QUARTERLY
WAGE REPORT &
This report can be filed online at:
UNEMPLOYMENT TAX RETURN
NOTICE: By submitting your payment by check, you are consenting to the department processing your check by using your routing numbers to initiate an electronic
funds transfer. If you do not want to electronically transfer funds from your bank account you must submit a money order or use a credit card for payment.
2. Account
1. Employer's Name and Address
Number ____ ____ ____ ____ ____ ____
Q
YYYY
3. Quarter Ending
Quarter
MM/DD/YYYY
Year
4. To avoid a penalty this return must be postmarked by
the last day of the month after the quarter ending date.
5. Number of continuation sheets attached
This report MUST BE FILED if you have an active account, even IF you have NO WAGES or NO TAX due.
6. Social Security Number
7. Employee Name
8. Total Wages
9. Excess Wages
Paid This Quarter
See instructions
000
00
0000
Last
First
Middle Initial
Dollars
Cents
Dollars
Cents
10. Total Wages for THIS page
1st Month
2nd Month
3rd Month
11. For each month, report the number of covered workers who worked or
received pay during the payroll period, this includes the 12th of the month.
Dollars
Cents
12. Total Wages from ALL pages
If NO WAGES were paid, enter ZEROS here and in items 13 & 14. Sign & Return.
13. Total Excess Wages from ALL Pages
14. Compute Taxable Wages
Total Wages (item 12) minus Excess Wages (item 13)
15. Unemployment Tax Due
Multiply Taxable Wages (item 14) by your Tax Rate
16. SUTA Penalty Rate
ADD
FOR KDOL USE
Multiply Taxable Wages (item 14) by your Penalty Rate
17. Maximum $200 late filing penalty
ADD
CODE
SUTA
Minimum $25 penalty. See instructions
Penalty
PENALTY
18. Interest on late payment
ADD
DEPOSIT
1% FOR EACH PART OR WHOLE MONTH
CONTRI
CODE
19. Prior Overpayment
SUBTRACT
Attach K-CNS 111 Adjustment OR K-CNS 2101 Credit Memo
11
PENALTY
ADD
INTEREST
20. Prior amount due
CODE
PENALTY
21. Total Due. If tax is $5 or more, pay to
KANSAS EMPLOYMENT SECURITY FUND
31
Send to:
PO Box 400, Topeka, KS 66601-0400
INTEREST
22. I certify that the information on this return is true, correct and complete, to the best of my knowledge and belief.
Name &
Area Code &
Signature ____________________________________________________________
Phone Number_____________________
Date______________
K-CNS 100 (Rev. 10-08)