For Quarter Ended 
                                                                          Employer Account No.                                                                                          MO.  DAY      YR. 
            QUARTERLY RETURN                                   942 –                                     –                                                                                           
            ADJUSTMENT FORM                                                 
        FOR SCHOOL EMPLOYERS                                                  STATUTE OF LIMITATIONS                  
 Please Follow Instructions on Reverse Side                                     A claim for refund or credit                     For Department Use Only 
                                                                                 must be filed within three 
                                                                                  years of the last timely                                                                             MO.    DAY   YR. 
  
                                                                                   filing date of the                EFFECTIVE                                                                           
 Name                                                                            quarter being adjusted.             DATE 
 Address                                                                                                                                                                                                 
                                                                                            (1)                           (2)                                                                  (3) 
                                                                                                                                                                                         DIFFERENCES 
     I. COMPUTATION      OF ADJUSTMENT IN         CONTRIBUTIONS                   Previously reported            Should have reported                                                    Debit/(Credit) 
      B.TOTAL WAGES IN SUBJECT EMPLOYMENT                                                                                                                                                         
  
      C.EMPLOYER CONTRIBUTIONS (Employer Rate           times B)                                                                                                                                  
                           I. Penalty (Refer   to instructions on reverse side)  .......................................................................................                          

                           J. Interest (Refer to instructions on reverse side)  ........................................................................................                          

                         L. TOTAL  ...............................................................................................................................................                
  
    II.REASON FOR ADJUSTMENT        

 III. 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 (Administrator, Accountant, Preparer, etc.)        PHONE           )(                                                         EXT. 
  
    X                                                                                                        FAX     (         )                                                        DATE 
 IV. EMPLOYEE WAGE ADJUSTMENT. Enter the              correct  total wages  which should have been reported for the quarter. 
 NOTE:   Ifyou are adjusting more than four (4) employees, list the items on a separate page with the same format, including employer name, account 
 number, and the adjusting quarter. 
       SOCIAL SECURITY                     EMPLOYEE NAME                          TOTAL WAGES               TOTAL WAGES SHOULD 
      ACCOUNT NUMBER               (First, Middle Initial, Last   Name)     PREVIOUSLY REPORTED              HAVE REPORTED FOR                                                          DIFFERENCES 
                                                                                                                 QUARTER  
                                                                                                                                                                                                
                            TOTAL of this page OR total for all pages attached.                                                                                                                 
  
 FOR DEPARTMENT USE ONLY 

 EXAMINER                              DATE                  REVIEWER                                        DATE                ORIGINATING UNIT 

   CD                                    BN                     SN                                           PMT                     OP 

 DE 938SEF Rev. 11 (7-14) (INTERNET)           Page 1 of   2        PO Box 2482,   MIC 68 / Sacramento CA 95812-2482                                                                               CU  

          Instructions for Completing the Quarterly Return Adjustment Form for School Employers (DE 938SEF) 
 
Information: Form DE 938SEF is to       be used when (a) an  adjustment is made to a prior quarter        Quarterly Contribution 
Return  (DE 9423); and/or   (b) Unemployment Insurance benefits were withheld from a backpay award made to an 
employee. 
 
To ensure timely processing of your document, complete in full your employer               account number, name, and   mailing    
address in the appropriate areas.       Post the date of the quarter which is being adjusted. As an example, adjustments to 
returns covering the first quarter (January, February, and March) should be shown as 03/31/_ _. 
 
Submit a separate form DE 938SEF for each quarter to be adjusted. 
 
Item I: Computation of Adjustment in    Contributions. This  part    is   used to compute the correct wage differences and the    
taxes. 
 
Lines B, C:  
 
Column 1 – enter the amounts reported on your quarterly report as filed. 
Column 2 –  enter the amounts that should have been reported.  
Column 3 –  enter the differences between Column 1 and Column 2.  
 
                                                                     rd 
Line I: Penalty. Add Penalty of 15% (10% for periods prior to 3       Quarter 2014) of the contributions shown on Line C. 
 
Line J: Interest. Add Interest computed on the total unpaid contributions plus penalty.        The rate and method is prescribed 
by Section 1113 of the CUIC and will change based on the date of the quarter you are adjusting. 
 
Line L: Total. Compute by adding the total unpaid contributions plus Penalty and Interest. Submit a check for this amount  
if a balance is due to the Employment Development Department. 
 
Item II: Reason For Adjustment. This item is used to explain the reason for the adjustment in Item I. 
 
Item III: Signature. To be a valid claim form, an authorized representative must sign the adjustment form showing title, 
telephone numbers, and date. 
 
Item IV:   Employee Wage Adjustment.          When adjustments are necessary to correctly report an individual employee’s         
wages or social security number, complete as  shown in the following examples.  
 
A.  Incorrect Amount of Wages Reported.        
     Enter Social Security Account Number, Employee Name, and the incorrect and correct total wages for the quarter. 
 
B.  Wrong Social Security Account Number Reported. Requires           two entries. 
     1.  Enter incorrect Social Security Account Number, Employee Name and enter zero (0) for amount of wages paid. 
     2.  Enter correct Social Security Account Number, Employee Name and enter the total wages paid for the quarter. 
 
C.  No Social Security Account Number         Available When Report was Filed. Requires     two entries. 
     1.  Enter  all zeros (000-00-0000) for Social Security Account Number, Employee Name and enter                 zero (0) for 
         amount  of wages paid.  
     2.  Enter correct Social Security Account Number, Employee Name and enter the            total wages paid for the quarter. 
 
NOTE:    If additional space is needed, list the items on a separate page using the same format, including employer name,         
         account number,  and the quarter adjusting.  
 
For assistance in completing this form, or in obtaining additional forms, contact the School Employees Fund at                     
916-653-5380.  
 
DE 938SEF Rev. 11  (7-14)  (INTERNET)                          Page 2 of  2