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Government of The District of Columbia Department of Employment Services
Office of Unemployment Compensation P.O. Box 96664 Washington, D.C. 20090-6664 Telephone: Local: (202 ) 698-7550 Toll Free: (877) 319-7346
FORM ID: EMPLOYER'S QUARTERLY POSTMARK DATE
DOES-UC30 CONTRIBUTION AND WAGE REPORT(DO NOT USE THIS SPACE)

EMPLOYER #: NAME CHK: EMPLOYER NAME AND ADDRESS FEDERAL EIN #:

TAX RATE: QUARTER ENDING:

TAXABLE WAGE BASE: THIS REPORT DUE:
$9,000.00
SEE INSTRUCTIONS ON PAGE 3
1st Month 2nd Month 3rd Month
1. TOTAL NUMBER OF COVERED WORKERS (employed in Washington, DC)

2. TOTAL WAGES PAID (this quarter, to all covered workers)............................................................... $
RATED EMPLOYERS COMPLETE ITEMS 3 THROUGH 10 -SELF INSURED SKIP TO ITEM 11
3. NON-TAXABLE WAGES ...................................................................................................................... $

4. TAXABLE WAGES (Subtract ITEM 3 from ITEM 2)............................................................................... $
5. CONTRIBUTION DUE (Multiply ITEM 4 by your tax rate of %)............................... $

6. PLUS ADMIN. ASSESSMENT DUE ( Multiply ITEM 4 by two tenths of one percent ( 0 2 . %) $
7. PLUS INTEREST DUE...................................................................................................... $

8. PLUS PENALTY DUE....................................................................................................... $
9. MINUS APPROVED CREDIT .................................................................................................... $
ATTACH CHECK OR MONEY ORDER HERE
10. EQUALS TOTAL REMITTANCE AMOUNT (Make check or money order payable to 'DOES') $
STATUS CHANGES
11. ENTER THE APPROPRIATE INFORMATION BELOW ONLY IF ANY CHANGE HAS OCCURED:
ENTITY NAME: * TRADE NAME: *

STREET ADDRESS: ADDRESS LINE 2:

CIT : Y STATE: ZIP:
CONTACT NAME: CONTACT TELEPHONE:

BUSINESS TELEPHONE: BUSINESS FAX:
EMAIL ADDRESS: FEIN CORRECTION: *

*
12. IF YOU HAVE SOLD OR TRANSFERRED YOUR BUSINESS, enter date of sale or transfer: / /
IF NO LONGER IN BUSINESS, enter date wages last paid in DC:......................................... / /

13. DESCRIBE ANY OTHER CHANGE IN STATUS:

Asterisk (*) Indicates supporting documents required. Please attach supporting documents to the report..
CERTIFICATION
I CERTIFY THAT THE INFORMATION CONTAINED IN THIS REPORT AND ANY WAGE REPORT(S) ATTACHED HERETO IS
TRUE AND CORRECT AND THAT NO PART OF THE TAX WAS OR IS TO BE DEDUCTED FROM THE WORKER'S WAGES.
SIGNATURE: TELEPHONE: DATE:

PRINT NAME: EMAIL: TITLE:

DO NOT EMAIL THIS REPORT
Page 1 UC30p1.FRM rev 03/19

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Government of The District of Columbia                                                  Department    of Employment Services
Office of Unemployment Compensation     P.O. Box           96664       Washington, D.C.    20090-6664         Telephone:    Local:  (202)698-7550            Toll Free -  (877) 319-7346 
FORM ID:                                                       EMPLOYER'S QUARTERLY                      POST MARK DATE:
         DOES-UC30
                                                          CONTRIBUTION AND WAGE REPORT                   (DO NOT USE THIS SPACE)
EMPLOYER #:                                     NAME CHK:      EMPLOYER'S NAME AND ADDRESS FEDERA        L  EIN #:

TAX RA   TE:                                                                               QUARTER  ENDING:

TA XABLE WAGE BASE:                                                                        THIS REPORT DUE:  
                                                $9,000.00
14. EMPLOY   EE WAGE INFORMATION FOR THIS QUARTER
   EMPLOYEE                                        EMPLOYEE NAME (PLEASE TYPE OR PRINT)    TOTAL         TOTAL GROSS WAGES
                                                                                           HOURS           PAID THIS QUARTER
                                SOC.  SEC.  NO.           LAST NAME,   FIRST NAME,   MI    WORKED                 DOLLARS                                    CENTS

                                                                       TOTAL WAGES THIS PA GE

NOTE:    DC law requires that employers with 250 or more employees  MUST FILE  wage reports electronically on Employer Self-Service 
         Portal (ESSP) at https://essp.does.dc.gov.  All employers are encouraged  to file wage reports electronically. For  further inform- 
         ation about electronic filing,  Please refer to PART 2  on page 4.  
   DO NOT EMAIL THIS REPORT                                                  Page 2                               UC30p2.FRM rev 03/19

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Government of The District of Columbia Department of Employment Services
Office of Unemployment Compensation P.O. Box 96664 Washington, D.C. 20090-6664. TELEPHONE: Local (202) 698-7550 Toll Free - (877) 319-7346

INSTRUCTIONS FOR FILING THE EMPLOYER'S QUARTERLY CONTRIBUTION AND WAGE REPORT
o You must file this report for the quarter indicated if you had employees who worked in the District of Columbia regardless of their
state of residence.
o You must also file this report even if you did not pay any wages to employees for work done in the District of Columbia unless you
have closed your account or have been placed in an inactive status.
o You must file this report even if you paid wages and had no tax liability.
RECORD KEEPING: Please make a copy of the report for your records.
EXTENSION: This Office has NO authority to offer extensions of time to file quarterly reports or to pay amount due.
PAYMENT POLICY: In addition to the PENALTY discussed in ITEM 8, if a payment to DOES is DISHONORED, a $65.00 penalty
will be imposed.
ITEM 1:TOTAL NUMBER OF COVERED WORKERS: For each month, count all workers (including corporate officials, executives, etc.)
who performed services in or received pay for any part of the payroll period that includes the 12th of the month.

ITEM 2: TOTAL WAGES PAID THIS QUARTER. Enter the total gross wages paid (before deductions) including the cash value of all
remuneration paid in any medium other than cash. Gross wages must agree with the total of all wages reported under ITEM 14
of your quarterly wage report. If you paid no wages, enter '0'.
ITEM 3: NON-TAXABLE WAGES. Non-taxable wages can never be greater than gross wages. Enter the total of wages paid to each
employee in this quarter that is in excess of the first $9,000 paid to each employee in this Calendar Year (See example in PART 1
on Page 4). If wages for an employee were reported to another state in this calendar year those wages should be included when
computing the first $9,000 paid.
ITEM 4: TAXABLE WAGES. Subtract ITEM 3 from ITEM 2. Taxable wages are limited to the first $9,000 of gross remuneration paid to
each employee in any Calendar Year, regardless of the state to which the wages were reported.

ITEM 5: CONTRIBUTION DUE. Amount of UI taxes owed to DOES. Multiply ITEM 4 by your tax rate. Report this amount on IRS form 940.

ITEM 6: ADMINISTRATIVE ASSESSMENT DUE. Amount of Administrative Assessment owed to DOES. Multiply ITEM 4 by two tenths of
one percent (0.2 %). Do not report this amount on IRS form 940

ITEM 7: INTEREST DUE. Interest of 1.5 % per month or fraction of month of the amount due will be assessed if the amount due
on the report is not paid by the end of the month following the close of the quarter to which it pertains.
ITEM 8: PENALTY DUE. In addition to interest, a penalty of 10 % of the amount due, BUT NOT LESS THAN $100.00, will be assessed if
this report is not filed, or if the amount due is not paid by the end of the month following the close of the quarter to which it
pertains.
ITEM 9: APPROVED CREDIT. The amount of your approved credit that will be applied towards your amount owed. (Please contact
DOES to confirm the amount of any credit balance on the account).
ITEM 10: TOTAL REMITTANCE AMOUNT. Add ITEMS 5, 6, 7 and 8, then subtract ITEM 9. Make check or money order payable to
'DEPARTMENT OF EMPLOYMENT SERVICES' or 'DOES'. You must include your employer UI Tax account number and the
quarter/year on your check or money order. Attach your payment on the first page in the space provided.
DO NOT send cash or EMAIL THIS REPORT.
MAIL REPORT AND PAYMENT TO: DC DOES, PO BOX 96664, WASHINGTON DC, 20090-6664
ITEMS: STATUS CHANGES. If any information listed has changed since the last reporting period, please enter the changed information
(11-13) and provide supporting documentation as indicated by asterisk (*).

ITEM 14: EMPLOYEE WAGE INFORMATION. Enter each employee's complete social security number, complete name, total hours
worked in the quarter, and total wages paid in this quarter. Wages for an employee are to include all remuneration paid, such as
tips received from customers, bonuses, commissions, severance pay, vacation pay, sick pay (unless paid under a third party
plan or system),and back pay awards resulting from reinstatement of employment as well as the value of meals and lodging.
NOTE: Employers with 250 or more employees MUST FILE wage reports electronically on Employers
Self-Service Portal (ESSP) at https://essp.does.dc.gov. All employers are encouraged to file wage
reports electronically. For further information about electronic filing, please refer to PART 2 on
Page 4.
Page 3 UC30p3.FRM rev 03/19

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Government of The District of Columbia                                        Department of Employment Services
       Office of Unemployment  Compensation     P.O. Box 96664       Washington, D.C.      20090-6664.     TELEPHONE:     Local  (202) 698-7550       Toll  Free - (877)  319-7346 

PART1        EXAMPLE NON-TAXABLE WAGE CALCULATION FOR AN EMPLOYER
Employee A:    Wages never exceed taxable wage base of $9,000 for this Calendar Year
               Reporting Quarter                     QTR1          QTR2       QTR3          QTR4
               Wages Paid                            $2000          $2000     $2300         $2000
               Non-Taxable Wages                         $0           $0            $0      $0
               Taxable Wages                         $2000          $2000          $2300          $2000
Employee B:  Wages exceed taxable wage base of $9,000 in 2nd  quar ter
               Reporting Quarter                     QTR1          QTR2       QTR3          QTR4
               Wages Paid                           $4,500        $5,500       $6,000        $5,000
               Non-Tax    able Wages                     $0         $1,000     $6,000        $5,000
               Taxable Wages                         $4,500      $4,500             $0            $0
Employee C:   Wages exceed taxable wage base of $9,000 in 1st  quarter
             Reporting Quarter                       QTR1          QTR2       QTR3          QTR4
             Wages Paid                            $20,000      $20,000        $20,000       $25,000
             Non-Taxable Wages                     $11,000      $20,000        $20,000       $25,000
             Taxable Wages                         $  9,000           $0           $0       $0

SA  MPLE  QUARTERLY REP     ORTS (UC 3 -  ) 0 FOR THIS EMPLOYER
                                                     QTR1          QTR2          QTR3          QTR4
       ITEM 2. Total Wages Paid                    $26,500      $27,500        $28,300       $32,000
       ITEM 3. Non-Taxable Wages                      $11,000       $21,000       $26,000       $30,000
       ITEM 4. Taxable Wages(2 minus 3)            $15,500       $6,500        $2300     $2000

PA  RT 2       DISTRICT OF COLUM     IAB  ELECTRONIC WAGE REPORTING REQUIREMENTS

Per DC law, D.C. Code     § 51-104(b)(2), employers with 250 or more employees are required to submit wage information 
electronically; however, all employers are encouraged to submit reports electronically. DC Department of Employment 
Services requires that all electronic wage files be uploaded on Employer Self-Service Portal (ESSP) at 
https://essp.does.dc.gov.
                 If you have any questions regarding the electronic filing formats
                            please contact us at the following email address:
                                          UItax.info@dc.gov 
                            Or visit us on the WEB at: WWW.DOES.DC.GOV

PART 3            TREASURY OFFSET PROGRAM (TOP)

TREASURY OFFSET PROGRAM (TOP): Your account could be subject to a TOP review. The U.S. Department of 
the Treasury (U.S. Treasury) could reduce or withhold any eligible payments made to collect your debt. This process, 
known as offset, is authorized by the Debt Collection Improvement Act of 1996, the Deficit Reduction Act of 1984, 
and other laws. 

The Treasury Offset Program is a centralized offset program, administered by the Bureau of the Fiscal Service's 
Debt Management Services (DMS), to collect delinquent debts owed to federal agencies and states (including 
past-due child support), in accordance with 26 U.S.C. § 6402(d) (collection of debts owed to federal agencies), 31 
U.S.C. § 3720A (reduction of tax refund by amount of the debts), and other applicable laws.

For more information visit https://fiscal.treasury.gov/fsservices/gov/debtColl/dms/top/debt_top.htm

                                                       Page 4                                          UC30p4.FRM rev 03/19

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