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nstructions for completing the Employer's Contribution & Payroll Report

PREPARE AND SEND ORIGINAL TO IOWA WORKFORCE DEVELOPMENT . KEEP A PHOTOCOPY FOR YOUR FILES.

Use black ink and print or type all information. Complete the Payroll Listing section

11. Enter the total amount being paid. If no remittance, enter 0.00. MAKE

first. Put Iowa Account Number and quarter/year on each page.

CHECK PAYABLE TO IOWA WORKFORCE DEVELOPMENT.

If no wages were paid during this quarter, complete the report by entering 0.00 on

12. Number the payroll pages of your report. If the cover page contains individual-

lines 1 and 2. If no remittance is being made, also enter 0.00 on line 11. Sign, date

by- individual payroll information, label it page 1. Enter O if this page shows

and mail this report by the delinquent after date shown on the report. If you wish to

no payroll breakdown, then number the following pages. If you have more

have your account placed in an inactive status, complete the "Employer's Notice of

than one page of payroll, each page must be numbered consecutively.

Change" provided in this booklet.

13. See "Definitions" for an explanation of this section. Enter your Federal

PAYMENT COMPUTATION

Employer Identification Number (FEIN) if it is not pre-printed.

1. Total the "total wages paid" columns for all pages of the report containing

PAYROLL LISTING

payroll information.

Attached payroll pages must be in the same four column format as shown on

2. Total the "taxable wages paid" columns for all pages of the report

the contribution report: social security number, employee's name, total wages

containing payroll information.

and taxable wages. Use the payroll continuation sheets issued by our

department (or photocopies of those sheets) or pages that are 8 1/2" in width

3. Multiply the taxable wages total by your contribution rate as shown (rate

by 11" in length. Each page must have total and taxable column totals.

expressed as a decimal).

14. Before completing the payroll list, indicate use of magnetic medium by

4. Multiply the taxable wages total by your surcharge rate as shown (rate

checking the appropriate box. If you are using one of these media

expressed as a decimal).

for reporting your payroll, do not complete the payroll list. If not, continue to

item 15. (For information on use of magnetic reporting, call 1-515-281-5339.)

5. Total lines 3 and 4.

NOTE: Mail "Employer's Contribution & Payroll Report" with payment, separate from

6. If this report is being filed late, interest will be assessed on the amount of

magnetic tape, cartridge, or diskette.

contributions and surcharge due. Compute the interest due by multiplying

the total on line 5 by the number of days the report is late. Then multiply

15. Enter the social security number of each employee who was paid wages

that figure by the interest rate decimal of 0.000333.

during this quarter.

EXAMPLE: If your contribution and

16. Enter the last name, first name and middle initial of each employee paid

Quarter

Delinquent

surcharge due is $44.00 and you

wages during this quarter.

Number

Months

After Date

are filing your report 20 days late.

Jan Feb Mar

Apr 30

Apr May Jun

Jul 31

17. Enter total wages paid as defined in "Definitions" for each employee paid

$44.00 x 20 = $880.00

Jul Aug Sep

Oct 31

wages during this quarter.

$880.00 x 0.000333 = $0.29

Oct Nov Dec

Jan 31

18. Enter taxable wages paid as defined in "Definitions" for each employee paid

7. If this report is being filed late, penalty will be assessed on the total wages

wages during this quarter.

listed on the report. Pay the minimum penalty amount or the computed penalty

amount, whichever is greater.

19. Enter the totals for columns 17 and 18 for this page only.

To determine a "minimum penalty amount", refer to the MINIMUM PENALTY

LABOR MARKET INFORMATION

TABLE. The minimum penalty amount escalates with each additional late

report. Penalty will return to the lowest minimum ($10.00) only after four

20. Enter the total number of employees listed on this and any continuation

consecutive timely quarterly reports have been filed.

payroll pages or on magnetic medium.

To determine a "computed penalty amount", use the "Delinquent After Date" to

21. Enter the total number of full-time and part-time employees who worked

figure the number of days your report is late. Then, refer to the COMPUTED

during or received wages in Iowa for the pay periods which included the 12th

PENALTY TABLE to find the correct penalty rate. Multiply the penalty rate times

day of each month of the quarter.

the "Total Wages" total.

22. Identify Iowa worksites. If only one business activity is conducted at only one

MINIMUM PENALTY TABLE

COMPUTED PENALTY TABLE

worksite during the quarter, enter the county number in which the worksite is

number of late reports

minimum

days

penalty rate

located. A listing of county numbers is provided in this booklet.

penalty

delinquent

(times total wages)

If you conducted business at more than one worksite during the quarter, you

001-60

.001

must complete a "Multiple Worksite Report". This report is mailed separately.

$10.00

061-120

.002

If you do not receive this report, please contact Research and Information

$25.00

121-180

.003

Services at 1-800-532-1249 (in Iowa) or 1-515-281-8415 (outside Iowa).

over 2

$50.00

181-240

.004

Return this report with your "Employer's Contribution and Payroll Report".

241-over

.005

23. Enter the amount of extraordinary pay as defined in "Definitions" which was

EXAMPLE: If your "Total Wages" total is $12,000.00, you are filing the report 14

paid to employees during the calendar quarter and was included as "total

days late and this is your second late report:

wages paid".

The "minimum penalty amount" = $25.00.

24. If your total employment increased or decreased during this quarter for any of

The "computed penalty amount "( $12,000.00 X .001) = $12.00.

the reasons listed, please check the appropriate box(es).

Therefore, you would pay the "minimum penalty amount" of $25.00.

25. If you sold all or a part of your business, discontinued business, ceased to

8. Total lines 5, 6 and 7.

have employment but continued doing business, or changed the address,

telephone number or FEIN of your business, please complete, sign and return

9. Enter any amount of unpaid contribution, surcharge, interest or penalty due

the "Employer's Notice of Change" provided in this booklet.

from previous quarters that you are paying with this report. Please attach

documentation to explain the payment.

Date and sign this report. Please, write your Iowa Account Number on

your check. If an account number has not been assigned, please use your

10. If you have received a "Credit Memo" indicating you have overpaid in previous

Federal ID Number. Be sure you have provided all of the information

quarters, enter the amount of credit shown on the document. If you are taking

requested. MAKE YOUR CHECK PAYABLE TO IOWA WORKFORCE

credit, but have not received a credit memo, attach an explanation.

DEVELOPMENT.

Instructions For Completing The Employer'S Contribution & Payroll Report - Iowa Workforce Development (Sample Form Included) Page 2

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