Division of Unemployment Insurance 
      Unemployment Insurance Employer Services 
      P.O. Box 8789, Denver, CO 80201-8789 
 
                UNEMPLOYMENT  INSURANCE  QUARTERLY-REPORT  ADJUSTMENT 
 
                                                    INSTRUCTIONS  ON  REVERSE 
Employer Account Number                                                                               Batch/Page 
 
Owner, Partners, or Corporate Name 
 
                                               th
1. Correct total number of workers as of the 12  of each month. 
          st                                     nd                    rd                              th
          1  Quarter                           2  Quarter             3  Quarter                      4  Quarter 
   Jan.    Feb.          Mar.      Apr.          May      June   July  Aug.            Sept.    Oct.     Nov.                                               Dec. 
                                                                                                                                                             
                                           Revised Report             Prior Report                    Difference 
 Qtr./Yr. 2. Total Wages                                                                                                                                     
1/        3. Excess Wages                                                                                                                                    
 Rate     4. Chargeable Wages                                                                                                                                
          5. Premiums Due                                                                                                                                    
          6. Interest                                                                                                                                        
                                                                                                                                                             
          7.Total Due 
 Qtr./Yr. 2. Total Wages                                                                                                                                     
2/        3. Excess Wages                                                                                                                                    
 Rate     4. Chargeable Wages                                                                                                                                
          5. Premiums Due                                                                                                                                    
          6. Interest                                                                                                                                        
                                                                                                                                                             
          7.Total Due 
 Qtr./Yr. 2. Total Wages                                                                                                                                     
3/        3. Excess Wages                                                                                                                                    
 Rate     4. Chargeable Wages                                                                                                                                
          5. Premiums Due                                                                                                                                    
          6. Interest                                                                                                                                        
                                                                                                                                                             
          7 .Total Due 
 Qtr./Yr. 2. Total Wages                                                                                                                                     
4/        3. Excess Wages                                                                                                                                    
 Rate     4. Chargeable Wages                                                                                                                                
          5. Premiums Due                                                                                                                                    
          6. Interest                                                                                                                                        
                                                                                                                                                             
          7 .Total Due 
 
                                                                                       10. Total Paid 
8.     Form UITR-1a  (enclosed)     Form UITR-6a (enclosed)      No wage report needed 
                                                                                        
9. Reason for Adjustment                                                               11. Signature 
                                                                                        
                                                                                       12. Date 
                                                                                        
UITR-3 (R 04/2019)                          303-318-9100 (Denver-metro area) 1-800-480-8299 (outside Denver-metro area) Fax 303-318-9013 www.coloradoui.gov 

INSTRUCTIONS  FOR  THE  UNEMPLOYMENT  INSURANCE  QUARTERLY-REPORT  ADJUSTMENT 
                                                   
1.  Number of Workers–Complete this item if the number of workers reported on the original Form 
    UITR-1, Unemployment Insurance Quarterly Report, was incorrect.  Enter the correct total number of 
    workers for each month. 
 
2.  Total Wages–Enter  the wages paid in  the  quarters that  are  subject  to unemployment insurance 
premiums (total wages minus allowable deductions).  Enter only wages  you actually paid during the 
quarter.    
     
      NOTE:  Form UITR-6a, Multiple Quarter Adjustment of Worker’s Wages, must be completed 
      and attached to show any quarterly wage adjustments. 
 
3.  Excess Wages–Enter wages paid during the quarter in excess of the chargeable wage limit for the 
calendar years  below.    You can download the Premiums Calculator  by going to the Unemployment 
Insurance Website;  click on Forms  & Publications;  and then Calculator:Premiums Calculator       “to 
track excess wages per year. 
 
Chargeable wage limits:  2019:  $13,100      2017:  $12,500     2015:  $11,800 
                                    2018:  $12,600      2016:  $12,200     2014:  $11,700 
 
4.  Chargeable Wages–This is the first $13,100 wages paid to a worker during calendar year 2019. 
 
      EXAMPLE  OF  COMPUTING  CHARGEABLE  WAGES FOR 2019 
 
                             st          nd                rd           th
                             1  Quarter  2  Quarter      3  Quarter     4  Quarter 
      Gross Wages               $6,000         $6,000         $4,000                      $6,000 
      Excess of $13,100             -0-            -0-        $4,900                      $6,000 
      Chargeable Wages          $6,000         $6,000         $1,100                      -0- 
       
5.  Premiums Due–Calculate this amount by multiplying the employer’s rate times the chargeable wages.   
 
      Example:  0.0170 x $6,000=$102.00. 
 
6.  Interest Due–Enter the amount of interest due.  Interest is charged at a rate of 1.5 percent (.015) per 
month or any portion of a month for premiums paid after the due date. 
 
7.  Check the appropriate box as described below: 
 
     Form UITR-1a, Your Report of Individual Employee’s Wages (enclosed)–Check this box if you 
      are reporting wages using a single quarter form. 
 
     Form UITR-6a, Multiple Quarter Adjustment of Worker’s Wages (enclosed)–Check this box if 
      you are correcting wages previously reported  or if  wages were incorrectly reported under  the 
      wrong unemployment insurance account number and must be transferred to another account. 
 
     No Wage Report Needed–Check this box if completing this form does not affect worker wages 
      previously reported. 
 
8.  Reason for Adjustment–List the reasons the original report is being changed. 
 
If  you have any questions, please call Unemployment Insurance  Employer Services  at 303-318-9100 
(Denver-metro area) or 1-800-480-8299 (outside the Denver-metro area)  Fax 303-318-9103. 
 
UITR-3 Page 2 (R 04/2019) 

UITR-3 (R 04/2019)                          303-318-9100 (Denver-metro area) 1-800-480-8299 (outside Denver-metro area) Fax 303-318-9013 
www.coloradoui.gov