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                               Instructions for Preparation of Form UC1-S Quarterly Contribution Report
       1. Employers are provided with a prescribed form for filing on or around the 25th day of the quarter mailed to their
            address of record.  Employers should use the prescribed forms or file reports on-line.  Employers using the
            Substitute UC1 form are responsible for all processing delays and information contained on the face of the form.
       2. Total gross wages: All remuneration paid to covered workers during this quarter. Per IC 22-4-8, If a worker is
           not:
                  1) Free from direction and control;
                  2) Performing services outside of the due course of the business, and
                  3) Independently established in the trade or business for the service provided –
                           then the worker is an employee and must be reported on the UC1.
       3. Total excess wages: Employers pay premiums on the first $9,500 per worker per year. Each quarter is reported
            separately. Excess wages cannot exceed gross wages. Example:
                  John makes $6000 in the first quarter, $3000 in the second quarter, $6000 in the third quarter, and $6000 in
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                  the 4 quarter. You report Gross wages of $6000 and $0 excess wages in the first quarter. You report $3000
                  in gross wages and $0 excess wages in the second quarter. You report $6000 in gross and $5500 in excess
                  wages in the third quarter. You report $6000 in gross and $6000 in excess in the fourth quarter.
            Calculate each employee separately and then add them together for the report.
       4. Total Taxable Wage: Total Gross Wages less total Excess Wages. Must be $0 or greater.
       5. Total Premium Due: Applied rate per notice times total taxable wage. Use only the rate provided to you by the
            department. Failure to use the correct applied rate will result in interest, penalties, and fines.
       6. Interest: One percent (1%) of premiums due per month for every month or portion of a month after the due date.
            The due date does not change for postal service availability. Please always postmark your report, or file on line,
            on or before the due date.  Late reports are assessed interest.
       7. Penalty: Ten percent (10%) of the premium due if payment in full is not received on or before the due date.
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       8. Employee count: the number of workers as of the 12  day of the month for each month in the quarter.
       9. If you are filing without a pre-assigned SUTA account number, this form must be accompanied by a SF2837
           Report to Determine Status.  You should also complete and submit form UC5-A.  All forms are available at
           www.IN.gov/dwd in the Business Services section.

      File only one original UC1 per quarter.  To correct a report, use the Employer Contribution Adjustment Report
      (SF44954).  If you no longer have covered employment in Indiana, update your status to inactive via ESS.
      Report any business transfer or reorganization promptly to the Department.
PLEASE CUT ON DOTTED LINE BEFORE MAILING
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QUARTERLY CONTRIBUTION REPORT (SUBSITUTE)                EMPLOYEE COUNT    1ST1ST                        2ND2ND 3RD3RD
State Form 251 (R12  / -14)6 DWD/ UC1-S                  (SEE INSTRUCTIONS)
                                                                           MO                            MO     MO

ACCOUNT NO.                QTR    YR    FEDERAL ID NO             UCUC     2. TOTAL GROSS WAGES PAID THIS QTR
                                                                           3. TOTAL EXCESS WAGES
PERIOD COVERED FROM                             TO                            (((SEE(S  INSTRUCTIONS)
                                                                           4 NNET TAXABLE WAGES
                                                                              ( (L ((LINE 2 MINUS LINE 3)
IICERTIFY, UNDER PENALTY OF PERJURY, THAT THIS REPORT IS TRUE AND COMPLETEC
                                                                           5. TOTAL PREMIUMS DUE
                                                                           LINE 4 X APPLIED RATE
SIGNATURE OF EMPLOYER                   T I T LE
                                                                           6. INTERESTN (SEE INSTRUCTIONS)
TELEPHONE NUMBER                  DATE          FAX NUMBER
CONFIDENTIAL RECORD PURSUANT TO IC-22-4-19-6,IC 4-1-6                      7. PENALTY (SEE INSTRUCTIONS)

INDIANA DEPT OF WORKFORCE                       DEVELOPMENT                             AMOUNT DUE
ATTN UI CASHIERING
10 N SENATE AVE RM SE001
INDIANAPOLIS IN 46204-2277






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