Form 21d - Employer'S Annual Contribution, Investment Fee And Wage Report
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1Form 21D (rev. 8/12)
Employer's Annual Contribution, Investment Fee and Wage Report
South Dakota Department of Labor and Regulation, Unemployment Insurance Division
PO Box 4730 • Aberdeen, SD 57402-4730 • Phone 605.626.2312 • Fax 605.626.3347 •
Account Number
Employer Name
R
1st Qtr
2nd Qtr
3rd Qtr
4th Qtr
Surcharge Rate
Address
Year
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
Computation of Payment Due
Totals
3/31/
___
6/30/
___
9/30/
___
12/31/
___
1. Total Gross Wages Paid during this Quarter
2. Wages in Excess of Annual Wage Base
3. Taxable Wages
4. UI Contribution Rate
% x Line 3
4a. Surcharge from Table Above
x Line 3
5. Investment Fee
% x Line 3
6. Total Tax Due
7. Adjustments from Prior Quarters
8. Interest
9. Penalty for Late Filing
10.Penalty for Late Payment
11.Total Remittance
Explanation (as needed):
Annual Taxable Wage Base
1. This item is calculated from individual's wages on Form(s) 21E.
2. Wages paid this quarter in excess of annual wage base per individual. This
2009 = $9,500
2013 = $13,000
item is calculated from individual's wages entered on Form(s) 21E.
2010 = $10,000
2014 = $14,000
3. Excel subtracts Line 2 from Line 1 and enters the difference here.
4. Please enter your Unemployment Insurance tax rate. Tax will be calculated.
2011 = $11,000
2015
& later = $15,000
4a.The surcharge will be calculated from the table at the top of the page.
2012 = $12,000
5. Please enter your Investment Fee tax rate. Tax will be calculated.
6. Lines 4, 4a and 5 will automatically be added and the total entered here.
7. Enter any amounts due or refunds due to you from prior quarters.
8. Enter the interest due if report is late for the corresponding calendar quarter.
Signature
The interest amount is computed by multiplying the tax due (Line 6) by 1.5%
per month or fractional part of a month the report is delinquent.
9. This penalty is imposed if the employer is late in filing a report. The penalty is
Date
Phone
$5 per month or fractional part of a month from the due date of a report.
Maximum penalty is $30 per quarter.
10.This penalty is imposed if the employer is late in making full payment. This
penalty is $5 per month or fractional part of a month. Maximum penalty is $30
Note: When you make a check payment, you authorize us to use information from your check to make a one-time electronic funds
per quarter.
transfer (EFT) from your account. When we use information from your check to make an EFT, funds may be withdrawn from your
11.This is the sum of Lines 6-10. Payable to "SD Unemployment Insurance."
account as soon as the same day we receive your payment. You will not receive your check back from your financial institution.
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Parent category: Financial