Form Ui-Wit - Combined Return For Household Employers - 2007 Page 2
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2Step 4: Number of employees who are covered for unemployment insurance
Write the total number of covered workers (full and part time) who performed services during or received pay for the payroll period ending the
12th of each month of each quarter. If none, write “0”
26
A
B
C
1st quarter
January 12
__________
February 12
__________
March 12
___________
27
2nd quarter
A
April 12
__________
B
May 12
__________
C
June 12
___________
28
A
B
C
3rd quarter
July 12
__________
August 12
__________
September 12 ___________
29
4th quarter
A
October 12
__________
B
November 12 __________
C
December 12
___________
Step 5: Figure your Illinois withholding income tax payment due
30
Write the amount from Line 19, Column G, Annual Illinois Withholding Tax.
This is the total Illinois income tax withheld for your household employees.
30
____________I ____
31
Write the amount of any previous payment to the Illinois Department of Revenue for the liability shown on Line 30.
31
____________I ____
32
32
Subtract Line 31 from Line 30.
____________I ____
Step 6: Figure your total unemployment insurance contribution due
33
Write the amount from Line 25.
33
____________I ____
34
Write the amount of any previous payment to the Illinois Department of Employment Security for the liability shown on Line 33.
34
____________I ____
35
Subtract Line 34 from Line 33.
35
____________I ____
Step 7: Figure your total payment due
36
Add Lines 32 and 35. This is the amount due. Make your check payable to the Illinois Department of Employment Security.
36
____________I ____
Step 8: Complete if you are no longer employing workers
37
Write the date you stopped employing workers.
37
____/_____/____
month
day
year
Step 9: Sign below
Under penalties of perjury, I state that I have examined this report and, to the best of my knowledge, it is true, correct, and complete.
38
____________________________________________________________
____/____/__________
(_____) ______________
Household employer’s signature (full name)
month
day
year
Daytime telephone number
April 15, 2008
Filing deadline:
You may file and pay on-line at household.illinois.gov
Mail your completed report along with your check to:
ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY
PO BOX 3637
SPRINGFIELD IL 62708-3637
This state agency is requesting information that is necessary to accomplish the statutory purpose as outlined under 820 ILCS405/100-3200.
Disclosure of this information is REQUIRED. Failure to disclose this information may result in statutorily prescribed liability and sanction,
including penalties and or interest. This form has been approved by the Forms Management Center.
Form UI-WIT back 2 of 2 (12/07)
PLEASE RETURN THIS PAGE AND PAGE 1 OF THIS FORM
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