Form De 945 - Annual Income Report For Disability Insurance Elective Coverage Page 2
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2INFORMATION REGARDING THE DE 945, ANNUAL INCOME REPORT
FOR DISABILITY INSURANCE ELECTIVE COVERAGE
Sections 708 and 708.5 of the California Unemployment Insurance Code require that you provide an
annual statement of your net profit as reported to the Internal Revenue Service (IRS) for the prior tax
year.
If your taxes are filed with IRS on a fiscal year basis, please provide the fiscal year end date and the
date by which IRS requires the information to be filed if no extension is requested. This information
will assist the Department in posting your annual income to the correct period for premium and
benefit purposes.
Fiscal Year End Date
/
/
Date Due to IRS
/
/
Failure to sign and submit this form may result in reduction of future disability insurance benefits.
Assistance in completing this form may be obtained by calling (916) 654-6288 or our Employment Tax
Customer Service Representative at 1-888-745-3886. For TTY (non verbal) access, call 1-800-547-9565.
DE 945 Rev. 3 (12-05) (INTERNET)
Page 2 of 2
CU-PB218
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