Quarterly Contribution Return and Report of Wages ...

1 D. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERE. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)( )( )( )( )( )( )( )(LAST NAME)(LAST NAME)(LAST NAME)(LAST NAME)(LAST NAME)(LAST NAME)(LAST NAME)Check this box if you are reporting ONLY Voluntary Plan Disability Insurance Wages on this Personal Income Tax (PIT) Wages and PIT Withheld, if appropriate.

2 (See instructions for Item B.) DAT NOT ALTER THIS AREAA. EMPLOYEES full-time and part-time who worked during or received pay subject to UI for the payroll period which includes the 12th of the month. 1st PAYROLLQUARTERLY CONTRIBUTIONRETURN AND Report OF Wages ( continuation )REMINDER: File your DE 9 and de 9c must FILE this Report even if you had no payroll. If you had no payroll, complete Items C and IFNOT POSTMARKEDOR RECEIVED BYQUARTERENDEDPage number _____ of _____YRQTREMPLOYER ACCOUNT TOTAL SUBJECT WAGESF. TOTAL SUBJECT WAGESF. TOTAL SUBJECT WAGESF.

3 TOTAL SUBJECT WAGESF. TOTAL SUBJECT WAGESF. TOTAL SUBJECT WAGESF. TOTAL SUBJECT WAGESG. PIT WAGESG. PIT WAGESG. PIT WAGESG. PIT WAGESG. PIT WAGESG. PIT WAGESG. PIT WAGESH. PIT WITHHELDH. PIT WITHHELDH. PIT WITHHELDH. PIT WITHHELDH. PIT WITHHELDH. PIT WITHHELDH. PIT TOTAL SUBJECT Wages THIS PAGE J. TOTAL PIT Wages THIS PAGE K. TOTAL PIT WITHHELD THIS PAGE File Online It s Fast, Easy, and Secure!Visit AND MAIL TO: State of California / Employment Development Department / PO Box 989071 / West Sacramento CA 95798-9071O.

4 I declare that the information herein is true and correct to the best of my knowledge and GRAND TOTAL SUBJECT Wages M. GRAND TOTAL PIT Wages N. GRAND TOTAL PIT WITHHELD Signature _____Title _____Phone ( ) _____Date _____(Owner, Accountant, Preparer, etc.)CUDE 9C Rev. 3 (3-17) (INTERNET) Page 1 of 2 RequiredDE 9C Rev. 1 (1-12) (INTERNET) Page 1 of 2D. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERE. EMPLOYEE NAME (FIRST NAME)E.

5 EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)( )( )( )( )( )( )( )(LAST NAME)(LAST NAME)(LAST NAME)(LAST NAME)(LAST NAME)(LAST NAME)(LAST NAME)Check this box if you are reporting ONLY Voluntary Plan Disability Insurance Wages on this Personal Income Tax (PIT) Wages and PIT Withheld, if appropriate. (See instructions for Item B.) NOT ALTER THIS AREAA. EMPLOYEES full-time and part-time who worked during or received pay subject to UI for the payroll period which includes the 12th of the month.

6 1st PAYROLLQUARTERLY CONTRIBUTIONRETURN AND Report OF Wages ( continuation )REMINDER: File your DE 9 and de 9c must FILE this Report even if you had no payroll. If you had no payroll, complete Items C and IFNOT POSTMARKEDOR RECEIVED BYQUARTERENDEDPage number _____ of _____YRQTREMPLOYER ACCOUNT TOTAL SUBJECT WAGESF. TOTAL SUBJECT WAGESF. TOTAL SUBJECT WAGESF. TOTAL SUBJECT WAGESF. TOTAL SUBJECT WAGESF. TOTAL SUBJECT WAGESF. TOTAL SUBJECT WAGESG. PIT WAGESG. PIT WAGESG. PIT WAGESG. PIT WAGESG. PIT WAGESG. PIT WAGESG. PIT WAGESH.

7 PIT WITHHELDH. PIT WITHHELDH. PIT WITHHELDH. PIT WITHHELDH. PIT WITHHELDH. PIT WITHHELDH. PIT WITHHELD..I. TOTAL SUBJECT Wages THIS PAGE J. TOTAL PIT Wages THIS PAGE K. TOTAL PIT WITHHELD THIS PAGE Fast, Easy, and Convenient!Visit EDD s Web site at TO: State of California / Employment Development Department / Box 989071 / West Sacramento CA 95798-9071O. I declare that the information herein is true and correct to the best of my knowledge and GRAND TOTAL SUBJECT Wages M. GRAND TOTAL PIT Wages N. GRAND TOTAL PIT WITHHELD Signature _____Title _____Phone ( ) _____Date _____(Owner, Accountant, Preparer, etc.)

8 FOR COMPLETING THE Quarterly Contribution Return AND Report OF Wages ( continuation ), de 9c PLEASE TYPE ALL INFORMATIONYou may be required to electronically submit this form. Visit for more information. You can file, pay, and manage your employer payroll tax account online with e-Services for Business at Contact the Taxpayer Assistance Center at 888-745-3886 (voice) or TTY 800-547-9565 for additional forms or inquiries regarding reporting Wages or the proper reporting status of employees. Refer to the California Employer s Guide, DE 44, for additional record information in the spaces provided.

9 If you use a typewriter or printer, ignore the boxes and type in UPPER CASE as not use dollar signs, dashes, commas, or slashes ($ - , /).EMPLOYEE (FIRST NAME)EMPLOYEE (FIRST NAME)(LAST NAME)(LAST NAME) SUBJECT WAGESTOTAL SUBJECT WAGESIf you must hand write this form, print each letter or number in a separate box as not use dollar signs, dashes, commas, decimal points, or slashes ($ - , . /).IMOGENE a copy of the de 9c form(s) for your records. If you have more than seven employees, use additional pages or a format approved by the Employment Development Department (EDD).

10 If using more than one page, number the pages consecutively at the top of the form. If the form is not preprinted, enter your employer payroll tax account number, business name and address, the year and quarter, and the quarter ended date. For information, specifications, and approvals of alternate forms, contact the Alternate Forms Coordinator at A. EMPLOYEES (page 1 only): Enter the number of full-time and part-time workers who worked during or received pay subject to Unemployment Insurance for the payroll period which includes the 12th day of the month.