~ Employment STATUTE OF LIMITATIONS
Development TAX AND WAGE ADJUSTMENT FORM A claim for refund or credit must
EDDDepartment Please read the Instructions for Completing the Tax and Wage be filed within three years of the
Adjustment Form (DE 678-I) before preparing this form last timely filing date of the year
State of California as filing requirements have changed. being adjusted.
SECTION I: EMPLOYER ACCOUNT NO.
BUSINESS NAME I ,.,
TAX YEAR
ADDRESS I ::,
CITY, STATE, ZIP
REASON FOR ADJUSTMENT __________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
SECTION II: REQUEST FOR REFUND OF OVERPAYMENT ON PAYROLL TAX DEPOSIT PRIOR TO FILING OF DE 7/DE 3HW.
Provide the following information and complete Items B through H in Section III, with correct deposit information.
PAY DATE YEAR QTR
AMOUNT PREVIOUSLY PAID $
I I I I I I I I I I I ! .,
M M D D Y Y YY Q
SECTION III: REQUEST FOR REFUND OR ANNUAL RECONCILIATION RETURN ADJUSTMENTS
A. TOTAL SUBJECT WAGES PAID THIS CALENDAR YEAR ...................................................... > (A)
I .,
B. UNEMPLOYMENT INSURANCE (UI) TAXES
UI TAXABLE WAGES UI CONTRIBUTIONS
UI RATE % X = (B)
- I ! , I ! .,
ETTCONTRIBUTIONS
C. EMPLOYMENT TRAINING TAX (ETT) RATE OF % X UI TAXABLE WAGES = (C)
- I .,
D. STATE DISABILITY INSURANCE (SDI) TAXES
(includes Paid Family Leave amount) SDI TAXABLE WAGES SDI EMPLOYEE CONTRIBUTIONS WITHHELD
SDI RATE % X = (D)
- I , .,
PIT WITHHELD PER FORMS W-2 AND/OR 1099R
E. CALIFORNIA PERSONAL INCOME TAX (PIT) WITHHELD ..................................................... > (E)
! .,
F. SUBTOTAL (Add Items B, C, D and E) ...................................................................................... > (F) .,
G. LESS: CONTRIBUTIONS AND WITHHOLDINGS PAID FOR THE YEAR ............................... > (G)
(DO NOT INCLUDE PENALTY AND INTEREST PAYMENTS) i 1
SDI not refunded to the employee(s)
H. LESS: ERRONEOUS SDI CONTRIBUTIONS NOT REFUNDED TO THE EMPLOYEE(S) ...... > (H)
(COMPLETE SECTION IV). 1
I. TOTAL TAXES DUE OR OVERPAID (ITEM F MINUS ITEM G PLUS ITEM H)
IF TAXES ARE DUE, SUBMIT PAYMENT WITH THIS FORM (DO NOT USE DE 88). ……………………….
1
IF SDI OR PIT WITHHOLDINGS ARE OVERPAID, COMPLETE SECTION IV.
Complete reverse side of this form if the adjustment changes what you reported on the Quarterly Wage and Withholding Report (DE 6).
SECTION IV: STATE DISABILITY INSURANCE (SDI) AND CALIFORNIA PERSONAL INCOME TAX (PIT) OVERPAYMENTS
The SDI and PIT deductions are employee contributions. The EDD cannot refund these contributions to you unless you first refund the erroneous
deductions to the employee(s). SDI deductions PIT deductions
1. Was the overpayment withheld from the wages of employee(s)? Yes No Yes No
If no, no further information is required in this Section. □ □ □ □
2. If yes, was this amount refunded to the employee(s)? Yes No Yes No
□ □ □ □
If the overpayment has not been refunded because employee(s) are no longer employed and you are unable to locate, the EDD will need
further information. On a separate page list: Social Security Number, employee(s) name, last known address, and amount of SDI not refunded.
If you have not issued Form(s) W-2, the EDD will allow PIT wage and withholding credit adjustments. Please enter changes in Section V.
If you have issued Form(s) W-2, the employee will receive a credit for the PIT overwithholdings when filing his/her California Income Tax Return
(Form 540) with the Franchise Tax Board. Do not refund PIT overwithholdings to the employee. Do not change the California PIT withholding amount
shown on the Form W-2. Do not file a claim for refund with the EDD. For additional information, see the DE 678-I, Section IV.
Signature Title Phone ( ) Date
(Owner, Accountant, Preparer, etc.)
' SIGN AND MAIL TO: Employment Development Department / P.O. Box 989071 / West Sacramento, CA 95798-9071
DE 678 Rev. 5 (2-14) (INTE RNET) Page 1 of 2 CU