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 FORM CONN UC-5A                     CORRECTION OF EMPLOYEE QUARTERLY EARNINGS REPORT                                     
 (CORR) (Rev.  3/18)                                                 
                                                                      
                      PLEASE READ INSTRUCTIONS BELOW FOR FILING REQUIREMENTS AND EXPLANATION OF ITEMS                                     
                                                                                     
CONN.                                                                               CONNECTICUT DEPARTMENT OF LABOR 
REG.   NO.:                                                                         EMPLOYER TAX ACCOUNTING UNIT 
                                                                                    200 FOLLY BROOK BOULEVARD 
QUARTER                         YEAR                                                WETHERSFIELD, CT 06109-1114 
                                                                                     
EMPLOYER                                                                            TOTAL PAGES ON THIS REPORT                           
TRADE NAME:                                                                         INCLUDING CONTINUATION SHEETS:      
 
TYPE OR PRINT                                                 LIST ONLY THOSE EMPLOYEES WHOSE WAGES ARE BEING CORRECTED. 
1.  EMPLOYEE             2.  NAME OF EMPLOYEE                  3.  WAGES AS LISTED 4.  CORRECT AMT. 5. INCREASE             6. DECREASE 
     SOCIAL SECURITY     FIRST INITIAL,  LAST NAME             ON ORIGINAL REPORT       OF WAGES 
     NUMBER 

DO NOT WRITE IN THIS                                           7.      TOTAL FOR THIS PAGE 
 SPACE                                                                                                                           
WAGE RECORD 
CORRECTED_______________                                                                                                         
                                                               8.      TOTAL FOR THIS REPORT 
  
                                                                INSTRUCTIONS 
  
This form is a Quarterly Combination Correction for to be used to correct an EMPLOYER CONTRIBUTION RETURN (Form Conn. UC-2) 
and EMPLOYEE QUARTERLY EARNINGS REPORT (Form UC-5A), which you have previously filed with this department.  Submit the 
original and keep a copy for your files.  A separate form must be submitted for each quarter in which there is a correction to be made. 
 
DO NOT USE these forms to correct social security numbers or employee names.  Please submit a detailed letter on your 
company letterhead explaining the correction addressed to the DEPARTMENT OF LABOR, EMPLOYER TAX ACCOUNTING UNIT, 
 200 FOLLY BROOK BLVD., WETHERSFIELD, CT 06109-1114. 
 
                                     HOW TO PREPARE FORM CONN. UC-5A (CORR.) 
Heading:        Enter your Connecticut Registration Number, Quarter/Year, and Employer Trade Name.  Enter the total pages on this 
                report, including Continuation Sheets. 
                                                                                                                           
LIST ONLY EMPLOYEES WHOSE WAGE ARE BEING CORRECTED. 
    
1.  Enter employees’ Social Security Numbers 
2.  TYPE or PRINT the name of each employee 
3.  Enter the Employees’ Wages as listed on original Employee Quarterly Earnings Report. 
4.  Enter the Employees’ Correct Wages. 
5.  If the difference in Item 3 and 4 is an increase, enter difference here. 
6.  If the difference in Item 3 and 4 is a decrease, enter the difference here. 
7.  Enter the Totals for this page in Column 5 and Column 6. 
8.  Enter the totals for this sheet and all Continuation sheets attached. 
   If there is no tenough space to list all employees on form Conn. UC-5A (Corr.) then a Continuation sheet may be used.  The 
   Continuation Sheet should be on 8½”X11” paper showing employer’s name and tax registration number.  Each page must show a page 
   number beginning with page 2, following the format of page 1. 
    
 IF YOU FILED YOUR ORIGINAL RETURN WITH ZERO GROSS WAGES PLEASE CHECK HERE.  
                                                                                                                            
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                                       FORM CONN. UC-2                                                            CORRECTION OF                             
                                       (CORR)  (Rev. 3/18) 
                                                                                                    EMPLOYER CONTRIBUTION RETURN                            
                                                                                               PLEASE COMPLETE BOTH PAGES OF THIS RETURN 
                                        
                                       QUARTER                                        YEAR               
                                                                                                                                             
                                       CONN. REG. NO.:                                                                                            CONNECTICUT DEPARTMENT OF LABOR 
                                                                                                                                                  EMPLOYER TAX ACCOUNTING UNIT 
                                       CORPORATE NAME OR                                                                                          200 FOLLY BROOK BOULEVARD 
                                       TRADE  NAME                                                                                                WETHERSFIELD, CT 06109-1114 
                                                                                                                                                  Pay Online at: www.ct.gov/doltax 
                                                            
                                       ADDRESS 
                                                            
                                                                                                           COLUMN A                        COLUMN B       COLUMN C                    COLUMN D 
                                                                                                           ORIGINAL                        CORRECTED      INCREASE 
                                       1      CONTRIBUTION RATE                         %                                                  RETURN                                     DECREASE 
                                                                                                           RETURN                                         (Difference between Column  (Difference between Column 
                                              See original return filed for contribution rate.             (Enter below amounts                           A and Column B when         A and Column B, when 
                                                                                                           reported on original return for                Column B is larger)         Column B is smaller) 
                                                                                                           corresponding items) 
                                       2      TOTAL GROSS WAGES PAID TO ALL EMPLOYEES FOR WORK                                                                                                                    
                                              PERFORMED IN CONNECTICUT THIS QTR 
                                       3      TOTAL GROSS WAGES PAID DURING THIS QUARTER TO EACH 
                                              EMPLOYEE IN EXCESS OF THE LIMITATION FOR THE                                                                                                                        
                                              CALENDAR YEAR 
                                       4      TOTAL TAXABLE WAGES-(ITEM 2 MINUS ITEM 3).  ENTER                                                                                                                   
                                              DIFFERENCE BETWEEN COL. A AND B IN COL. C OR D. 
                                       5      CONTRIBUTION OR CREDIT DUE: SEE INSTRUCTIONS BELOW.                                                                                                                 
                                              INTEREST DUE.  IF CORRECTION RESULTED IN AN INCREASE IN CONTRIBUTION (LINE 5, COLUMN C), ENTER INTEREST      
                                       6      DUE IN COLUMN C.  SEE INSTRUCTIONS BELOW.                                                                                               ********** 
                                              IF INCREASE IN CONTRIBUTIONS DUE (ITEM 5C), ENTER PENALTY DUE, IF ANY, IN COLUMN C.  SEE INSTRUCTIONS        
                                       7      BELOW.                                                                                                                                  ********** 
                                              TOTAL ADDITIONAL AMOUNT DUE – SUM OF ITEMS 5C, 6C AND 7C.  PAY ONLINE AT: WWW.CT.GOV/DOLTAX                  
                                       8                                                                                                                                              ********** 
                                       9      EXPLAIN REASON  
                                              FOR CORRECTION          

                                       10     SIGNED                                                    TITLE                               PHONE NUMBER  (     )                     DATE     
                                        
                                                                                                    HOW TO PREPARE FORM CONN. UC-2 (CORR.) 
                                       HEADING:                     Enter QUARTER/YEAR, Connecticut Registration Number, Employer Trade Name, Name of Owners, Partners, or 
                                                                    Corporate name (if other than trade name) and your Mailing address 
                                       Item 1:         Contribution Rate – enter Contribution Rate for this quarter.  If Rate has been corrected, use Corrected Rate. 
                                                        
                                       Item 2:         Enter Column “A” the Gross Wages Listed on the Original Return.  Enter in Column “B” the correct amount of Gross Wages.  If 
                                                       Column “B” is larger than Column “A”, enter the difference in Column “C”.  If Column “B” is smaller than Column “A”, enter the 
                                                       difference in Column “D”. 
                                                        
                                       Item 3:         Excess Wages – Wages paid during quarter in excess of the limitation for the calendar year.  Enter the Column “A” excess 
                                                       wages as listed on original Return.  Enter in Column “B” the correct amount of Excess Wages.  Enter the Difference between 
                                                       Columns “A” and “B” in appropriate Column “C” or “D”. 
                                                        
                                       Item 4:         Item 2 minus Item 3 
                                                       Enter in Column “A” the taxable Wages subject to contributions as listed on the Original Return. 
                                                       Enter in Column “B” the correct amount of Taxable Wages subject to contributions.  Enter difference between Columns “A” and 
                                                       “B” in the appropriate Column “C” and “D”. 
                                                        
                                       Item 5:         Enter in Column “A” the Contributions listed on the Original Return.  Enter in Column “B” the amount of Contributions due on 
                                                       corrected wages by multiplying Item 4B by the Contribution rate in Item 1.  If Column “B” is larger than Column “A”, it 
                                                       represents Additional Contributions Due, and the difference should be entered in Column “C” (INCREASE).  IF Column “B” is 
                                                       less than Column “A”, it represents an Overstatement of Contributions and the difference should be entered in Column “D” 
                                                       (DECREASE).  If a DECREASE, a refund may be issued, if applicable. 
                                                        
                                       Item 6:         Enter in Column “C” the interest due on the additional contributions due.  Multiply item 5C by the appropriate interest rate.  One
                                                        percent interest is charged for each month, or part thereof, that this return is filed late.  Example:  If the quarter being filed is 
                                                       the first quarter, the due date is April 30.  Beginning May 1st , calculate 1% interest due.  On June 1, 2% interest; on July 1, 3%
                                                         interest; etc.  If it is a second quarter return, interest begins to accrue August 1st;  for a 3rd quarter return, November 1st; and 
                                                       for a 4th quarter return,  February 1st .
                                              Item 7:  Enter in Column “C” any penalty on the additional contributions due.  A penalty of ten percent (10%) or fifty dollars ($50), 
                                                        whichever is greater, is assessed if the balance of contributions due is not paid within thirty days of the due date.  Penalty 
                                                       dates: 1st quarter —June 1st; 2nd quarter—September 1st; 3rd quarter—December 1st; and 4th quarter—March 1st.  Note:  
                                                        penalty may not be due if it was already assessed on the original return.  Please call the Employer Tax Accounting Unit 
                                                       (860)263-6470 for any necessary clarification.  
Pay online at:  and “7C”).  “6C”        Item 8:         Enter       the total Amount due (the Sum of Items “5C”,                                          www.ct.gov/doltax   
                                              Item 9:   Explain the reason for Correction fully.  If additional space is required, attach a letter furnishing all facts and refer to the letter in 
                                                        this space.                                                              
                                              Item 10:  This correction return must be signed by a responsible and duly authorized person and mailed to the address listed 
                                                        above.  Any payment due, however, must be made online at www.ct.gov/doltax.                                                              PAGE 2 OF 2 






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