Form Uct-7878-E - Wage Adjustment Report
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1Unemployment Insurance
P.O. Box 7945
Adjustments For
Madison, WI 53707
Wage Adjustment Report
Fax: (608) 266-8089 PH: (608) 266-6877
1. Calendar Year:
2. Account Number
UI Account Number
Employer Name
Employer Address
1st Quarter ending 3/31
2nd Quarter ending 6/30
3rd Quarter ending 9/30
4th Quarter ending 12/31
3. Social Security
4. Last Name
5. First Name
6. Reported
7. Correct
6. Reported
7. Correct
6. Reported
7. Correct
6. Reported
7. Correct
Number
Wages
Wages
Wages
Wages
Wages
Wages
Wages
Wages
8. Signature
Phone Number
Date Signed
Title
Return To: Unemployment Insurance, PO Box 7945, Madison, WI 53707
UCT-7878-E (N. 06/2016)
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Parent category: Legal