Enlarge image | UI-HA Report for Household Employers Instructions You may file on-line at https://mytax.illinois.gov Line 15 If you had more than eight household employees during 2022, use an additional sheet of paper and include the information in Step 2 Step 1 for each additional worker. Total each Column C through F on the Line 1a Enter your 7-digit Illinois Unemployment Insurance Account Number. attachment, and write the totals on Line 15 in the appropriate column. Line 1b Enter the nine digit Federal Employer's Identification number (FEIN) assigned to you by the Internal Revenue Service. Line 16a Add Lines 7 through 15 within each column. This is the total Line 2 Enter your first name, middle initial and last name. wages paid for each quarter. Line 3 Enter the street address . . Step 3 Line 4 Enter the city, state and zip code Line 16b Copy totals from line 16a above. Step 2 Line 17 Write in the total wages paid in excess of the unemployment insurance taxable wage base amount for each worker. For 2022, Lines 7 through 1 5 - use one line for each employee the taxable wage base amount is $12, 960 for each worker. Column A An employer must pay unemployment insurance contributions on only the first $12, 960 in wages for each employee. Print the last and first name(s) of your household employee(s). Column B Example: You have one household employee that you pay $5,000 each quarter. During the first and second quarter, the Complete this item by entering your employee’s social security wages paid to the employee total $10,000, so you would enter “0” number. in each column for the first and second quarters. During the third Columns C through F (quarters) quarter, the total amount paid to the employee reaches $15,000 which exceeds the $12, 960 unemployment insurance taxable Enter the total wages paid to each employee for each quarter of the wage base by $2,040. So the amount to be entered on Line 17 year. If no wages were paid for that quarter, please enter "0". for the third quarter, is $2, 040 ($15,000-$12,960 ). The fourth Wages include (a) salaries, commissions and bonuses, tips reported quarter wages of $5,000 must be entered on Line 17 for the to the employer, separation pay, vacation pay, prizes, sick pay, fourth quarter since the wage base was met during the third payments on account of retirement; (b) the reasonable cash value quarter. of remuneration paid other than cash, such as goods, meals and 1st quarter 2nd quarter 3rd quarter 4th quarter lodging; and (c) any remuneration for services performed within the State which is considered wages under the Federal Unemployment Ex Line 17 $ 0 $ 0 $2,040 $5,000 Tax Act. UI-HAinstructions (2/2023) |
Enlarge image | Step 3 continued Line 18 Subtract Line 17 from Line 16b and enter the result on Line 18. Step 6 These are your taxable wages. Line 30 If you have stopped employing workers, write the date of the last Lines 19 and 20 day you employed workers. For each quarter, calculate your unemployment insurance contribution. Within each column, complete either Line 19 or 20, whichever is applicable. Step 7 Line 31 This report must be signed by the person named in Step 1, Line 2. Line 21 Quarter totals: Enter the amount from Line 19 or 20 in each column. If signed by any other person, a Power of Attorney must be This is your contribution due for each quarter. attached. Line 22. Grand total. Add the quarterly totals from Line 21 (Columns C, D, E and F) and enter the result on Line 22. This is your total unemployment insurance contributions for 2022. MAIL YOUR COMPLETED REPORT ALONG WITH YOUR CHECK TO: ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY Step 4 PO BOX 19300 SPRINGFIELD IL 62794-9300 Line 23-26 Enter the total number of employees (full or part time) who are covered by unemployment insurance and who performed services during or received pay for the payroll period including the 12th of each month of the quarter. Include workers who have earned General Instructions more than $12, 960 in the calendar year and those on vacation or paid sick leave. Exclude workers on strike. What if I do not file or pay by the due date? If you do not file a processable return or pay the tax you owe by the due date, you will owe penalty and interest. Step 5 Line 27 Write the amount shown on line 22. This is your What if I need to correct information I reported? total unemployment insurance contribution for 2022. Where may I obtain help or more information? Line 28 Write the amount of any previous payment made to the Illinois For other related forms or help with questions regarding unemployment Department of Employment Security for the liability shown on insurance, please call the Unemployment Insurance Hotline toll-free at Line 27. 800)247-4984. ( Line 29 Subtract Line 28 from Line 27. The TTY number for the hearing impaired is (866) 212-8831. This is the amount of unemployment insurance contribution due. Make your check payable to the Illinois Department of Employment Security. UI-HAinstructions (2/2023) |
Enlarge image | State of Illinois Illinois Department of Employment Security Form UI-HA 2022 Report for Household Employers File on-line at https://mytax.illinois.gov Step 1: Tell us about yourself 1a ________________________________ b ___ ___–___ ___ ___ ___ ___ ___ ___ Illinois account number (Unemployment Insurance) Federal employer’s identification number 2 ___________________________________________________________________ Your name (first, middle initial, last) 3 ___________________________________________________________________ Street Address 4 ___________________________________________________________________ City State Zip Step 2: Report your household employee information 5 For unemployment insurance reporting, complete Columns A-F 6 ABD F C E Name Social 1/2022 2/2022 3/2022 4/2022 (last, first) Security No. QTR. ending Mar. 31QTR. ending June 30 QTR. ending Sept. 30 QTR. ending Dec. 31 • • • • • • 7 _____________________________ ______________• • __________________• __________________• _________________• _________________• • • • • • • • • • • • • 8 _____________________________ ______________• • __________________• __________________• _________________• _________________• • • • • • • • • • • • • 9 _____________________________ ______________• • __________________• __________________• _________________• _________________• • • • • • • • • • • • • 10 _____________________________ ______________• • __________________• __________________• _________________• _________________• • • • • • • • • • • • • 11 _____________________________ ______________• • __________________• __________________• _________________• _________________• • • • • • • • • • • • • 12 _____________________________ ______________• • __________________• __________________• _________________• _________________• • • • • • • • • • • • • 13 _____________________________ ______________• • __________________• __________________• _________________• _________________• • • • • • • • • • • • • 14 _____________________________ ______________• • __________________• __________________• _________________• _________________• • • • • • • • • • • • • 15 Other (attach) ________________________ __________________• • ______________________• ______________________• ______________________• _____________________• • • • • • • • • • • 16a Column totals: Add Lines 7 through 15 in each column ______________________• ______________________• ______________________• _____________________• • • • • Step 3: Figure your unemployment insurance contribution due for each quarter 1st quarter 2nd quarter 3rd quarter 4th quarter 16b Column totals: Copy totals from line 16a above. ______________________ ______________________ ______________________ _____________________ 17 Write the total wages paid in excess of the taxable wage base amount ($12, 960 per employee for 2022). ______________________ ______________________ ______________________ _____________________ 18 Subtract Line 17 from Line 16b. ______________________ ______________________ ______________________ _____________________ 19 If Line 16a is less than $50,000, multiply Line 18 by ______________________ ______________________ ______________________ _____________________ your 2022 contribution rate or 5.400%, whichever is less. 20 If Line 16a is $50,000 or more, multiply ______________________ ______________________ ______________________ _____________________ Line 18 by your 2022 contribution rate. 21 Quarter totals: Enter the amount from Line 19 and/or 20. ______________________ ______________________ ______________________ _____________________ 22 Grand total: Add the quarter totals from Line 21 (Columns C, D, E and F) and write the result on Line 22. 22 _________________ UI-HAfront 1 of 2 (2/2023) PLEASE RETURN THIS PAGE AND PAGE 2 OF THIS FORM |
Enlarge image | Step 4: Number of employees who are covered for unemployment insurance Write the total number of covered workers (full and part time) who performed services during or received pay for the payroll period including the 12th of each month of each quarter. If none, write “0” 23 1st quarter A January 12 __________ B February 12 __________ C March 12 ___________ 24 2nd quarter A April 12 __________ B May 12 __________ C June 12 ___________ 25 3rd quarter A July 12 __________ B August 12 __________ C September 12 ___________ 26 4th quarter A October 12 __________ B November 12 __________ C December 12 ___________ Step 5: Figure your total unemployment insurance contribution due 27 Write the amount from Line 22. 27 ____________I ____ 28 Write the amount of any previous payment to the Illinois Department of Employment Security for the liability shown on Line 27. 28 ____________I ____ 29 Subtract Line 28 from Line 27. Make your check payable to the Illinois Department of Employment Security. 29 ____________I ____ Step 6: Complete if you are no longer employing workers 30 Write the date you stopped employing workers. 30 ____/_____/____ month day year Step 7: Sign below Under penalties of perjury, I state that I have examined this report and, to the best of my knowledge, it is true, correct, and complete. 31 ____________________________________________________________ ____/____/__________ (_____) ______________ Household employer’s signature (full name) month day year Daytime telephone number Filing deadline: April 15, 2023 You may file and pay on-line at https:// mytax.illinois.gov Mail your completed report along with your check to: ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY PO BOX 19300 SPRINGFIELD IL 62794-9300 This state agency is requesting information that is necessary to accomplish the statutory purpose as outlined under 820 ILCS405/100-3200. Disclosure of this information is REQUIRED. Failure to disclose this information may result in statutorily prescribed liability and sanction, including penalties and or interest. This form has been approved by the Forms Management Center. UI-HAback /2 of 2 (22023) PLEASE RETURN THIS PAGE AND PAGE 1 OF THIS FORM |