UC-522-FF (12-18) ARIZONA DEPARTMENT OF ECONOMIC SECURITY                                        Page 1 of 2
                                   Employer Engagement Administration

                                   ADJUSTMENT REPORT

Use this form if you need to make corrections to a previously submitted Unemployment Tax and Wage Report 
(UC-018).

INSTRUCTIONS:

Section A:
Document the Social Security Number, Name and Wage Information of each worker for which wages must be 
corrected. 

VERY IMPORTANT: Provide the reason for the adjustment (if more space is needed, continue the expla-
nation on the reverse side of the form after printing it). Your adjustment report will be rejected without 
this information.

If only changes to Social Security Numbers are being made, you do not need to complete section.

Section B:
Do not complete this section if only making corrections to Social Security Numbers, not wages.

Section C:
Unsigned requests will be rejected.

If you have questions about completing this form or adjusting wage reports, contact the UI Tax Section at:

                  Arizona Department of Economic Security
                  Unemployment Tax – Mail Drop 5881
                  Accounting Unit
                  P.O. Box 6028
                  Phoenix, AZ 85005-6028
                  Telephone: (602) 771-6601
                  Fax: (602) 532-5562
                  Email: UITAccounting@azdes.gov

For faster processing, please submit your Adjustment Report via email at the email address above.

Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the 
Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 
1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department prohibits discrimination in 
admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, disability, 
genetics and retaliation. To request this document in alternative format or for further information about this policy, Contact 
the UI Tax Office at 602-771-6606; TTY/TDD Services: 7-1-1. • Free language assistance for DES services is available upon 
request. Ayuda gratuita con traducciones relacionadas con los servicios del DES esta disponible a solicitud del cliente.

ADJ   Scan both sides if box is checked.                       ARIZONA DEPARTMENT OF ECONOMIC SECURITY                                                  UC-522-FF (12-18) - Page 2 of 2
      (Checkbox above is for DES use only.)                    Employer Engagement Administration Mail Drop 5881
                                                               P.O. Box 6028, Phoenix, AZ 85005-6028                          Adjustment will be rejected unless the 
ACCOUNT NUMBER                                                 Phone: 602-771-6601 ● Fax: 602-532-5562                        reason for it is provided. 
                                                                                                                              Use reverse side if more space is needed.
CALENDAR QUARTER ENDING                                                 ADJUSTMENT REPORT
EMPLOYER’S NAME                                                ADDRESS (No., Street, City, State, ZIP)

A. CORRECTION TO REPORT OF WAGES PAID TO INDIVIDUAL EMPLOYEES                                                                 THIS BOX REQUIRED FOR EACH ENTRY
      Employee’s Social                                                   Amount of Wages 
                                     Employee’s Name                                                  Correct Amount of Wages             Reason for Adjustment
      Security Number                                                     Previously Reported
0   0 0    0    0 0 0   0 0                 Last               First                                                          If  reason  for  adjustment  varies  by  employee,  explain  each 
                                                               Initial    Dollars and Cents             Dollars and Cents     error on the lines below. 

B. CORRECTION TO TAXABLE WAGES & AMOUNTS DUE                   TOTALS:           $ 0.00                         $ 0.00
                                                                                                                              C. CERTIFIER INFORMATION
                    As Previously Reported       As Corrected             Net Increase                  Net Decrease
                                                                                                                              PREPARED BY                      DATE
Total Wages         $                       $                           $                             $ 
Excess Wages        $                       $                           $                             $                       VERIFIED BY                      DATE
Taxable Wages       $                       $                           $                             $ 
UI TAX
Adjustment at        % (tax rate in effect for quarter indicated above) $                             $ 
UI INTEREST
Add 1% for each full and/or partial month from delinquent date          $                                                     YOUR SIGNATURE
JOB TRAINING TAX
Adjustment at 0.10% of Taxable Wages                                    $                             $ 
SPECIAL ASSESSMENT (APPLIES TO CALENDAR QUARTERS IN 2011 AND 2012 ONLY)                                                       YOUR TITLE
Adjustment at 0.40% (2011) or 0.50% (2012) of Taxable Wages             $                             $ 
NET ADJUSTMENT
Underpayment                                                            $                                                     YOUR PHONE NUMBER                DATE
NET ADJUSTMENT
Overpayment                                                                                           $ 

REASON FOR ADJUSTMENT (Required): 
* Changes to SSN must be made indicating the removal of wages from the incorrect SSN on one line and adding to the correct SSN on the next.