Form Uct-10 - Quarterly Contribution Report - Wisconsin Department Of Workforce Development
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1QUARTERLY CONTRIBUTION REPORT
ITEM 7. MUST BE COMPLETED
7. MONTHLY DATA SHOULD COUNT ALL FULL-TIME AND PART-TIME
TO BE FILED WITH QUARTERLY WAGE RPT.
WORKERS IN COVERED EMPLOYMENT THAT WORKED DURING OR RECEIVED
INSTRUCTIONS ON REVERSE SIDE
PAY FOR THE PAYROLL PERIOD WHICH INCLUDES THE 12TH OF THE
MONTH.
IF NONE, ENTER -0-.
1ST
2ND
3RD
1. U.I. ACCOUNT NUMBER
2. QUARTER
YEAR
MONTH-
MONTH-
MONTH-
1a. INTERNET ACCESS NUMBER
8. TOTAL COVERED WAGES
DOLLARS
CENTS
Must agree with total
wages on Wage Report.
9. LESS EXCLUSIONS FOR
WAGES OVER
3. REPORT AND PAYMENT DUE
10. DEFINED (TAXABLE) PAYROLL
Item 8 minus Item 9
THIS LINE MUST BE COMPLETED
4. FEIN
5. EMPLOYER TELEPHONE NO.
11. Multiply Item 10. by:
12. TAX DUE
6. EMPLOYER NAME AND ADDRESS
13. IF FILED AFTER DUE DATE,
ADD INTEREST OF
PER MONTH OF ITEM 12, above
14. IF WAGE RPT. (Form UC-7823)
FILED AFTER DUE DATE, ADD LATE
FILING FEE. (See reverse side)
15. LESS ELECTRONIC FUND TRANSFER
(EFT) PAYMENT
16. LESS CREDIT AVAILABLE
as of
17. TOTAL AMOUNT ENCLOSED
WITH THIS REPORT
RETURN THIS FORM AND ANY PAYMENT DUE.
18.
DO
ANY
OF
YOUR
EMPLOYEES
HAVE
MAKE
CHECK
OR
MONEY
ORDER
PAYABLE
TO
DIVISION OF
ACCESS
TO
A
HEALTH
INSURANCE
PLAN
(608) 261-6700.
YES
NO
UNEMPLOYMENT INSURANCE.
FOR INFORMATION CALL
SPONSORED
BY
YOU,
A
UNION,
OR
A
TRADE/PROFESSIONAL ASSOCIATION?
SIGNATURE
TITLE
DATE
19. I CERTIFY THE TAX AND
WAGE REPORTS ARE CORRECT.
GENERAL INFORMATION
This report is required from all employers covered under Wisconsin's Unemployment Insurance (UI)
Law. If a Quarterly Wage Report (UC-7823) form is also enclosed, it must be completed and submitted in
addition to this report.
Mail reports and payments to:
Department of Workforce Development
Division of Unemployment Insurance
P.O. Box 7945
Madison, Wisconsin 53707-7945
INSTRUCTIONS ON THE REVERSE SIDE.
UCT-101 (R. 07/09/2002)
(U00036)
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