Form Does-Uc30 - Employer'S Quarterly Contribution And Wage Report Form

ADVERTISEMENT

W
W W
Government of the District of Columbia
Department of Employment Services
Office of Unemployment Compensation P.O. Box 96664 Washington, D.C. 20090-6664 Telephone: Local: (202) 698-7550 Toll Free: (877) 319-7346
FORM ID:
POSTMARK DATE
EMPLOYER'S QUARTERLY CONTRIBUTION AND
DOES-UC30
WAGE REPORT
EMPLOYER NUMBER:
NAME CHK:
(DO NOT USE THIS SPACE)
FEDERAL IDENTIFICATION NUMBER:
TAX RATE:
QUARTER ENDING:
TAXABLE WAGE BASE:
THIS REPORT DUE:
9000.00
m m m m m m m m m m m m
m m m m m m m m m m m m m m m m m m m m m m m m m m
SEE INSTRUCTIONS ON PAGE 3
First Month
Second Month
Third Month
1.
TOTAL NUMBER OF COVERED WORKERS
m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m
2.
TOTAL WAGES PAID (this quarter, to all covered workers)
$
m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m
RATED EMPLOYERS COMPLETE ITEMS 3 THROUGH 9 - SELF INSURED EMPLOYERS SKIP TO ITEM 10
m m m m m m m m m m m m m m m m m m m m m
3. NON-TAXABLE WAGES
$
m m m m m m m m m m
4. TAXABLE WAGES ( Subtract ITEM 3 from ITEM 2)
$
m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m
m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m
5. CONTRIBUTION DUE (Multiply ITEM 4 by your tax rate of
%)
$
m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m
6.
ADMINISTRATIVE ASSESSMENT DUE ( Multiply ITEM 4 by 0.2%)
$
m m m m m m m m m m
7.
PLUS INTEREST DUE
$
8.
PLUS PENALTY DUE
$
9.
MINUS APPROVED CREDIT
$
10.
EQUALS TOTAL REMITTANCE AMOUNT (Make check or money order payable to 'DOES')
$
STATUS CHANGES
11. ENTER THE APPROPRIATE INFORMATION IF ANY CHANGE HAS OCCURRED:
ENTITY NAME:
TRADE NAME:
ADDRESS LINE 1:
ADDRESS LINE 2:
CITY:
STATE:
ZIP CODE:
CONTACT NAME:
CONTACT TELEPHONE:
BUSINESS TELEPHONE:
BUSINESS FAX:
EMAIL ADDRESS:
NEW FEIN:
12. IF YOU HAVE SOLD OR TRANSFERRED YOUR BUSINESS, enter date of sale or transfer:
Month
Day
Year
IF YOU ARE OTHERWISE NO LONGER IN BUSINESS, enter date wages last paid in DC:
Month
Day
Year
13. DESCRIBE ANY OTHER CHANGE IN STATUS:
CERTIFICATION
I CERTIFY THAT THE INFORMATION CONTAINED IN THIS REPORT AND ANY WAGE REPORTS ATTACHED HERETO IS TRUE
AND CORRECT AND THAT NO PART OF THE TAX WAS OR IS TO BE DEDUCTED FROM THE WORKER'S WAGES.
SIGNATURE:
TELEPHONE:
DATE:
PRINT NAME:
TITLE:
JOB SERVICE
Page 1
uc30p 1.frm rev 12/05
"Helping People Help Themselves"
5Z1035 4.000

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 2