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 ANNUAL CONTRIBUTION POSTMARK DATE
 DOES-UC30H
AND WAGE REPORT 
(DO NOT USE THIS SPACE)
EMPLOYER # NAME CHK:        EMPLOYER'S NAME AND ADDRESS   FEDERAL  EIN #

TAX RATE:   YEAR  ENDING:

TAXABLE WAGE BASE:   THIS REPORT DUE:  
$9,000.00
WAGE  REPORTING  (See instructions on page 3)

1. TOTAL NUMBER OF COVERED WORKERS WHO RECEIVED PAY FOR THE PAY PERIOD WHICH INCLUDES THE 12th OF EACH MONTH
   JAN FEB           MAR            APR           MAY           JUN JUL            AUG            SEP            OCT NOV           DEC         

Note:  Please enter all employees wage detail on page 2.   Employees wage details are mandatory 

2. TOTAL TAXABLE WAGES PAID (to all covered workers this year from page 2).....................................................  $
3. CONTRIBUTION DUE (Multiply        ITEM 2 by your tax rate of %)......................................               $
4. PLUS ADMIN. ASSESSMENT DUE (Multiply ITEM 2 by two tenths of one percent (0.2%).............$
5.PLUSINTEREST DUE...........................................................................................................$
6.PLUS  PENALTY DUE............................................................................................................$
7. MINUS APPROVED CREDIT................................................................................................$
8. EQUALS TOTAL REMITTANCE AMOUNT  (Make check or money order payable to 'DOES') ................................................ $

The IRS will disallow your FUTA tax credit if you do not pay your District of Columbia annual contributions by April 15. DC DOES does not allow deferments
of the due date over weekends or holidays.  No extensions are permitted.
STATUS CHANGES
ATTACH CHECK OR MONEY ORDER HERE
9.
ENTER THE APPROPRIATE INFORMATION BELOW ONLY  IF ANY CHANGE OCCURRED.
NAME:        CONTACT NAME: (I f different) 

STREET ADDRESS: ADDRESS LINE 2: 

CITY: STATE: ZIP:   

PHONE NO:     CONTACT PHONE: (If different)

EMAIL ADDRESS: FEIN CORRECTION: (Supporting documentation required,  please attach)

10. IF YOU NO LONGER RESIDE IN THE DISTRICT OF COLUMBIA,  ENTER DATE MOVED  (MM/DD/YYYY)          _____/_____/_______
11. IF YOU NO LONGER HAVE EMPLOYEES IN DC,  ENTER DATE WAGES LAST PAID IN DC (MM/DD/YYYY)        _____/_____/_______
12. DESCRIBE ANY OTHER CHANGE IN STATUS: _______________________________________________________________
       ______________________________________________________________________________________________________
CERTIFICATION
UNDER PENALTIES OF PERJURY, I CERTIFY THAT THE INFORMATION CONTAINED IN THIS REPORT AND ANY WAGE REPORT(S) AND ANY/OR SUPPLEMENTAL 
PAGE(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:
UC30H1.FRM rev 12/18
    DO NOT EMAIL THIS REPORT Page 1 of 3

  GOVERNMENT OF THE DISTRICT OF COLUMBIA                                                               DEPARTMENT OF EMPLOYMENT SERVICES
Office of Unemployment compensation                     P. O. Box 96664 Washington    DC    20090-6664 Telephone  Local:  (202) 698-7550                                  Toll Free:   (877) 319-7346 
FORM ID:                                                                EMPLOYER'S ANNUAL CONTRIBUTION                                                                   POSTMARK DATE
           DOES-UC30H                                                   AND WAGE REPORT     
                                                                                                                                                                     (DO NOT USE THIS SPACE)
EMPLOYER #            NAME CHK                                          EMPLOYER NAME AND ADDRESS      FEDERAL EIN #:

TAX RATE:                                                                                              YEAR ENDING:

TAXABLE WAGE BASE:      $9,000.00                                                                      THIS REPORT DUE:
13:  EMPLOYEE WAGE INFORMATION FOR THIS ANNUAL REPORTING PERIOD.                          NUMBER OF HOURS WORKED IS MANDATORY       

    EMPLOYEE                             EMPLOYEE  NAME 1ST QTR         HRS      2ND QTR         HRS      3RD QTR         HRS       4TH QTR                          HRS  TOTAL             TAXABLE      
SOC. SEC. NO            LAST                            FIRST                       MI        WAGES        WRKD    WAGES          WRKD     WAGES        WRKD   WAGES WRKD WAGES             WAGES

                                                                                                    Transfer TAXABLE WAGE TOTAL to page 1, item 2
TO REPORT MORE THAN 1O EMPLOYEES, PLEASE MAKE A COPY OF THIS FORM
                                                                                                       TOTAL WAGES ON THIS PAGE
                                                                                                                                                                                            uc30h2.frm  rev   12/18
             DO NOT EMAIL THIS REPORT                                         PAGE 2 OF 3 

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 ANNUAL CONTRIBUTION AND WAGE REPORT
NOTE:   If you do not have an account number, you are required to register on the Employers Self-Service Portal (ESSP)
        at https://essp.does.dc.gov.
        All employers are encouraged to file wage reports electronically on ESSP at https://essp.does.dc.gov. 
        o You must file this report for the year 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 on 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 this report and proof of mailing for your records.
EXTENSION: This Office has NO authority to offer extensions of time to file annual reports or to pay contributions.
PAYMENT POLICY: If a payment made to DOES is DISHONORED, a $65.00 dishonored payment penalty will be imposed.
ITEM 1: TOTAL NUMBER OF COVERED WORKERS. For each month in the calendar year being reported, count all workers who
        performed services in or received pay for any part of the payroll period that includes the 12th of the month.
ITEM 2: TOTAL TAXABLE WAGES. Enter the sum of taxable wages paid to all employees for the reporting calendar year.
ITEM 3: CONTRIBUTION DUE. Amount of UI taxes owed to DOES. Multiply ITEM 2 by your tax rate. Report this amount on IRS
        Form Schedule H, Household Employment Taxes (form 1040).
ITEM 4: ADMINISTRATIVE ASSESSMENT DUE. Amount of Administrative Assessment owed to DOES. Multiply ITEM 2 by two
        tenths of one percent (0.2 %). Do not report this amount on IRS form Schedule H.
ITEM 5: INTEREST DUE. Interest of 1.5 % per month or fraction thereof of the contribution due reported on line 3 will be assessed if
        the contribution due on the report is not paid on or before April 15.
ITEM 6: PENALTY DUE. In addition to interest, a penalty of 10 % of the contribution due reported on line 3, but not less than $100.00,
        will be assessed if this report is not filed, or if the contribution due is not paid on or before April 15.
ITEM 7: APPROVED CREDIT. Subtract the amount of credit on your account as reported to you on the Credit Memorandum.
        (Please contact DOES to confirm the amount of credit memorandum is still valid).
ITEM 8: TOTAL REMITTANCE AMOUNT. Add ITEM 3, 4, 5 and 6, then subtract ITEM 7. Make check or money order payable to
        'DEPARTMENT OF EMPLOYMENT SERVICES'  or 'DOES'. You must include your employer UI Tax account number and
        the year reported on your check or money order. Attach your payment on the first page in the space indicated.
                                    DO NOT SEND CASH. DO NOT EMAIL THIS REPORT.
        MAIL REPORT AND PAYMENT TO: DC DOES, PO BOX 96664, WASHINGTON DC, 20090-9664
ITEMS 9
THRU 12: STATUS CHANGES. If any information listed has changed since the last reporting period, please enter the changed
        information and any other status changes. Please provide supporting documentation if required by asterisk (*).
ITEM 13: EMPLOYEE WAGE INFORMATION. Enter each employee's social security number, name, wages paid and number of
        hours worked in each quarter of the calendar year (1st Qtr Jan-Mar; 2nd Qtr April -June; 3rd Qtr July-Sept; 4th Qtr Oct-
        Dec). Wages for an employee are to include cash value of all remuneration paid in any medium other than cash. If you
        paid no wages in a quarter, enter '0'.
        TOTAL WAGES FOR EACH EMPLOYEE: The total wages for each employee must equal the sum of the wages paid
        to the employee in each quarter.
        TAXABLE WAGES FOR EACH EMPLOYEE: Enter the total of taxable wages paid to each employee for the reporting
        calendar year. If total wages are $9000.00 or more, taxable wages are $9000.00. If total wages are less than $9000.00,
        taxable wages are the same as total wages. Taxable wages are limited to the first $9,000 paid to each employee in the
        Calendar Year. If you reported wages for an employee to another state in the calendar year, those wages should be included
        when computing the first $9,000 paid regardless of the state to which the wages were reported.

IMPORTANT NOTICE: 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 paymentsmade to collect your debt. This process, known as “offset,” is authorized by the Debt Collection ImprovementAct
of 1996, the Deficit Reduction Act of 1984, and other laws.
The Treasury Offset Program is a centralized offset program, administeredby 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.
Formoreinformationvisithttps://fiscal.treasury.gov/fsservices/gov/debtColl/dms/top/debt_top.htm

          DO NOT EMAIL THIS REPORT                         PAGE 3 OF 3                                                  UC30H REV 12/18