Form Tq01c - Alaska Quarterly Contribution Report - 2016
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1
2Alaska Quarterly Contribution Report
THE 2016 TAXABLE WAGE BASE FOR EACH EMPLOYEE IS $39,700
Quarter ending:
Due date:
Employer account no:
If none enter "0"
FEIN:
1. For each month, report the number
st
nd
rd
1
2
3
of workers who worked during or
Month
Month
Month
received pay for the payroll period,
th
which includes the 12
of the month.
2. Total reportable wages paid this
$
quarter. (See instructions, page 2)
3. Less excess wages over the taxable
($
)
wage base.
$
4. Taxable wages paid this quarter.
Employer's rate
A report must be filed even if no wages are paid for
$
5. Employer's contribution
%
the quarter.
Employee's rate
You may now file your quarterly contribution
$
6. Employee's contribution
.50
%
report online. Please visit our website located
at
labor.state.ak.us/estax
or call (888) 448-3527.
$
7. Total contributions due
%
To amend your quarterly report, please submit a
“Correction of Wage Item,” Form TADJ also
$
8. Amount remitted
available online.
Notice to em ployers: W age inform ation and other
9. Wages reported to other states? See
Yes
confidential UC inform ation m ay be requested and
instructions explaining this on page 2.
utilized for other authorized governmental purposes,
including, but not lim ited to, verification of an
individual’s eligibility for other government programs.
*See area map for geographic location codes
10.
11.
12.
13.
14.
Employee's
Employee’s name – type or print
Reportable wages
Full
Geographic
paid this quarter.
code *
Social Security
(Do not list more than once.)
occupational
Number
Last
First
M.I.
(No negative wages)
title or code
S
T
N
A
O
P
L
S
E
T
U
C
B
H
S
E
C
P
K
L
S
E
A
H
S
E
E
R
E
Make checks payable to the
15. Total number of pages
16. Total reportable wages - all pages
Alaska Department of Labor and Workforce Development.
(Same total as in block 2 above.)
If you have any questions,
call toll free (888) 448-3527
I hereby certify that the information on this report is true and correct.
Signed: _____________________________________________ Title: ________________________ Date: ________________
Printed name: ____________________________________________
Contact telephone number: (
) ________________
Alaska Department of Labor and Workforce Development, Employment Security Tax, P.O. Box 115506, Juneau AK 99811-5506
TQ01C (1/16)
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