Form Ui-Wit - Combined Return For Household Employers - 2009
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2State of Illinois
Illinois Department of Employment Security
2009 Form UI-WIT
Illinois Department of Revenue
Combined Return for Household Employers
File on-line at household.illinois.gov
Unemployment Insurance Contributions and Illinois Income Tax Withheld
Step 1: Tell us about yourself
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___ ___ ___–___ ___–___ ___ ___ ___
1a
___ ___ ___–___ ___–___ ___ ___ ___
b
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Your spouse’s Social Security number (SSN)
Your Social Security number (SSN)
Federal employer’s identification number
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___________________________________________________________________
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_________________________________________________
Your name (first, middle initial, last)
Spouse’s name (first, middle initial, last)
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___________________________________________________________________
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_________________________________________________
Street Address
Illinois account number (Unemployment Insurance)
___________________________________________________________________
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Check any box that applies to this report
City
State
Zip
I I
I I
Unemployment insurance
Illinois income tax withheld
Step 2: Report your household employee information
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For unemployment insurance reporting, complete Columns A-F
For Illinois withholding tax reporting, complete Columns A, B, and G
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A
B
C
D
E
F
G
Name
Social
1/2009
2/2009
3/2009
4/2009
2009 Illinois Income
(first, last)
Security no.
QTR. ending Mar. 31 QTR. ending June 30 QTR. ending Sept. 30 QTR. ending Dec. 31
Tax Withheld
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Other (attach)
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Column totals: Add Lines 10 through 18 in each column
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Step 3: Figure your unemployment insurance
contribution due for each quarter
1st quarter
2nd quarter
3rd quarter
4th quarter
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Column totals: Add Lines 10 through 18 in each column
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Write the total wages paid in excess of the taxable
wage base amount ($12,300 per employee for 2009).
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Subtract Line 20 from Line 19.
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If Line 19 is less than $50,000, multiply Line 21 by
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your 2009 contribution rate or 5.4%, whichever is less.
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If Line 19 is $50,000 or more, multiply Line 21 by
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your 2009 contribution rate.
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Quarter totals Enter the amount from Line 22 and/or 23.
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Grand total Add the quarter totals from Line 24 (Columns C, D, E and F) and write the result on Line 25.
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Form UI-WIT front 1 of 2 (12/09)
PLEASE RETURN THIS PAGE AND PAGE 2 OF THIS FORM
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