THIS IS A FILLABLE FORM

               INSTRUCTIONS - EMPLOYER’S QUARTERLY ADJUSTMENT REPORT

1.       Enter Federal Identification Number.

2.       Enter Oklahoma Account Number.

3.       Enter business name and address.

4.       Signature and title of individual authorized to complete this form.

5.       Quarter and year being adjusted.

6.        Automatically calculates when Item's 6-b & 6-c are entered.

6-a.     Enter the Total Wages previously reported on the OES-3, Employers Quarterly Contribution Report.

6-b.     If Item 6 is greater than Item 6-a, enter the Total Wages under reported here  (Item 6 - Item 6-a).

6-c.     If Item 6 is less than Item 6-a, enter the Total Wages over reported here (Item 6-a - Item 6). Enter as a negative.

7.       Enter the correct amount of wages in excess of the taxable limitation (Item 6 - Item 8).

8.        Automatically calculates when Item's 8-b & 8-c are entered.

8-a.     Enter the Taxable Wages previously reported on the OES-3, Employers Quarterly Contribution Report.

8-b.     If Item 8 is greater than Item 8-a, enter the Taxable Wages under reported here (Item 8 - Item 8-a).

8-c.     It Item 8 is less then Item 8-a, enter the Taxable Wages over reported here (Item 8-a - Item 8). Enter as a negative.

9.       Enter the contribution rate for the quarter being adjusted.   Enter rate as a decimal.  Ex: 0.3% = .003

10.      Automatically calculates when rate is entered. (Item 8-b x Item 9).

11.      Enter the amount of interest due (1% per month x Item 10).

12.      Total amount due for the quarter being adjusted.

13.      C  redit due (Item 8-c x Item 9).

14.      Enter Oklahoma Account Number.

15.      Quarter and year being adjusted.

16.      Enter the SSN(s) for ONLY the employee(s) being corrected.
         Enter the Name of the employee(s) being corrected.
         Enter the Total Wages previously reported for each employee listed as reported on the OES-3, Employers Quarterly
               Contribution Report.
         Enter the Taxable Wages previously reported for each employee listed as reported on the OES-3, Employers Quarterly
               Contribution Report.
         Enter the Correct Total Wages paid for each employee listed.
         Enter the Correct Taxable Wages paid for each employee listed.

OES-3B (Rev. 09-19)                          AUXILIARY AIDS AND SERVICES ARE AVAILABLE UPON
                                             REQUEST TO INDIVIDUALS WITH DISABILITIES
                                     OKLAHOMA EMPLOYMENT SECURITY COMMISSION
       RESET                     EMPLOYER’S QUARTERLY ADJUSTMENT REPORT
                                                                                                                  PO Box 52003
                                                      Oklahoma City, OK  73152-2003

1. Federal Identification Number 2. Oklahoma Account Number                                                              6. Correct total wages paid this quarter              $ _________________________0.00

                                                                                                                            6-a. Total wages previously reported               $ _________________________
3.  
                                                                                                                            6-b. Total wages under reported                    $ _________________________
Name         ________________________________________________
                                                                                                                            6-c. Total wages over reported (Enter as Negative) $ _________________________
Address  ________________________________________________
                                                                                                                         7. Correct wages in excess of taxable limitation $ _________________________
   Email     ________________________________________________                                                            8. Correct taxable wages paid this quarter            $ _________________________0.00

Phone        _________________________________________________                                                              8-a. Taxable wages previously reported             $ _________________________
                                                                                                                            8-b. Taxable wages under reported                  $ _________________________
4.  I certify that the information contained in this report is true and correct.                                            8-c. Taxable wages over reported (Enter as Negative) $ _________________________
   Signed _________________________________________________
                                                                                                                         9. Contribution Rate   (Enter rate as a decimal)        _________________________0.0%
   Title ____________________________ Date ___________________
                                                                                                                         10. Contribution Due (Item 8-b x Item 9)              $ _________________________0.00

5.  Quarter ______________________                                                                                       11. Interest due (1% per month from due date)         $ _________________________
                                                                                                                                                                                                                        0.00
                          List in the schedule below ONLY those                                                          12. Total amount due with this report                 $ _________________________
PLEASE NOTICE:            employees whose wages are being
                          corrected.                                                                                     13. Credit due (Item 8-c x Item 9)                    $ _________________________0.00

14.  Oklahoma Account Number ____________________________                                                                                                 15.  Quarter ______________________
16. Employee’s Social                 Employee’s Name                                                                   Total Wages       Taxable Wages              *Correct Total   *Correct Taxable
    Security Number                  (Type or Print)                                                              Previously Reported     Previously Reported       Wages Paid                                     Wages Paid

ENTER THE TOTALS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                        0.00                      0.00                      0.00                                   0.00
FOR COMMISSION USE ONLY-DO NOT WRITE IN THE SPACES BELOW
Date Rec’d                       Batch #
OES-3B Rev. 10-16-19                                                                                              EQUAL  OPPORTUNITY EMPLOYER/PROGRAM                                                               003B