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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 20 21, 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 2021,
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 for
year. If no wages were paid for that quarter, please enter "0". the third quarter, is $2, 040 ($15,000-$12,960). The fourth quarter
Wages include (a) salaries, commissions and bonuses, tips reported wages of $5,000 must be entered on Line 17 for the fourth
to the employer, separation pay, vacation pay, prizes, sick pay, quarter since the wage base was met during the third quarter.
payments on account of retirement; (b) the reasonable cash value
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 (1/2022)
