Electronic Form Processing - DO NOT STAPLE OR SUBMIT COPIES - Use Black Ink                                    DOL - 3C  (R-9/14)

          GEORGIA                          REPORT TO ADD NEW WAGES                            *00301* 
DEPARTMENT OF LABOR                AND/OR CORRECT REPORTED WAGES                                          00301

                                                                                                               Wage
Mail Completed Form To:                                          For Department Use Only                       Investigation
GDOL - Employer Accounts, Room 752
148 Andrew Young International Blvd., N.E.                       Date Received                                 Supplemental
Atlanta, Georgia 30303-1751
Phone: (404) 232-3245                                            M M        / D D  /        Y Y Y Y            Correction
                          SECTION A                              Employer Name, Address and E-mail Address
DOL Account Number                         Total Tax Rate
                          -                       .
Qtr / Yr                       End Date
Q / Y Y Y Y                    M M     /   D D /   Y Y Y Y
Federal I.D. Number 

                                         SECTION B
  DOL-4N, Item 2                       DOL-4N, Item 3            DOL-4N, Item 4               PLEASE INCLUDE YOUR DOL  
Total Reportable Gross Wages      Non-Taxable Wages              Taxable Wages                ACCOUNT NUMBER ON ALL CHECKS 
                                                                                              AND CORRESPONDENCE

                                                               SECTION C
                                           Individual Quarterly Wages Reported And Corrected
                                                                 Total Reportable Gross Wages             Taxable Wages
Social Security No.            Employee’s Full Name
                                                         Pages   Reported       Corrected          Reported            Corrected

                                           Totals
                                                               SECTION D
                                                        Increase                                    Decrease
1. Total Reportable Gross Wage
 Corrections  ....................                ,            ,          .                   ,           ,              .

2. Non-Taxable Wage Corrections .....             ,            ,          .                   ,           ,              .

3. Taxable Wage Corrections .........             ,            ,          .                   ,           ,              .
4. Contribution Tax on Corrections
5. Admin Assessment on Corrections
6. Interest on Lines 4 & 5
7. Additional Tax or Credit Due
                                                               SECTION E
Corrected Summary of Total Reportable Gross Wages                Corrected Summary of Taxable Wages

Explanation

Submitted By                                      Title                       Date                 Phone  (           )

                                                        Page     of

                                                                                                                DOL - 3C  (R-3/14)

                                 INSTRUCTIONS FOR COMPLETING FORM DOL-3C

                   “REPORT TO ADD NEW WAGES AND/OR CORRECT REPORTED WAGES”

The form is designed to:  (1) correct previously reported wages and/or (2) report wages of individuals who were omitted from the original 
Employer’s Quarterly Tax and Wage Report, Form DOL-4N.  Completeone or more of these forms separatelyfor        each quarterly 
report that is to be corrected.  

SECTION A
Enter the DOL Account Number, Total Tax Rate (Contribution plus Administrative Assessment),  quarter and 4-digit year, 
quarter ending date, Federal I.D. Number, Employer Name, Address and E-mail Address.

SECTION B
Enter the amounts as originally reported on lines 2, 3 & 4 of the Employer’s Quarterly Tax and Wage Report, Form DOL-4N being cor-
rected. Taxable wages in Georgia for 2012 and prior years is the first $8,500 paid per employee per year. Taxable wages beginning 2013 
is $9,500.

SECTION C
Enter the following information:
  •   9 digit Social Security Number(s)
  •  Full Last Name(s) and Full First Name(s) of any employee(s) omitted or incorrectly reported on the original report
  •  Total reportable gross wages reported for the employee(s) and the corrected amount of total reportable gross wages
  •  Taxable wages as originally reported and the corrected amount of taxable wages

Add
  •  All entries in the Total Reportable Gross Wages Reported column and enter total
  •  All entries in the Total Reportable Gross Wages Corrected column and enter total
  •  All entries in the Taxable Wages Reported column and enter total
  •  All entries in the Taxable Wages Corrected column and enter total

If more than one form is submitted for the same quarter, each form should include the totals for that form only.

SECTION D
Line 1:  Enter the difference between the reported Total Reportable Gross Wages and the corrected Total Reportable Gross Wages from 
      Section C as either an increase or decrease, if applicable.
Line 2:  Enter the difference in the Corrected Non-Taxable Wages and the previously reported Non-Taxable Wages from
      Section B as either an increase or decrease, if applicable.  
Line 3:  Enter the difference between the Total Taxable Wages from Section B and the corrected Total Taxable Wages from
       Section C as either an increase or decrease, if applicable.
Line 4:  Multiply the Taxable Wage amounts in the increase and/or decrease column on Line 3 by the contributory tax rate for
       the quarter.
Line 5:  Multiply the Taxable Wage amounts in the increase and/or decrease column on Line 3 by the administrative assessment tax rate 
      for the quarter.  
Line 6:  Multiply the total tax due (Lines 4 +5 increase column only) by one and one-half percent (1 ½ %) per month or fraction of a 
      month calculated from the due date until paid.  Interest is not applicable on the tax amount in the decrease column.
Line 7:  Enter the total of the increase column for Lines 4 through 6, minus the total of the decrease columns for Lines 4 and 5.  If the 
      total reflects an increase in tax due, submit payment to Georgia Department of Labor.  If paying by check, please include your 
      Georgia DOL Account Number on your check.  A decrease may result in a credit to your account.

SECTION E
To adjust total reportable gross wages, the amount of increase should be added to the amount entered in Item 2 in Section B or the 
amount of decrease should be subtracted from Item 2 in Section B.  The result of the addition or subtraction should be entered as Cor-
rected Summary of Total Reportable Gross Wages.

To adjust taxable wages, the amount of increase should be added to the amount entered in Item 4 in Section B or the amount of decrease 
should be subtracted from Item 4 in Section B.  The result of the addition or subtraction should be entered as Corrected Summary of Tax-
able Wages.

Enter your explanation of the adjustment in the space provided.

Enter your Name on the “Submitted By” line, Title, Date, and Telephone Number and return as indicated on the front of the form.