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: If you 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