Workers' Compensation (Wc) Summary Report Instruction Sheet
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2WORKERS’ COMPENSATION (WC) SUMMARY REPORT INSTRUCTION SHEET
NOTE: Do NOT Change the Reporting Period on this return. Use this form only for the Reporting
Period indicated. To amend a report for a prior quarter or to file reports for an earlier quarter call
(307) 777-6763 to obtain the correct forms.
The Summary report form is used to submit total wage and tax information and payments for the
Division of Workers' Compensation. The forms and remittance are to be mailed in the green
preaddressed envelope to Cheyenne Wyoming for timely processing. This summary needs to be
submitted EVERY reporting period, even when there are no employees to report. If there are
no employees, Please fill out the summary report with zeros before submitting.
INCLUDE EMPLOYEE WAGE LISTINGS WITH THIS REPORT WHEN MAILING
INCLUDE ONLY THOSE EMPLOYEES COVERED BY WORKERS’ COMPENSATION (Coverage
type W or B on Wage Listing)
Section 9A
Assigned by the Division.
Section 9B
Enter the total number of employees who worked in each class code.
Section 9C
Enter the total wages paid per class code for non-corporate officer employees. For
Corporate officers/LLC Members/Owners who have elected coverage, use appropriate
Workers' Compensation corporate officer average wage and class code.
Section 9D
Assigned by the Division.
Section 9E
Multiply Section 9C by Section 9D, for each class code and enter the result.
Line 10
Enter the total of columns 9B, 9C, and 9E.
Line 11
Workers' Compensation interest is computed at two percent (2%) per month, beginning
on the day following the DUE DATE, which is the end of the month following the end of
the reporting period. Reports submitted more than 30 days late will incur a Late Filing
Penalty of $100.00.
Line 12
Enter the total Workers' Compensation amount due (tax, interest, service charges, court
costs, etc.) from prior quarters.
Line 13
Enter the total Workers' Compensation amount of credit you are due.
Line 14
Add lines 10, 11, and 12, and subtract line 13. Enter the result on line 14.
Line 16
This is the total amount that should be remitted for WC taxes.
BE SURE TO SIGN AND DATE THE SUMMARY REPORT FORM
MAIL THE FORM WITH THE EMPLOYEE WAGE LISTING
AND YOUR REMITTANCE IN THE GREEN SELF-ADDRESSED ENVELOPE.
USE CHECK OR MONEY ORDER FOR PAYMENT MADE PAYABLE
TO THE WYOMING DEPARTMENT OF WORKFORCE SERVICES. DO NOT SEND CASH.
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