Form Does-Uc30 - Employer'S Quarterly Contribution And Wage Report - 2007
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1
2Government of The District of Columbia
Department of Employment Services
O
ff
ice o
f
Unemployment Compensation
P.O. Bo
x
96664
Washington, D.C.
20090-6664
Telephone:
Local: (202 ) 698-7550
Toll Free: (877) 319-7346
EMPLO
Y
ER'S QU
A
RTERL
Y
CONTRIBUTION
POSTMARK DATE
FORM ID:
DOES-UC30
A
ND W
A
GE REPORT
(DO NOT USE THIS SP
A
CE)
FEDER
A
L IDENTIFIC
A
TION NUMBER:
EMPLO
Y
ER NUMBER:
N
A
ME CHK:
QU
A
RTER ENDING:
T
A
X R
A
TE:
THIS REPORT DUE:
T
A
X
A
BLE W
A
GE B
A
SE:
SEE INSTRUCTIONS ON PAGE 3
1st Month
2nd Month 3rd Month
1. TOT
A
L NUMBER OF CO
V
ERED WORKERS (employed in Washington, DC.)
2. TOT
A
L W
A
GES P
A
ID (this quarter, to all covered workers).........................................................................
$
DO
Y
OU SUBMIT
Y
OUR W
A
GE D
A
T
A
ON M
A
GNETIC MEDI
A
?......................
Y
ES
NO
RATED EMPLOYERS COMPLETE ITEMS 3 THROUGH 10 -SELF INSURED EMPLOYERS SKIP TO ITEM 11
3. NON-T
A
X
A
BLE W
A
GES
................................................................................................................................
$
Subtract
4. T
A
X
A
BLE W
A
GES
(
.........................................................................................
$
ITEM 3 from ITEM 2)
Multiply
5. CONTRIBUTION DUE (
.......................
$
ITEM 4 by your ta
x
rate o
f
%)
6
P .
LUS
A
DMIN.
A
SS
E
SS
MEN
T
D
E U
M (
i t l u
y l p
$
I
T
EM
4
b
y
two te
n
t
h
s
of o
n
e
p
e
r
ce
n
t ( 0
.
2
%
)
PLUS
7.
INTEREST DUE............................................................................................
$
PLUS
8
PEN
A
LT
Y
DUE..............................................................................................
$
.
MINUS
9.
A
PPRO
V
ED CREDIT..................................................................................
$
EQUALS
'DOES'
10.
TOT
A
L REMITT
A
NCE
A
MOUNT
............................
$
(Make check or money order payable to
)
STATUS CHANGES
11. ENTER THE
A
PPROPRI
A
TE INFORM
A
TION IF
A
N
Y
CH
A
NGE H
A
S OCCURRED:
TR
A
DE N
A
ME:
ENTIT
Y
N
A
ME:
A
DDRESS LINE 1:
A
DDRESS LINE 2:
CIT
: Y
ST
A
TE:
ZIP CODE:
CONT
A
CT TELEPHONE:
CONT
A
CT N
A
ME:
BUSINESS TELEPHONE:
BUSINESS F
AX
:
NEW FEIN:
EM
A
IL
A
DDRESS:
12. IF
Y
OU H
AV
E SOLD OR TR
A
NSFERRED
Y
OUR BUSINESS, enter date of sale or transfer:
/
/
Month
Day
Y
ear
IF NO LONGER IN BUSINESS, enter date wages last paid in DC:.........................................
/
/
Month
Day
Y
ear
13. DESCRIBE
A
N
Y
OTHER CH
A
NGE IN ST
A
TUS:
CERTIFICATION
I CERTIFY THAT THE INFORMATION CONTAINED IN THIS REPORT AND ANY WAGE REPORT(S) ATTACHED HERETO IS
TRUE AND CORRECT AND THAT NO PART OF THE TAX WAS OR IS TO BE DEDUCTED FROM THE WORKER'S WAGES.
D
A
TE:
TELEPHONE:
SIGN
A
TURE:
PRINT N
A
ME:
TITLE:
uc30p1.frm rev 06/07
Page 1
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