ITEM BY ITEM INSTRUCTIONS - CONTRIBUTION REPORT
To avoid penalties, you must use our form or an approved facsimile with scan line, typed or printed clearly will all items
completed. Do not send photocopy. You must return this report, EVEN if no wages are paid.
ADDITIONAL FORMS: Contact this Department to request a supply of additional reporting forms at (802) 828-4253.
When submitting additional information without a Department form, paper must be 8 1/2" x 11" with print NO LESS
THAN 1/8" HIGH, SPACED VERTICALLY NO MORE THAN 3 OR 4 LINES PER INCH, and TYPED or BLOCK PRINTED
in BLUE OR BLANK INK ONLY. Each sheet must be headed with your account number, employer name and quarter-
ending date. Your format must include six columns in this order: SS#, name (last, first, middle initial), total gross wages
paid, H/S (hourly/salary), hourly rate and gender, M-F. If using a company printout, and additional columns must be
crossed out. Make only one entry per employee. Negative wages are not accepted. Each page must end with the page
number and a subtotal of the wages on that page. Additional report pages need not be individually signed and dated, but
they must be returned with a properly signed and dated Quarterly Wage and Contribution Report (Form C-101). Call
(802) 828-4253 for additional forms.
ITEM 1, 2 & 3 - For each subject employee enter: 1. Social Security Number, 2. The employee's last name, first name
middle initial and, 3. The total GROSS WAGES PAID the employee during the quarter. See definitions under General
ITEM 4 - Enter H is hourly worker or S is salaried worker. If "S", skip to item 6.
ITEM 5 - Enter hourly rate. If worker is receiving multiple rates, enter the predominant rate. (Ex. If a worker works 15
hours at $7.00 an hour and 25 hours at $8.00 an hour, enter $8.00).
ITEM 6 - Enter F for Female or M for Male.
Do not fill in the above information if you have been approved to report by magnetic media.
MAGNETIC MEDIA - If you are interested in submitting wage information via computerized magnetic media, please
contact the wage record unit at (802) 828-4249 for specifications and prior authorization. Employers authorized to submit
magnetic media must complete and return the bottom portion of Form C-101.
ITEM 7 - Enter page number and total gross wages paid to all employees for the quarter for each page. (The total of all
pages should agree with Item 9 on the Employer's Quarterly Wage & Contribution Report.)
ITEM 8 - Enter the monthly employment data for Item 9. This is a count of all full-time and part-time workers in covered
employment who perform services during or received pay for the payroll period which includes the 12th of each month. If
no employment occurred during the payroll period, enter zero. Do not leave any box blank.
ITEM 9 - Enter total gross wages PAID to all employees.
Non-profit or Governmental Reimbursable employers, OMIT Items 10 through 14.
ITEM 10 - Enter total excess wages paid this quarter. "Excess wages" means the amount paid to each employee after
his or her year-to-date earnings have exceeded the maximum calendar year taxable wage limit ($8,000.00) as shown on
the report form.
EMPLOYEE 1 earned $5,000 per quarter. The $8,000 per year EXCESS limit
EXCESS EXAMPLE
was met in the 2nd quarter by $2,000. All wages for this employee after the
$8,000 limit are EXCESS.
EMPLOYEE 1
EMPLOYEE 2 does not reach the $8,000 EXCESS limit until the 4th quarter.
Quarter
Total Wages/Qtr.
EXCESS
Taxable Wages/Qtr.
1st
$5,000
$0
$5,000
EXCESS is based on individual wages, however, Item 11 must be the
2nd
$5,000
$2,000
$3,000
total excess for ALL employees.
3rd
$5,000
$5,000
$0
Excess for Employee 1 AND Employee 2 is as follows: (Line 11 on the Form
4th
$5,000
$5,000
$0
C-101)
EMPLOYEE 2
Quarter
Total Wages/Qtr.
EXCESS
Taxable Wages/Qtr.
Quarter
Total Wages/Qtr.
EXCESS
Taxable Wages/Qtr.
1st
$2,000
$0
$2,000
1st
$7,000
$0.00
$7,000
2nd
$2,000
$0
$2,000
2nd
$7,000
$2,000
$5,000
3rd
$2,000
$0
$2,000
3rd
$7,000
$5,000
$2,000
4th
$3,000
$1,000
$2,000
4th
$8,000
$6,000
$2,000