Form Ui11w - Wage Report - Nebraska Department Of Labor
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1*QTR
STATE OF NEBRASKA
*YR
DEPARTMENT OF LABOR
UNEMPLOYMENT INSURANCE
PO BOX 94600
LINCOLN, NE 68509-4600
PHONE: 402.471.9898/FAX: 402.471.9994
* Employer Tax Account No.
WAGE REPORT UI-11W
File at
* Federal I. D. No.
Page _____ of _____
Report gross quarterly wages paid to each worker.
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paid (regular, vacation & sick rounded down to four whole numbers)
THIS DOCUMENT MUST BE FILED WITH THE COMBINED TAX REPORT - UI-11T
and the primary job title for each worker.
* Social Security
* Gross wages paid each
Hours Paid in
* Worker Name
Primary Job Title
Number
covered worker in this quarter
this quarter
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* Required Fields
TOTAL OF THIS PAGE
Total of all pages reported must equal Line 2 (Gross Wages) on the
TOTAL OF ALL PAGES
Combined Tax Report - UI-11T.
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Form UI11W
Rev. 05-02-2017
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