Form Uitr-3 - Unemployment Insurance Quarterly-Report Adjustment
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1Colorado Department of Labor and Employment, Unemployment Insurance Employer Services
P.O. Box 8789, Denver, CO 80201-8789
303-318-9100 (Denver-metro area) or 1-800-480-8299 (outside Denver-metro area)
UNEMPLOYMENT INSURANCE QUARTERLY-REPORT ADJUSTMENT
INSTRUCTIONS ON REVERSE
UI Employer Account Number
Batch/Page
Owner, Partners, or Corporate Name
th
1. Correct total number of workers as of the 12
of each month.
st
nd
rd
th
1
Quarter
2
Quarter
3
Quarter
4
Quarter
Jan.
Feb.
Mar.
Apr.
May
June
July
Aug.
Sept.
Oct.
Nov.
Dec.
Revised Report
Prior Report
Difference
Qtr./Yr.
2. Total Wages
3. Excess Wages
Rate
4. Chargeable Wages
5. Premiums Due
Credit
6. Interest
Rate
7. Premium Credit*
8. Total Due
Qtr./Yr.
2. Total Wages
3. Excess Wages
Rate
4. Chargeable Wages
5. Premiums Due
Credit
6. Interest
Rate
7. Premium Credit*
8. Total Due
Qtr./Yr.
2. Total Wages
3. Excess Wages
Rate
4. Chargeable Wages
5. Premiums Due
Credit
6. Interest
Rate
7. Premium Credit*
8. Total Due
Qtr./Yr.
2. Total Wages
3. Excess Wages
Rate
4. Chargeable Wages
5. Premiums Due
Credit
6. Interest
Rate
7. Premium Credit*
8. Total Due
11. Total Paid
9.
Form UITR-1a (enclosed)
Form UITR-6a (enclosed)
No wage report needed
10. Reason for Adjustment
12. Signature
13. Date
* Item 7—Premium Credit applies only to eligible employers for calendar years 2001 and 2002.
UITR-3 (R 02/2014)
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