Form DE945 "Annual Income Report for Disability Insurance Elective Coverage" - California

What Is Form DE945?

This is a legal form that was released by the California Employment Development Department - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2013;
  • The latest edition provided by the California Employment Development Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DE945 by clicking the link below or browse more documents and templates provided by the California Employment Development Department.

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Download Form DE945 "Annual Income Report for Disability Insurance Elective Coverage" - California

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DE 945 ANNUAL INCOME REPORT FOR
DISABILITY INSURANCE ELECTIVE COVERAGE
THIS IS NOT A BILL
YEAR
YEAR ENDED
DUE
DIEC Account Number
Social Security Number
DO NOT ALTER THIS AREA
Mo.
Day
Yr.
EFFECTIVE
=
=
=
DATE
The net profit or loss reported for the calendar year listed above will be used to determine your quarterly premiums
and benefits for future years. Please see the Disability Insurance Elective Coverage (DIEC) Rate Notice and
Instructions for Computing Annual Premiums (DE 3D-I) for further information.
$
1. Enter the net profit or loss from line 3 of your Internal Revenue Service (IRS) Schedule SE
in this box. (Please attach a copy of your Schedule SE to this form.)
Net Profit <Loss> from IRS
Schedule SE, C, F, or K-1
OR
2. If you did not file an IRS Schedule SE, enter the net profit or loss
from your IRS Schedule C, F, or K-1.
(Please attach a copy of the appropriate schedule to this form.)
Note: The name and the last four digits of your Social Security Number on your schedules(s) must agree with
those preprinted on this form. If the IRS has granted you a filing extension, please DO NOT submit this
form until you file your tax return.
BE SURE TO SIGN THIS DECLARATION: I DECLARE that the information herein is true and correct to the best of
my knowledge and belief.
Signature _______________________________________
Title ________________________________
Phone (
) ___________
Date ____/____/____
THIS IS NOT A BILL.
PLEASE DO NOT SEND PAYMENTS WITH THIS FORM.
P.O. Box 826880 / MIC 5 / Sacramento, CA 94280-0001
DE 945 Rev. 6 (11-13) (INTERNET)
Page 1 of 2
CU
DE 945 ANNUAL INCOME REPORT FOR
DISABILITY INSURANCE ELECTIVE COVERAGE
THIS IS NOT A BILL
YEAR
YEAR ENDED
DUE
DIEC Account Number
Social Security Number
DO NOT ALTER THIS AREA
Mo.
Day
Yr.
EFFECTIVE
=
=
=
DATE
The net profit or loss reported for the calendar year listed above will be used to determine your quarterly premiums
and benefits for future years. Please see the Disability Insurance Elective Coverage (DIEC) Rate Notice and
Instructions for Computing Annual Premiums (DE 3D-I) for further information.
$
1. Enter the net profit or loss from line 3 of your Internal Revenue Service (IRS) Schedule SE
in this box. (Please attach a copy of your Schedule SE to this form.)
Net Profit <Loss> from IRS
Schedule SE, C, F, or K-1
OR
2. If you did not file an IRS Schedule SE, enter the net profit or loss
from your IRS Schedule C, F, or K-1.
(Please attach a copy of the appropriate schedule to this form.)
Note: The name and the last four digits of your Social Security Number on your schedules(s) must agree with
those preprinted on this form. If the IRS has granted you a filing extension, please DO NOT submit this
form until you file your tax return.
BE SURE TO SIGN THIS DECLARATION: I DECLARE that the information herein is true and correct to the best of
my knowledge and belief.
Signature _______________________________________
Title ________________________________
Phone (
) ___________
Date ____/____/____
THIS IS NOT A BILL.
PLEASE DO NOT SEND PAYMENTS WITH THIS FORM.
P.O. Box 826880 / MIC 5 / Sacramento, CA 94280-0001
DE 945 Rev. 6 (11-13) (INTERNET)
Page 1 of 2
CU
INFORMATION REGARDING THE ANNUAL INCOME REPORT FOR
DISABILITY INSURANCE ELECTIVE COVERAGE (DE 945)
Sections 708 and 708.5 of the California Unemployment Insurance Code require participants to provide a copy of
their annual income statement of net profit or loss as reported to the IRS for the prior tax year to the EDD.
If your tax filing period with the IRS is not based on a calendar year (January 1 to December 31), please provide
your tax period ending date and the due date reported with the IRS for filing your taxes. This information will assist
the EDD in posting your annual income to the correct period for premium and benefit determination purposes.
Tax Year End Date _____ / _____ / _____
Date Due to IRS _____ / _____ / _____
Please submit this form postmarked by the due date indicated on the top of the first page. Failure to timely submit
this signed form with the requested information without good cause may result in receiving delinquency notices
and potentially impact your future Disability Insurance benefits.
For assistance in completing this form, please call 916-654-6288 or the Taxpayer Assistance Center at
888-745-3886. For TTY (non-verbal) access, call 800-547-9565.
DE 945 Rev. 6 (11-13) (INTERNET)
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