Form 72-S - Idaho Hire One Act Credit Supplemental Schedule
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1F
72-S
Idaho Hire One Act Credit Supplemental Schedule
O
R
EFO00244
M
07-31-12
Name(s) as shown on return
Social Security Number or EIN
Tax year ending
A
E
B
C
D
F
G
H
I
Gross Wages
Gross Wages
Gross Wages
in Counties with
Paid to Employee
in Counties with
Health Care
During the
Unemployment Rate
Unemployment Rate
Date
Benefit Coverage
Employee's Initial
less than 10% to
Equal to or more than
Social Security
Date
Employment
County of
(Single 80% or
12 Months of
Form 72,
10% to Form 72,
Employee's Name
Number
Hired
Ceased
Employment
Family 70%)
Employment
Part III, line 1b
Part III, line 1a
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Page _______ of ________
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Parent category: Financial