Form Me Uc-1a (Cssf) - Authorization To Correct Wages - Maine Department Of Labor - 2016
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1MAINE DEPARTMENT OF LABOR
Bureau of Unemployment Compensation
AUTHORIZATION TO CORRECT WAGES
47C State House Station
Augusta, ME 04333-0047
Maine Employer
Employer’s Name and Address
Account Number
Authorization is hereby made for an adjustment to the account for the following reasons:__________________________
________________________________________________________________________________________________
Quarter Ending___________________________________
(A separate form must be submitted for each quarter.)
A.
B.
C.
Contributions
Item
Amount Reported
Corrected Amount
Difference
Rate
1.
Total Wages
$
$
$
______%
Wages in Excess of $12,000
$
$
$
2.
Per Employee
CSSF Rate:
.06% for 2010 to
Taxable Wages
$
$
$
3.
current year
4.
Contributions Tax
$
$
$
1
5.
CSSF
Tax
$
$
$
6.
Total Overpayment
$___________________________
(Do not reduce future tax liabilities by this credit.)
7.
Total Underpayment
$___________________________
(Please remit payment with this report.)
>>> MAKE CHECK OR MONEY ORDER PAYABLE TO TREASURER, STATE OF MAINE<<<
8. INDIVIDUAL EMPLOYEE WAGE CORRECTIONS
Originally Reported
Corrected Amounts
Employee’s Social
Name of Employee
Nonseasonal
Seasonal
Nonseasonal
Seasonal
Security Number
(T)
(P)
(T)
(P)
Date
Signature
Title
Telephone
QUESTIONS ABOUT THIS FORM?
Contact a Customer Service Representative at (207) 621-5120
Fax: (207) 287-3733
TTY users call: Maine Relay 711
Email: division.uctax@maine.gov
______________________
1
Competitive Skills Scholarship Fund
ME UC-1A (CSSF) (11/16)
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Parent category: Legal