Colorado Department of Labor and Employment, Unemployment Insurance Employer Services 
                                              P.O. Box 8789, Denver, CO 80201-8789 
                        303-318-9100 (Denver-metro area) or 1-800-480-8299 (outside Denver-metro area) 
                                                         www.colorado.gov/cdle/ui 
                                                                     
                       MULTIPLE  QUARTER  ADJUSTMENT  OF  WORKERS’  WAGES 
 
This report is being used as (check one of the following)  :                                      Indicate the Year Being 
         Original report(Complete Item  1and Items  3through  .)5                                         Corrected 
                                                                                                                     
         Correction to original report (Complete Item  1and Items  3through  . 5Use total wages                     
          paid in the quarter, not the difference.  List only employees whose wages require                          
          correction.) 
                                                                                                        Year______ 
         Transfer from one employer account to another.      (Complete Items 1through  . 5A wage 
          list may be substituted for Items  3through 5.) 
1.  To  :                             Owners, Partners, or Corporation Name 
     Employer Account Number           
 
                                      Doing Business As (DBA) 
            
2:  From:                             Owners, Partners, or Corporation Name 
     Employer Account Number           

                                      DBA 
            
3.                       4.                                                       5.  
    Employee Social                           Name of Employee                                    Total Wages Paid  
                                                                                   st        nd         rd              th
    Security Number                          (Please type or print)               1  Quarter 2  Quarter 3  Quarter      4  Quarter 
                                                         
6. Comments 
 
7. Preparer’s Signature                                                 8. Date 
                                                                         
9.  Title                                                               10. Telephone Number 
                                                                         
Office Use Only 
     UITR-6, original report made               UITR-3, adjustment report made               No quarterly report needed 
                                                                     
UITR-6a (R 11/2010)                                   Instructions on Reverse Side 

                                              INSTRUCTIONS 
            MULTIPLE  QUARTER  ADJUSTMENT  OF  WORKERS’  WAGES 
 
This form should be used to report worker wages never reported before, to correct previously reported wages, or to transfer earnings 
from one employer unemployment insurance account to another.  Please use an additional form for each additional year to be adjusted. 
 
 1. ALL  EMPLOYERS  MUST  COMPLETE  THIS                     4. NAME  OF  EMPLOYEE 
    SECTION 
                                                                Please type or print the worker’s name.  Confirm that 
     Employer Account Number—the current 9-digit               the correct SSN has been listed for the worker listed. 
      unemployment insurance account number under 
                                                             5. TOTAL  WAGES  PAID 
      which wages are to be reported. 
                                                              Reportthe  totalwages paid in the calendar quarter.  
     List the name(s) of the owner, partners, or 
                                                                If correcting wages, do not report the difference.   
      corporation. 
                                                                List only those employees whose wages require 
     Report the DBA or the trade name of the                   correction. 
      business, if applicable. 
                                                             6.   COMMENTS 
 2. T H I S   S E C T I O N   S H O U L D   O N L Y   B E    
                                                                Note any additional information that might be needed 
    COMPLETED  IF  WAGES  WERE  
                                                                to clarify the reason for submitting this wage-
    INCORRECTLY  REPORTED  UNDER  
                                                                adjustment report.  
    ANOTHER  ACCOUNT  NUMBER 
                                                             7 through 10.  PREPARER’S  INFORMATION  
     Employer Account Number—the incorrect 9-
      digit unemployment insurance account number               This section is to be completed by the person actually 
      from which wages should be deleted.                       completing and submitting this document.  Please 
                                                                include a telephone number. 
     List the name of the owner, partners, or 
      corporation. 
     Report the DBA or the trade name of the 
      business, if applicable. 
 3. EMPLOYEE  SOCIAL  SECURITY  NUMBER 
    List the social security number (SSN) of the worker.  
    You must provide the SSN to report new wages or 
    for correcting previously reported wages. 

UITR-6a Page 2 (R 11/2010)