Form 5208a - Quarterly Unemployment Insurance - Tax Summary
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1Quarterly Unemployment Insurance - Tax Summary
(Form 5208A)
To file or pay electronically, go to esd.wa.gov/employer-taxes.
See separate instructions. Use black ink. Send only original forms with orange-ink boxes. Report any change in business status or address on Form 5208C.
NOTE: For all out-of-state wage reporting please check box 13 on this form, and visit ESD.WA.GOV/employer-taxes/forms-and-publications to complete form 5208B1.
EMPLOYER
1) UBI
2) EIN
3) QUARTER/YEAR
4) ESD NUMBER
0 0 0
5) BUSINESS NAME
6) DUE DATE
(MMDDYY)
TAX PREPARER
7) FIRST AND LAST NAME OF TAX PREPARER
DATE PREPARED
PHONE
(MMDDYY)
(WITH AREA CODE AND ANY EXTENSION)
EMAIL ADDRESS OF TAX PREPARER
FAX
(WITH AREA CODE AND ANY EXTENSION)
8)
NO PAYROLL THIS QUARTER?
INCLUDES OUT-OF-STATE WAGES
13)
CALL 888-836-1900 TO FILE. OR WRITE “X” IN
If yes, write “X” in this box, and visit esd.wa.gov/employer-taxes/forms-and-publications
THE BOX, FILL OUT #1 TO #11, AND RETURN
THIS PAGE TO THE ADDRESS IN #26B.
14) TOTAL GROSS WAGES
.
,
,
,
(The total amount in box #39 of all
9)
NUMBER OF CORPORATE OFFICERS EXEMPT
Wage Detail pages – Form 5208B.)
FROM UNEMPLOYMENT INSURANCE.
15) EXCESS WAGES
.
,
,
,
,
See instructions; taxable wage
base is $
10) WAGES OF CORPORATE OFFICERS EXEMPT
FROM UNEMPLOYMENT INSURANCE.
.
16) TAXABLE WAGES
,
,
,
.
Subtract line #15 from line #14
,
,
17) UI TAX DUE THIS QUARTER
.
,
,
,
11) TOTAL EXERCISED STOCK OPTIONS FOR ALL
Multiply line #16 by the combined
EMPLOYEES AND OFFICERS.
tax rate (breakdown in left column):
.
,
,
18) EMPLOYMENT ADMINISTRATION
.
,
,
,
12) NUMBER OF EMPLOYEES OF ALL TYPES WHO WERE
FUND (EAF)
Multiply the amount on
PAID WAGES DURING THE PAYROLL PERIOD THAT
line #16 by the EAF rate:
INCLUDES THE 12TH DAY OF THE MONTH.
1ST MONTH
19) TOTAL TAX DUE
.
,
,
,
,
Add lines #17 and #18
2ND MONTH
20) LATE PAYMENT PENALTY
.
,
,
,
,
See instructions
3RD MONTH
21) INTEREST
.
,
,
,
,
See instructions
22) LATE-REPORT PENALTY
.
,
,
,
See instructions
COMBINED TAX RATE MENTIONED ON LINE #17 INCLUDES:
EARNED TAX RATE
23) PRIOR BALANCE TO ADD
.
,
,
,
(or credits to subtract)
SOCIAL COST
ADJUSTED REDUCTION AMOUNT
24) AMOUNT DUE Add lines
.
,
,
,
SOLVENCY SURCHARGE
#19, #20, #21, #22 and #23
25) PAYMENT AMOUNT
.
,
,
,
THIS SECTION FOR EMPLOYMENT SECURITY USE ONLY
SUBMITTED
DATE RECEIVED
M
M
D
D
Y
Y
MD
26
) PAY ONLINE
26
) PAY BY MAIL
A
B
RECEIVED BY
CLASS CODE
RP
1) Write a check to Employment Security Dept.
At esd.wa.gov/employer-taxes.
2) Write your ESD number on the check.
3) Mail your check plus tax and wage report to:
Employment Security Department
PO Box 34729
ID 1210 (11/18/15) TAX SUMMARY
EMS 5208A
Seattle, WA 98124-1729
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