TRANSMITTAL  # 
                                                                                                                                                             of 
     PENNSYLVANIA UNEMPLOYMENT COMPENSATION CORRECTION REPORT 
                                                             (To Amend Quarterly UC-2/2A Tax Reports)                  (A separate form must be submitted for each quarter) 
1.   EMPLOYER  ACCOUNT  NUMBER                                                                      3.  QUARTER/YEAR 

    ITJ-1 I IRIor M ICHECKIDDIGITI                                                                  D1,  2,   I I I I I 
                                                                                                    3 or 4 

                                                                      4.  Reason  For Adjustment  (Check  all  that apply): 
2.  Employer Name and Address:                                        D Incorrect Gross Wages. *Please explain:        D Exempt Wages Reported in Error.* Please explain: 

                                                                      D Incorrect Employee Withholding Rate Used       D     Calculation Error. Please explain:  _____ _ 
                                                                             List Rate Used ______ _ 
                                                                      D      Incorrect Taxable Wages. Please explain:  D     Other Error. Please explain: --------

                                                                      D      Incorrect Employer Contribution Rate Used       *PROVIDE INDIVIDUAL EMPLOYEE CORRECTION 
                                                                                                                             FORM (UC-2AX). IF NECESSARY. 
                                                                             List Rate Used -------
                                                                      D Wages Reported to Wrong State *                D     PLEASE CHECK IF EMPLOYEE WAGE DETAIL  WAS 
                                                                                                                             CORRECTED ON ELECTRONIC MEDIA. 
5.  Was the employee withholding correctly withheld?               D  Yes      D   No               D  Not applicable  (Please see instructions on reverse side.) 
                                                                             AMOUNT PREVIOUSLY 
     TAX RATE                                                                  REPORTED                            CORRECT AMOUNT              DIFFERENCE (OVER) UNDER 
6.                            GROSS WAGES 
7.                            EMPLOYEE WITHHOLDING 
8.                            TAXABLE WAGES 
9.                            EMPLOYER  CONTRIBUTION 
1 O.TOTAL  (REFUND/CREDIT)  OR  TAX  DUE  (ADD LINES  7 AND  9) IN  THE  DIFFERENCE  COLUMN                            REFUNDS/CREDITS  SHOULD 
                                                                                                                       BE IN PARENTHESES I  I 
11.  Please check one:      D Refund                     D Credit  D Not Applicable   (Please see instructions on reverse side.) 
12.  Employer Certification:  I  certify  that the information on this form is  true and correct to the best of my  knowledge and belief. No part of the 
     amount of employer  contributions  reported on taxable wages was deducted or is  to be deducted from  the employees'  wages. 

        SIGNATURE OF OWNER, OFFICER, PARTNER,  RESPONSIBLE OFFICER OR AUTHORIZED AGENT                                 TITLE          DATE                PHONE NUMBER 

-------------------------------------------------------- DEPARTMENT USE ONLY  (DO NOT WRITE BELOW THIS LINE)-------------------------------------------------------------
0 CORRECTION  REPORT        O JOURNAL  VOUCHER 
SY   MO   YR      QTR  YR     BASIC  (X)                     WAGES           CONTRIBUTION                                    INTEREST                     PENAL TY        A 
                              RATE                                           DEBIT                     CREDIT      DEBIT            CREDIT      DEBIT        CREDIT 
                                                         _J 
                                                         _J 
                                                         _J 
                                                         _J 
                                                         _J 
                              Totals 
COMMENTS:                                                                                                          TOTAL REMITTANCE 

Rate Verification ---------�                             Certification:  Date Contribution Received ---------�               Date Report Received __________ _ 
8.1. Audit Needed D Yes     D No D                       N/A Benefit Charges D Yes D                No D      N/A      FSD CERTIFICATION/DA TE _________ _ 

    TAX AGENT                    DATE                        TAX TECHNICIAN                                   DATE     OTHER REQUIRED SIGNATURE              DATE 

Year      D       No Change Rate Revised From                ----  to ----            Year ___                D    No Change Rate Revised From -----      to -----
UC-2X REV 06-16 (Page 1)      COMMONWEAL TH OF PENNSYLVANIA                                         DEPARTMENT OF LABOR & INDUSTRY             OFFICE OF UC TAX SERVICES 

          INSTRUCTIONS FOR COMPLETION OF FORMS UC-2XAND UC-2AX 
Purpose of Forms                                                        Questions 
Use Form UC-2X to make changes to Gross and/or Taxable wages            Questions regarding the processing of your correction form(s) 
(increase or decrease) from those wages reported on the original PA     should be referred to the UC Employer Contact Center, Monday 
FormUC-2.                                                               through Friday 8:30 a.m. to 4:30 p.m. Eastern Time at 866-403-6163.

Use Form UC-2AX to correct wage records or credit weeks from that       Photocopying 
reported on the original PA Form UC-2A. This includes correcting        The Forms UC-2X and UC-2AX may be photocopied. 
Social Security Numbers (SSN) or credit weeks previously reported; 
adding SSN's or credit weeks not previously reported to our agency;     Quarters 
adding or increasing wages or credit weeks previously reported in­         Quarter One-January, February, March ( due April 30) 
correctly; or deleting or decreasing wages or credit weeks previ­          Quarter Two-April, May, June (due July 31) 
ously reported incorrectly.                                                Quarter Three-July, August, September ( due October 31) 
                                                                           Quarter Four-October, November, December (due January 31) 
If you are changing Gross and/or Taxable wages and individual em­
ployee wages or credit weeks, you will be required to submit both       Adjusting Wage Information Electronically 
Forms UC-2X and UC-2AX.                                                 For information on adjusting wage information online or by 
                                                                        file upload, call the UC Employer Contact Center at 
Where to File                                                           866-403-6163.
Send completed forms to the PA Department of Labor &
Industry, Office of Unemployment Compensation Tax Services,                       SPECIFIC INSTRUCTIONS FOR UC-2X 
PO Box 68568, Harrisburg, PA 17106-8568.                                1. Enter your PA Unemployment Compensation account num­
                                                                           ber. (Only complete the shaded box if you are "R" -reimburs­
Overpayment Corrections                                                    able or "M" -municipality.)
Refund requests may not always result in the refund of the exact        2. Complete your business name and address.
amount of your calculation. Offsets of the refund request will be       3. Complete the quarter and year using four digits. A separate
processed and the net check will be sent to you with an explanation        form must be submitted for each quarter being corrected.
for the reduction or increase in the refund amount requested. Ex­       4. Check the appropriate box to indicate the reason for the
amples where this offset may happen are:                                   adjustment.
1. Taxable wage reductions along with reduction in the contri­          5. Check the appropriate box to indicate the correct employee
   butions paid cause an increase in rates subsequent to year of           contribution amount was calculated and withheld from your
   adjustment.                                                             employees on the original report (employee withholding rate
2. Correction of exempt employment previously reported where               times gross wages). This applies only on a request for refund or
   these indi victuals were paid UC benefits because of this               credit of employee withholding. IF ANY PORTION OF THE
   reported employment.                                                    OVERPAYMENTISDUETOEXCESSIVEEMPLOYEEWITH­
3. A calculation error was made in the requested refund amount.            HOLDING, IT IS YOUR RESPONSIBILITY TO DISTRIBUTE
4. You owe contribution, interest, penalty and/or court costs on           TO THE EMPLOYEES THE APPLICABLE AMOUNTERRO­
   your account or have past due unfiled quarterly reports in              NEOUSLYWITHHELD.
   another quarter.                                                     6. Enter the amount of gross wages previously reported, the cor­
                                                                           rected amount and the net difference between the two columns.
Underpayment Corrections                                                7. In the tax rate column, enter the employee withholding rate
For any corrections made by you that result in additional tax due, our     applicable for the year of adjustment. Enter the amount of em­
agency must have a check attached for the additional contribution          ployee withholding previously reported, the correct amount
due (unless an overpayment was also made). Do not include any              and the net difference between the two columns.
penalty or interest that may be due. We will bill you for these amounts 8. Enter the amount of taxable wages previously reported, the
due, if any. Make all checks payable to the PA UC Fund.                    corrected amount and the net difference between the two col­
                                                                           umns.
Statute of Limitations on Refunds                                       9. In the tax rate column, enter your contribution rate for the year
The PA UC Tax Law specifies certain limitations on refunds.  In            of adjustment. Enter the amount previously reported, the cor­
general, your request for refund must be submitted within four ( 4)        rected amount and the net difference between the two columns.
years from the date the original tax report was due.                    10. Enter in the difference column, the total (refund) or tax due by
                                                                           adding lines 7 and 9.
Documentation Requirements                                              11. Check appropriate box. Refunds will be sent to the address of
You may be contacted for documentation depending on the reason             record when approved. Credits will be applied to your next quar­
for the adjustments.  For this reason, we ask that your form be            terly report.
complete and accurate and that you include a phone number in the        12. Complete employer certification by signing, and entering title,
event we must contact you.                                                 date and phone number.
                                                                        NOTE: Billing errors may occur due to credits not being posted at the 
                                                                           time the report is filed. 
                            Auxiliary aids and services are available upon request to individuals with disabilities. 
                                                     Equal Opportunity Employer/Program 
UC-2X  REV  06-16  (Page 2)