Form 68-0061 - Employer'S Wage Adjustment Report
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1IOWA
Employer's Wage Adjustment Report
IOWA WORKFORCE DEVELOPMENT
TAX BUREAU, UIS DIVISION
Assignment A _________________
68-0061 (10-06)
1000 E Grand Avenue
DEVELOPMENT
(For correcting quarterly Employer's Contribution and Payroll Report 65-5300)
Des Moines, IA 50319-0209
Smart. Results.
Page ______ of ______
This form is available at no cost to the public from Iowa Workforce Development.
Employer Name
Iowa Account No. (6-digit)
>
>
Trade Name
Location Code (if Applicable)
>
>
Reason(s) for Adjustment >
(1)
Quarter And Year (Q/YY)
>
(A separate report must be prepared for each quarter)
SCHEDULE A:
PAYROLL LISTING CORRECTIONS -- LIST ONLY THOSE WORKERS WHOSE WAGES ARE TO BE CORRECTED
EMPLOYEE NAME
TOTAL WAGES
TAXABLE WAGES
RSN
Social Security Number
Last Name
First Name
MI
As Reported
As Reported
Should Be
Should Be
CDE
1
Page Totals >
Should Be (Col 2)
As Reported (Col 1)
SCHEDULE B: CORRECTION OF PAYMENT COMPUTATION
1. Total Wages
>
INSTRUCTIONS FOR LINES 1-5: Column 1 - COPY the figures
2. Taxable Wages >
previously reported on the same lines in the Payment Computation section of
3. State Exp Rate @
% >
Employer's Contribution & Payroll Report or, if this quarter has been
previously adjusted with this form, COPY from Schedule B, Col. 2 of that
4. Reserve Fund @
% >
form. Column 2-Start with Col. 1 figures and add or subtract the net wage
5. Surcharge @
% >
increases or decreases resulting from Sched. A adjustments. Recalculate
6. State Experience Underpaid/(Overpaid [Line 3, Col 2 - Col 1] >
State Experience, Reserve Fund, & Surcharge using corrected Line 2 figure.
7. Reserve Fund Underpaid/(Overpaid)
[Line 4, Col 2 - Col 1] >
Taxable Wage Base
>
8. Surcharge Underpaid/(Overpaid)
[Line 5, Col 2 - Col 1] >
9. Subtotal Additional Due or (Total Credit)
[Line 6 + 7 + 8] >
Preparer's Signature/Name >
Preparer's Title
10. Interest Due [Line 9 X # Days Late X 0.000333] >
>
Preparer's Phone
>
11. Additional Penalty Due
[Only if penalty on original filing] >
Date Signed
12. Total Additional Due
[Line 9 + 10 + 11] >
>
Equal Opportunity Employer/Program
Auxiliary aids and services are available upon request to individuals with disabilities. - For deaf and hard of hearing, use Relay 711.
PHOTOCOPY BLANK FORM IF MORE ADJUSTMENTS ARE NEEDED. PLEASE ENCLOSE PAYMENT FOR TOTAL ADDITIONAL DUE.
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