Quarterly Contribution and Wage 
                                                                                   Adjustment Form 

The   Quarterly Contribution and Wage Adjustment Form                              (DE 9ADJ) is used to request corrections to information previously 
reported on a Quarterly Contribution Return and Report of Wages (DE 9) and/or Quarterly Contribution Return and Report of 
Wages  (Continuation) (DE 9C).   A claim for refund must be filed within 3 years of the last timely date of the quarter being 
adjusted, 6 months after an assessment becomes final, or 60 days from the date of the overpayment, whichever date occurs 
later. 
You   can also file adjustments to previously filed returns online through the Employment Development Department (EDD) 
e-Services for Business (edd.ca.gov/e-Services_for_Business). Refer to the Instructions for Completing the Quarterly
Contribution and Wage Adjustment Form           (DE 9ADJ-I) (PDF)                      (edd.ca.gov/pdf_pub_ctr/de9adji.pdf) for additional information.
Check the box       ☐ If only adjusting the DE 9,                                 ☐ If only adjusting the DE 9C,        ☐   If adjusting DE 9 and DE 9C,
that applies:         complete Sections I, II, III, and V.                          complete Sections I, II, IV, and V.     complete all sections.

Section I: Employer Information. Complete all fields (Please print).                                                                         Quarter 
Business Name:        _______________________________________________                                                                        YYQ 
                      _______________________________________________                                                   Employer Account Number 
Street Address:       _______________________________________________ 
City, State, ZIP Code: _______________________________________________ 
Section II: Reason for Adjustment. Enter a detailed reason for the adjustments requested. (Required) 
_____________________________________________________________________________________________________ 
_____________________________________________________________________________________________________ 
Section III: Request to Adjust the DE 9.                                                   (1)                   (2)                       (3) 
Complete all fields. If requesting a credit (decrease) to  Amounts Reported on                          Amounts That                Difference 
SDI or PIT, you must also complete Line   below. O                                 DE 9 or Most Recent  Should Have Been            Debit/(Credit)     
                                                                                    Adjustment Form             Reported 
A. Total Subject Wages
B. Unemployment Insurance (UI) Taxable Wages
C. State Disability Insurance (SDI) Taxable Wages
D. Employer’s UI Contributions (UI rate_____% times B)
E. Employment Training Tax (ETT rate_____% times B)
F. SDI Withheld (SDI rate_____% times C)
   (Includes Paid Family Leave)
G. Personal Income Tax (PIT) Withheld
H. Subtotal (Add amounts on Lines D, E, F, and G)
I. Plus: Erroneous SDI Deductions Not Refunded (Refer to Note below)
J. Less: Contributions and Withholdings Paid for the Quarter
K. Total Taxes Due or Overpaid (H2 + I – J). (If balance is due, complete L,
   M, and N)
L. Penalty (If balance is due, calculate 15% of the amount on Line K)
M. Interest (Refer to the DE 9ADJ-I for instructions)
N. Total Due (Lines K + L + M)

O. SDI and PIT overpayments. If requesting a credit (decrease) to SDI or PIT, you must                           SDI Deductions  PIT Deductions 
   answer the following questions:
 1. Was the credit claimed above (column 3) withheld from the wages of employee(s)?                                     ☐ Yes   ☐ No       ☐ Yes   ☐No
 2. If yes, has this amount been refunded to the employee(s)?                                                           ☐ Yes   ☐ No       ☐ Yes   ☐No
 3. Was the correct PIT reported on the Form W-2 issued to the employee(s)?                                                                ☐ Yes   ☐No
Note: SDI and PIT deductions are employee contributions. The EDD cannot refund these amounts unless you first refund the 
erroneous deductions to the employee(s). If you have issued Form(s) W-2, do not refund PIT overwithholdings or 
change the amount reported on the employee(s) Form W-2. The employee will receive a credit for the PIT overwithheld 
when they file their California Income Tax Return (Form 540) with the Franchise Tax Board. If you are requesting a PIT credit 
for a prior year because you paid the EDD more than the amount withheld from the employee(s), attach a copy of Form(s)   
W-2 filed for each affected employee. Refer to the DE 9ADJ-I for additional instructions.
       Sign on Page 2 and Mail To: Employment Development Department / PO Box 989073 / West Sacramento, CA 95798-9073 

DE 9ADJ Rev. 4 (1-23) (INTERNET)                                                  Page 1 of ________                                                   CU 

                                                                                      Quarter         Employer Account Number 
                        Business Name: ______________________________________               YYQ 

Section IV: Request to Adjust the DE 9C. Complete Item A for all DE 9C adjustments. Complete Item B only for wage plan 
code corrections to all employees. Complete Item C to request adjustments to individual employee information.  
A. DE 9C Grand Totals for the Quarter
   A1.  Enter the correct grand totals for all  Total Subject Wages               Total PIT Wages       Total PIT Withheld 
       employees for the quarter. 
   A2.  Enter the number of employees full-time and part-time who                 1st Month       2nd Month            3rd Month 
       worked during or received pay subject to UI for the pay period 
       which includes the 12 thof the month. 
                                                                                                                  Wage Item Count 
   A3. Enter the correct total number of wage lines for all employees for the quarter. 

B. Wage Plan Code Corrections for All Employees. Leave blank if not correcting all wage plan codes. Refer to the
   Information Sheet: Reporting Wage Plan Codes on Quarterly Wage Reports and Adjustments (DE 231WPC) (PDF)
   (edd.ca.gov/pdf_pub_ctr/de231wpc.pdf) for additional information.
   Enter Number of Employees: _________ Prior Plan Code: ____ Correct Plan Code: _____
   (Item C below is not required if only adjusting wage plan codes for all employees.)

C. Individual Wage Line Adjustments. Identify the adjustment type for each affected employee and complete the fields
   indicated. Include only the wage lines that need to be corrected. Make corrections to the quarter(s) in which the
   information was originally reported. Do not report negative amounts.
   Adjustment Type                                                                Fields to Complete for Each Affected Employee 
   Add employee(s) not previously reported.                                       C1 – C6. Leave C7 – C9 blank. 
   Remove employee(s) reported in error.                                          C1 – C6. Enter 0.00 in C3 – C5. 
   Adjust wages or PIT amounts previously reported.                               C1 – C6. Leave C7 – C9 blank. 
   Correct employee name(s).                                                      C1 – C6 and C7. Leave C8 – C9 blank. 
   Correct a Social Security number (SSN).                                        C1 – C6 and C8. Leave C7 and C9 blank. 
   Correct wage plan code for one or more employees but not all.                  C1 – C6 and C9. Leave C7 and C8 blank. 
   Multiple adjustments.                                                          C1 – C6 and C7 – C9 if they apply to adjustment. 
                                                                                  For name, SSN, or plan code corrections, enter 
Enter the information that should have been reported in fields C1 – C6.           the information previously reported in fields 
If a correction reduces wages or withholdings amount to zero, enter 0.00 in 
                                                                                  C7 – C9. Leave these fields blank for all other 
the field.                                                                        adjustment types. 
C1. Social Security Number (SSN)  C2. Employee Name (First, Middle Initial, Last) C7. Previously Reported Name (First, Middle Initial, Last) 

C3. Total Subject Wages C4. PIT Wages          C5. PIT Withheld                   C6. Plan Code  C8. Previously Reported SSN  C9. Previously Reported Plan Code 

C1. Social Security Number (SSN)  C2. Employee Name (First, Middle Initial, Last) C7. Previously Reported Name (First, Middle Initial, Last) 

C3. Total Subject Wages C4. PIT Wages          C5. PIT Withheld                   C6. Plan Code  C8. Previously Reported SSN  C9. Previously Reported Plan Code 

C1. Social Security Number (SSN)  C2. Employee Name (First, Middle Initial, Last) C7. Previously Reported Name (First, Middle Initial, Last) 

C3. Total Subject Wages C4. PIT Wages          C5. PIT Withheld                   C6. Plan Code  C8. Previously Reported SSN  C9. Previously Reported Plan Code 

                        Please attach additional pages if reporting more than 3 wage line adjustments. 
Section V: Declaration. I declare that the information herein is true and correct to the best of my knowledge. (A signature is 
required on all adjustments)  
Signature  _____________________________  Title  _______________________________________   Date ____________  
Print Name  ____________________________  Phone  ________________  Email __________________________________ 

           Sign and Mail To: Employment Development Department / PO Box 989073 / West Sacramento, CA  95798-9073 

DE 9ADJ Rev. 4 (1-23) (INTERNET)                    Page 2 of  ________ 

                                                                                  Quarter           Employer Account Number 
                        Business Name: ______________________________________     YYQ 

                                                                                  For name, SSN, or plan code corrections, enter 
Enter the information that should have been reported in fields C1 – C6.           the information previously reported in fields 
If a correction reduces wages or withholdings amount to zero, enter 0.00 in       C7 – C9. Leave these fields blank for all other 
the field.                                                                        adjustment types. 
C1. Social Security Number (SSN)  C2. Employee Name (First, Middle Initial, Last) C7. Previously Reported Name (First, Middle Initial, Last) 

C3. Total Subject Wages C4. PIT Wages C5. PIT Withheld                            C6. Plan Code  C8. Previously Reported SSN  C9. Previously Reported Plan Code 

C1. Social Security Number (SSN)  C2. Employee Name (First, Middle Initial, Last) C7. Previously Reported Name (First, Middle Initial, Last) 

C3. Total Subject Wages C4. PIT Wages C5. PIT Withheld                            C6. Plan Code  C8. Previously Reported SSN  C9. Previously Reported Plan Code 

C1. Social Security Number (SSN)  C2. Employee Name (First, Middle Initial, Last) C7. Previously Reported Name (First, Middle Initial, Last) 

C3. Total Subject Wages C4. PIT Wages C5. PIT Withheld                            C6. Plan Code  C8. Previously Reported SSN  C9. Previously Reported Plan Code 

C1. Social Security Number (SSN)  C2. Employee Name (First, Middle Initial, Last) C7. Previously Reported Name (First, Middle Initial, Last) 

C3. Total Subject Wages C4. PIT Wages C5. PIT Withheld                            C6. Plan Code  C8. Previously Reported SSN  C9. Previously Reported Plan Code 

C1. Social Security Number (SSN)  C2. Employee Name (First, Middle Initial, Last) C7. Previously Reported Name (First, Middle Initial, Last) 

C3. Total Subject Wages C4. PIT Wages C5. PIT Withheld                            C6. Plan Code  C8. Previously Reported SSN  C9. Previously Reported Plan Code 

C1. Social Security Number (SSN)  C2. Employee Name (First, Middle Initial, Last) C7. Previously Reported Name (First, Middle Initial, Last) 

C3. Total Subject Wages C4. PIT Wages C5. PIT Withheld                            C6. Plan Code  C8. Previously Reported SSN  C9. Previously Reported Plan Code 

C1. Social Security Number (SSN)  C2. Employee Name (First, Middle Initial, Last) C7. Previously Reported Name (First, Middle Initial, Last) 

C3. Total Subject Wages C4. PIT Wages C5. PIT Withheld                            C6. Plan Code  C8. Previously Reported SSN  C9. Previously Reported Plan Code 

C1. Social Security Number (SSN)  C2. Employee Name (First, Middle Initial, Last) C7. Previously Reported Name (First, Middle Initial, Last) 

C3. Total Subject Wages C4. PIT Wages C5. PIT Withheld                            C6. Plan Code  C8. Previously Reported SSN  C9. Previously Reported Plan Code 

C1. Social Security Number (SSN)  C2. Employee Name (First, Middle Initial, Last) C7. Previously Reported Name (First, Middle Initial, Last) 

C3. Total Subject Wages C4. PIT Wages C5. PIT Withheld                            C6. Plan Code  C8. Previously Reported SSN  C9. Previously Reported Plan Code 

C1. Social Security Number (SSN)  C2. Employee Name (First, Middle Initial, Last) C7. Previously Reported Name (First, Middle Initial, Last) 

C3. Total Subject Wages C4. PIT Wages C5. PIT Withheld                            C6. Plan Code  C8. Previously Reported SSN  C9. Previously Reported Plan Code 

C1. Social Security Number (SSN)  C2. Employee Name (First, Middle Initial, Last) C7. Previously Reported Name (First, Middle Initial, Last) 

C3. Total Subject Wages C4. PIT Wages C5. PIT Withheld                            C6. Plan Code  C8. Previously Reported SSN  C9. Previously Reported Plan Code 

DE 9ADJ Rev. 4 (1-23) (INTERNET)      Page ______  of  ______