Form De 3d - Quarterly Contribution Return printable pdf download

QUARTERLY CONTRIBUTION RETURN

PLEASE TYPE THIS FORM - DO NOT ALTER PREPRINTED INFORMATION

Approved Extension To

You can file this return online through the EDD e-Services for Business at to comply with the e-file and e-pay mandate.

For more information on this mandate, visit You must FILE this return even if you had no payroll. If no payroll, enter "0" in Item B

and then sign the declaration below line K.

DELINQUENT IF

QTR

QUARTER

NOT POSTMARKED

ENDED

DUE

OR RECEIVED BY

Employer Account Number

DO NOT ALTER THIS AREA

Mo.

Day

Yr.

WIC

EFFECTIVE

DATE

A. NUMBER OF EMPLOYEES earning wages during or receiving pay for the pay

1st

3rd

2nd

periods that include the 12th day of the calendar month (enter numerals only).

Month

Please complete all fields. Blank fields will be identified as missing data.

B. TOTAL SUBJECT WAGES PAID THIS QUARTER ............................................................................................................

(B)

C. UNEMPLOYMENT INSURANCE (UI) TAXABLE WAGES

(Individual Employee Wages to $

per calendar year) .........................................................................

(C)

D. VOLUNTARY PLAN DISABILITY INSURANCE (VPDI) AND STATE DISABILITY INSURANCE (SDI) WAGES

per calendar year) ..........................................................................

(Individual Employee Wages to $

(D1 VPDI Wages)

(D2 SDI Wages)

BREAKDOWN OF ITEM D ..............................................

PLUS

(D3)

(E)

E. EMPLOYER'S UI CONTRIBUTIONS

% Times C .............................................................................

E1.

EMPLOYMENT TRAINING TAX (ETT)

% Times C .............................................................................

(E1)

F. EMPLOYEE SDI CONTRIBUTIONS

(F1 SDI Employee Contribution)

(F2 SDI Previously Paid This Quarter)

WITH-

% Times D2

LESS

(F3)

HELD

(G1 Total Employee PIT Withheld)

(G2 PIT Previously Paid This Quarter)

G. CALIFORNIA PERSONAL INCOME

LESS

(G3)

TAX (PIT) WITHHELD

H. SUBTOTAL (Add Items E, E1, F3, and G3) .......................................................................................................................

(H)

VPDI ASSESSMENT

% Times D1 ..............................................................................

(I)

TOTAL TAXES DUE OR OVERPAID THIS QUARTER (Add Items H and I)

(J)

DEPT

Make check payable to EMPLOYMENT DEVELOPMENT DEPARTMENT

Check Number

________________________

USE

INCLUDE EMPLOYER ACCOUNT NUMBER ON CHECK.

DO NOT STAPLE CHECK TO RETURN

FOURTH QUARTER ONLY

K. CALIFORNIA PERSONAL INCOME TAX (PIT) WITHHELD - PIT WITHHELD PER FORMS W-2 AND/OR 1099-R

BE SURE TO SIGN THIS DECLARATION: I DECLARE that the information herein is true and correct to the best of my knowledge and belief.

Signature ________________________________________ Title ________________________________ Phone (_______)____________________ Date ______________

(Owner, Accountant, Preparer, etc.)

IMPORTANT INFORMATION FOR REPORTING INDIVIDUAL EMPLOYEE WAGE DETAIL

VPDI employers are required to file a Quarterly Contribution Return and Report of Wages (Continuation), DE 9C, in addition to the DE 3D. If reporting the DE 9C

electronically, you must indicate the correct wage plan code for each employee to identify the benefit coverage the employee is entitled to receive. Please see the

back of this form for wage plan code information and/or for information on how to report your DE 9C.

SEE INSTRUCTIONS ON THE BACK OF THIS FORM.

DE 3D Rev. 15 (2-17) (INTRANET)

Page 1 of 2

PO Box 826847 / Sacramento, CA 94247-0001