Form Tq01c - Alaska Quarterly Contribution Report - 2010
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1Alaska Quarterly Contribution Report
THE 2010 TAXABLE WAGE BASE FOR EACH EMPLOYEE IS $ 34,100.
Quarter Ending:
Due Date:
Employer Account No:
If None enter "0"
FEIN:
1. For each month, report the number
st
nd
rd
1
2
3
of workers who worked during or
Month
Month
Month
received pay for the payroll period,
th
which includes the 12
of the month.
2. Total Reportable wages paid this
quarter. (See Instructions, page 2)
$
AGENCY USE ONLY
3. Less excess wages over the taxable
wage base.
($
)
4. Taxable wages paid this quarter.
$
A report must be filed even if no wages are
Employer's Rate
$
paid for the quarter.
5. Employer's Contribution
%
Employee's
Rate
You may now file your quarterly contribution
$
6. Employee's Contribution
report on-line. Please visit our web site located at
.50
%
or call
Total Rate
$
1-888-448-3527. To amend your quarterly report,
7. Total Contributions Due
please submit a “Correction of Wage Item”, Form
%
TADJ also available on-line.
8. Amount Remitted
$
Notice to Employers: Wage information and other
confidential UC information may be requested and
utilized for other authorized governmental purposes,
9.
Wages Reported to other states? See
Yes
including, but not limited to, verification of an
instructions explaining this on page 2.
individual’s eligibility for other government programs.
FOLD IN HALF
NO CHECK STUBS PLEASE
FOLD IN HALF
NO CHECKSTUBS PLEASE
WAGE SCHEDULE
* See Area Map for Geographic Location Codes
10. Employee's
11. Employee's Name - Type or Print
12. Reportable wages
13. Full
14.
Social Security
(Do not list employees more than once.)
paid this quarter.
Occupational
Geographic
(No negative wages)
Number
Last
First
MI
Title or Code
Code *
S
T
A
P
L
E
C
H
E
C
K
S
H
E
R
Make checks payable to the
15. Total Number of Pages
16. Total Reportable Wages - All Pages
E
Alaska Department of Labor and Workforce Development
(Same Total as in Block 2 above.)
If you have any questions,
call toll free 1-888-448-3527
I hereby certify that the information on this report is true and correct.
Signed: ________________________________________________ Title: ________________________________ Date: ________________
Printed Name:
Contact Telephone Number: (
)
Alaska Department of Labor & Workforce Development, Employment Security Tax, PO Box 115506, Juneau, AK 99811-5506
TQ01C (11/09)
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Parent category: Financial