Employer'S Tax Reports Forms - Nevada Employment Security Division printable pdf download

Employment Security Division

Contributions Section

*0*

500 East Third Street

Carson City, NV 89713-0030

(775) 684-6300

Employer's Quarterly Report

Use BLACK INK only. Instructions on separate page.

Please report any changes on the enclosed Employer's Report of Changes.

EMPLOYER

FEDERAL I.D. NO.

YOUR RATES

ACCOUNT NO.

CEP

QUARTER ENDING

DELINQUENT

DATE

AFTER

2. LABOR MARKET STATISTICS

MONTH 1

MONTH 2

MONTH 3

Enter for each month, the number of workers who worked during or received pay

for the payroll period that includes the 12th of the month.

PAYMENT CALCULATION (Line 3 through Line 12)

If no wages were paid in this quarter, enter 0.00 on Line 3. Sign report and return.

DOLLARS

CENTS

3. TOTAL GROSS WAGES (INCLUDING TIPS) PAID THIS QUARTER

Enter Grand Total amount from Wage Report.

4. LESS WAGES IN EXCESS OF _____________ PER INDIVIDUAL

(Cannot exceed amount on Line 3. See instructions on separate page.)

5. TAXABLE WAGES PAID THIS QUARTER

Line 3 less Line 4.

6. UI AMOUNT DUE THIS QUARTER

Line 5 x the UI Rate shown above in "Your Rates."

7. CEP AMOUNT DUE THIS QUARTER

Line 5 x the CEP Rate shown above.

8. PRIOR CREDIT

(If applicable.)

9. CHARGE FOR LATE FILING OF THIS REPORT

(One or more days late add $5.00 forfeit.)

10.ADDITIONAL CHARGE FOR LATE FILING, AFTER 10 DAYS.

Line 5 x 1/10% (.001) for each month or part of month delinquent.

11.INTEREST ON PAST DUE UI CONTRIBUTIONS

Line 6 x 1% (.01) for each month or part of month delinquent.

12.TOTAL PAYMENT DUE

Total Line 6 through Line 11.

Pay online at then select Employer Self Service (ESS).

Enclosing check payable to NEVADA EMPLOYMENT SECURITY DIVISION.

(Include Employer Account Number on check.)

(FOR DIVISION USE ONLY)

I certify that no part of the contribution was deducted from an employee's wages.

Authorized Signature: ________________________________________________

Print Signer's Name/Title: _____________________________________________

Employer's Phone Number/Email: ______________________________________

If Other Than Employer

Print Preparer's Name: _______________________________________________

Preparer's Phone Number/Email: ______________________________________

NOTE: Information collected may also be provided to various federal and state agencies as required or permitted by federal and state law.

*RPT3795*

Report suspected UI Fraud online at or

FRAUD

call (775) 684-0475

RPT3795

Employer'S Tax Reports Forms - Nevada Employment Security Division

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