......................................................................................

J. Interest (Refer to instructions on reverse side) ........................................................................................

L. TOTAL ...............................................................................................................................................

II. REASON FOR ADJUSTMENT

III.

I declare that the above information is true and correct to the best of my knowledge and belief. This section must be completed for credit to be allowed.

SIGNATURE

TITLE (Administrator, Accountant, Preparer, etc.)

PHONE (

)

EXT.

FAX

(

)

DATE

IV. EMPLOYEE WAGE ADJUSTMENT. Enter the correct total wages which should have been reported for the quarter.

NOTE: If you are adjusting more than four (4) employees, list the items on a separate page with the same format, including employer name, account

number, and the adjusting quarter.