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Form 21D (rev. 7/16)
Employer's Annual Contribution, Investment Fee and Wage Report
South Dakota Department of Labor and Regulation, Unemployment Insurance Division
PO Box 4730 • Aberdeen, SD 57402-4730 • Phone 605.626.2312 • Fax 605.626.3347 • www.sdjobs.org
Account Number
Employer Name 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
Surcharge Rate
Address % % % %
* Surcharge announced quarterly. See www.sdjobs.org for most current form.
Year
1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
Computation of Payment Due Totals
3/31/ 6/30/ 9/30/ 12/31/
1. Total Gross Wages Paid during this Quarter
2. Wages in Excess of Annual Wage Base
3. Taxable Wages
4. UI Contribution Rate % x Line 3
4a. Surcharge from Table Above x Line 3
5. Investment Fee % x Line 3
6. Total Tax Due
7. Adjustments from Prior Quarters
8. Interest % % % %
9. Penalty for Late Filing
10.Penalty for Late Payment
11.Total Remittance
1. Enter total gross wages paid to all employees, per quarter, from Form(s) 21E.
2. Enter total wages paid in excess of annual wage base, per individual, from Explanation (as needed): Annual Taxable Wage Base
Form(s) 21E. See table at right for annual wage base amount. 2006 & prior = $7,000 2011 = $11,000
3. Subtract Line 2 from Line 1. 2007 = $8,500 2012 = $12,000
4. Enter your Unemployment Insurance contribution rate. Multiply Line 3 by rate.
4a.Surcharge rate announced prior to end of each quarter. See www.sdjobs.org 2008 = $9,000 2013 = $13,000
for further information. Multiply Line 3 by quarterly surcharge rate. 2009 = $9,500 2014 = $14,000
5. Enter your Investment Fee tax rate. Multiply Line 3 by rate. 2010 = $10,000 2015 & later = $15,000
6. Add Lines 4, 4a and 5. This is total quarterly tax due.
7. Enter any amounts due or refunds due to you from prior quarters.
8. Enter the interest due if report is late for the corresponding calendar quarter.
The interest amount is computed by multiplying the tax due (Line 6) by 1.5% Signature
per month or fractional part of a month the report is delinquent.
9. Enter penalty due if you are late in filing a report. The penalty is $25 per month Date Phone
or fractional part of a month from the due date of a report. Maximum penalty is
$150 per quarter.
10.Enter penalty due if you are late making full payment. This penalty is $25 per
month or fractional part of a month. Maximum penalty is $150 per quarter.
11.Enter the sum of Lines 6-10. Payable to "SD Unemployment Insurance."
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