Instructions For Completing The Enclosed Quarterly Report Form, For Washington Workers' Compensation Page 2
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1
2Late payment penalty and interest worksheet
For Lines 10 and 11 of your Quarterly Report for Workers’ Compensation
Get started
Find your premium subtotal from Box 7
$___________
Enter here
of your Quarterly Report form.
Line 1
If you wish, you may now go to latepayment.Lni.wa.gov
and let our online calculator complete the math for you.
Step 1 - Figure your late payment penalty
A
___________%
Find the percentage below that matches
Enter here
Line 2
how late you are paying.
Days late
Penalty
1-30 5%
31-60 10%
61+ 20%
$___________
B
Multiply: Line 1 x Line 2
Enter here
Line 3
Percentages into numbers:
Write this amount
5% = .05
on line 10 of your
Quarterly Report.
10% = .1
($10 minimum)
20% = .2
Step 2 - Figure your late payment interest
___________%
A
Enter here
Multiply: The number of months you are late x 1% (.01)
Line 4
Days late
=
Month
1-30 1
31-60 2
61-90 3
$___________
B
Enter here
Multiply: Line 1 x Line 4
Enter this amount
on line 11 of your
Quarterly Report.
Now return to your Quarterly Report form and complete.
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