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                                         QUARTERLY ADJUSTMENT FORM FOR VOLUNTARY 
                                                PLAN DISABILITY INSURANCE EMPLOYERS 

Instructions for completion are available on reverse            Employer Account No.                                             For Quarter Ended 
side of this form. PRINT OR TYPE IN BLUE OR                                                                                      MO.     DAY     YR. 
BLACK INK ONLY. 

                                                                                                STATUTE OF LIMITATIONS 
                                                                                                A claim for refund or credit     For Department Use Only 
Name                                                                                            must be filed within three                                          MO.    DAY    YR. 
DBA                                                                                             years of the last timely     EFFECTIVE 
Address                                                                                         filing date of the           DATE 
                                                                                                quarter being adjusted. 
                                                                                                (1)                          (2)                                         (3) 
                                                                                                                                                                    DIFFERENCES 
I. ADJUSTMENT TO WAGES AND CONTRIBUTIONS                                                        Previously reported Should have reported                            Debit/(Credit) 
  A.  TOTAL SUBJECT WAGES ..........................................................                0.00                         0.00                                          0.00
  B.  UNEMPLOYMENT INSURANCE (UI) Taxable Wages .................                                   0.00                         0.00                                          0.00
  C1. VOLUNTARY PLAN DISABILITY INSURANCE (VPDI) WAGES    ..                                        0.00                         0.00                                          0.00
  C2. STATE DISABILITY INSURANCE (SDI) Taxable Wages .............                                  0.00                         0.00                                          0.00
  D.  EMPLOYER’S UI CONTRIBUTIONS (UI Rate 0.00 % times B)    ....                                  0.00                         0.00                                          0.00
  E.  EMPLOYMENT TRAINING TAX (ETT Rate 0.00 % times B)  ........                                   0.00                         0.00                                          0.00
  F1. DI VOLUNTARY PLAN ASSESSMENT ........................................  
                       (Vol. DI Assmt Rate        0.0  0% times C1)                                 0.00                         0.00                                          0.00
  F2. STATE DISABILITY INSURANCE* (SDI) Withheld (SDI Rate 
    0.00 % times C2; complete Box 1 below if credit on row F2.) .......                             0.00                         0.00                                          0.00
  G.  PERSONAL INCOME TAX (PIT) Withheld (Complete 
    Box 2 below if credit.) ..................................................................      0.00                         0.00                                          0.00
         H.  SUBTOTAL (Lines D, E, F1, F2, & G) . ...........................                       0.00                         0.00                                          0.00
         I.  Penalty (Refer to instructions on reverse side.) ...................................................................................................              0.00
         J.  Interest (Refer to instructions on reverse side.) ...................................................................................................             0.00
         K.  Less Erroneous SDI Deductions not refunded (See Box 1 Line 2 below) ............................................................                                  0.00
         L. Less contributions and withholdings paid for the quarter ......................................................................................                    0.00
         M.  Total taxes due or overpaid (H2 + I + J + K) - L ...................................................................................................              0.00
    *Includes Paid Family Leave amount. 
BOX 1.  STATE DISABILITY INSURANCE OVERPAYMENTS (Must be completed for credit to be allowed.) 
    1.  Was the credit claimed in column 3 withheld from the wages of employee(s)? ...............................................................                         Yes   No 
     If yes, has this amount been refunded to employee(s)?..................................................................................................               Yes   No 
    2.  Not refunded; employee(s) no longer employed, unable to locate. (List Social Security Number, employee name, last known address, and 
     amount of SDI not refunded on a separate page. Show the total on Line K above.) 
BOX 2.  PERSONAL INCOME TAX OVERPAYMENTS (Must be completed for credit to be allowed.)                               
     If you paid the Employment Development Department (EDD) more than the amount of California PIT withheld from wages of employee(s), 
       you can adjust the amount reported by using this form. The EDD will allow credit adjustments prior to the issuance of Forms W-2. If you 
       have already issued Forms W-2, please read the additional information on page 2 before proceeding. 
    1.  Was the credit claimed in column 3 withheld from the pay of employee(s)? ...................................................................                       Yes   No 
     If yes, has this credit been refunded to employee(s)? .....................................................................................................           Yes   No 
    2.  Was the credit claimed in column 3 included on Forms W-2 issued to employee(s)? .....................................................                              Yes   No 
II. REASON FOR ADJUSTMENT 

III. EMPLOYEE WAGES/PIT WITHHOLDINGS ADJUSTMENT Enter the correct information which should have been reported. 
    Enter only those employees whose wages, withholdings, or Social Security Account numbers are being corrected. If you are reporting 
    adjustments for more than three (3) employees, list the items on a separate page with the same format or use a Quarterly Contribution 
    Return and Report of Wages (Continuation) (DE 9C). 
  SOCIAL SECURITY                          EMPLOYEE NAME                                            TOTAL WAGES SHOULD                                      TOTAL STATE PIT SHOULD 
  ACCOUNT NUMBER       First Initial                                Last Name                       HAVE BEEN REPORTED                                            HAVE BEEN REPORTED 

         Total of this page OR total for all pages attached 
IV. I declare that the above information is true and correct to the best of my knowledge and belief.  This section must be completed for credit to be allowed. 
SIGNATURE                                  TITLE  (Owner, Accountant, Preparer, etc.)                               PHONE                                           DATE 
X                                                                                                                   (      ) 
DE 938 Rev. 46 (7-14) (INTERNET)    Page 1 of 2              P.O. Box 826880 / Sacramento CA 94280-0001                                                                        CU      



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                                                    Instructions for Completing the 
                  Quarterly Adjustment Form for Voluntary Plan Disability Insurance Employers (DE 938) 

The Employment Development Department’s (EDD) Quarterly Adjustment Form for Voluntary Plan Disability Insurance 
Employers (DE 938) is used to make changes to the Quarterly Contribution Return (DE 3D). 

 You need to complete this form if                 You do not need to complete this                If you are not an employer with 
 you are an employer with Voluntary  adjustment form if:                                           Voluntary Plan Disability 
 Plan Disability Insurance and:                    1.  You have made an overpayment and can        Insurance, do not use a DE 938 
 1.  You are adjusting wages and/or Personal        internally adjust the contribution on a        to request adjustments to your 
 Income Tax (PIT) withholding by                    subsequent   Payroll Tax Deposit (DE 88).      account. 
 individual. or                                     For example, an overpayment of Personal        Contact the Taxpayer Assistance Center 
                                                    Income Tax (PIT) is considered as a            at 888-745-3886 for assistance, forms, 
 2.  You are reporting additional wages             prepayment of the PIT for the subsequent       or if you are reporting back pay awards. 
 and/or PIT. or                                     DE 88. The amount reported and paid on 
 3.  You are filing a claim for refund. or          the subsequent DE 88 should be the actual      Forms are also available on our website 
                                                    amount of PIT withheld for the period minus    at www.edd.ca.gov. 
 4.  You have reported wages, withholdings,         the overpayment in PIT. or 
 or contributions incorrectly and need to 
 adjust them.                                      2.  You have reported contributions incorrectly 
                                                    and can internally adjust the individual 
                                                    contributions on your subsequent DE 88s. 
I.  ADJUSTMENTS TO WAGES AND CONTRIBUTIONS 
Lines A through G: 
•  Column 1 - Enter the amounts previously reported on your return, report, or your most recent adjustment form. Complete for 
 affected fields only. 
•  Column 2 - Enter the amounts that you should have reported on the above return report or adjustment form. 
•  Column 3 - Enter the difference between Column 1 and Column 2. 
                                                           rd
Line I: Penalty: Penalty of 15% (10% for periods prior to 3  quarter 2014) of Line H is due if you are paying additional taxes with this 
adjustment form.  
Line J: Interest: Interest is computed on the total of Line H and Line I. Since the interest rate changes periodically, please contact your 
nearest Employment Tax Office for assistance. 
Line K: Erroneous SDI Deductions Not Refunded: Since SDI deductions (includes Paid Family Leave amount) are employee contributions, 
the EDD cannot refund these contributions to you unless the erroneous deductions have been first refunded to the employees. 
Line L: Enter total contributions and withholdings paid. 
Line M: Total: Add Subtotal (Line H2), plus Penalty (Line I) and Interest (Line J), plus Erroneous SDI Deductions Not Refunded (Line K), 
minus contributions and withholdings paid for the quarter (Line L). If a balance is due, please pay this amount. In order to reduce costs, 
 credits under $10 will not be refunded unless requested in writing. 
Personal Income Tax Overpayments 
After you have issued a Form W-2 to an employee, you cannot adjust the amount reported as income tax withheld when you have 
over-withheld from an employee’s wages. The EDD cannot allow a credit or refund of any overpayment of income tax withheld from an 
employee’s wages that are reported on Form W-2. The employee will receive credit for any overwithholding when filing their California 
Resident Income Tax return (Form 540) with the Franchise Tax Board. You should not refund the overwithholding to the employee, 
change the California PIT withholding amount shown on the Form W-2, or file a claim for refund with the EDD. 
You may claim a credit or refund of California PIT overwithheld from an employee’s wages when the excess amount is credited or 
refunded to the employee during the same calendar year and the excess amount is not shown on the Form W-2 issued to the 
employee. If you paid the EDD more than the amounts withheld from an employee’s wages, and you want a refund, you can adjust the 
amount reported on this form. Otherwise, you can consider this overpayment of PIT as a prepayment of the PIT for the subsequent 
deposit. You do not need to complete this adjustment form. The amount indicated on the subsequent payment should be the actual 
amounts due in the PIT minus the overpayment in PIT. The payment submitted should always equal the stated amounts on deposit. 
Do not show a credit on the DE 88.  
If you issued a Form W-2 showing the wrong amount, you must issue a Form W-2C to the employee and make the necessary changes 
in Section III on page 1 of this form, or submit the appropriate Quarterly Contribution Return and Report of Wages (Continuation) (DE 9C) 
with this adjustment form. 
II.  REASON FOR ADJUSTMENT. This item is used to explain the reason for the adjustment in the above section. 
III. EMPLOYEE WAGES/PIT WITHHOLDINGS ADJUSTMENT. Attach additional DE 9C forms if you need additional space. 
 Complete as described in the following examples: 
 A. Incorrect wages and/or PIT withholdings reported. Enter Social Security Account (SSA) number, name, and correct amount of 
      wages and PIT withholdings. 
 B.  Wrong SSA number originally reported. This correction requires two entries. First enter the incorrect SSA number, name, zero (0) 
      wages, and zero (0) PIT withholdings; then enter the correct SSA number, name, correct amount of wages and PIT withholdings. 
IV. SIGNATURE. Please include your phone number so we can contact you if we need additional information. Thank you.

DE 938 Rev. 46 (7-14) (INTERNET)        Page 2 of 2     P.O. Box 826880 / Sacramento CA 94280-0001 






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