Form DOL-4A "Annual Tax and Wage Report for Domestic Employment" - Georgia (United States)

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COMPLETING PARTS I AND II OF ANNUAL TAX AND WAGE REPORT
FOR DOMESTIC EMPLOYMENT, FORM DOL-4A
Part I
Enter your DOL account number, the report year, employer name, mailing address, and email
address. Note: If you are a new employer and have not yet been assigned a DOL account
number, enter "Applied For" in the account number field and attach a DOL-1A, Employer
Status Report, if not previously submitted.
Enter the Social Security Number, last name, first name, and total covered wages paid in
each quarter separately. All wages paid to an employee must be reported by the employer
for the quarter in which payment was actually made.
Part II
Amount of total reportable gross wages paid for all employees. Show the amount paid
Line 1
for each quarter separately.
Subtract non-taxable wages (amount of wages above $9500 per employee per calendar
Line 2
year) as applicable for each quarter.
Enter the difference between Lines 1 and 2. This amount is used to calculate the
Line 3
amount of taxes to be paid.
In the area provided, enter the Contribution tax rate. To calculate the Contribution tax,
Line 4
multiply your Contribution tax rate by the amount in Line 3 for each quarter. Effective
January 1, 2017, new employers must use 2.64%. For tax periods prior to January 1,
2017, new employers must use 2.62%.
In the area provided, enter the Administrative Assessment rate. To calculate the
Line 5
Administrative Assessment tax, multiply the Administrative Assessment rate (.06% or
.0006 effective January 1, 2017) by the amount in Line 3 for each quarter. For tax
periods prior to January 1, 2017, the Administrative Assessment rate is .08% or .0008.
This applies to all employers except employers with the minimum rate or the maximum
rate and those employers who have elected to make payments in lieu of contributions as
provided by Code Section 34-8-158.
*The total tax rate is contribution + administrative assessment.
The sum of Lines 4 and 5 for each quarter.
Line 6
Enter the amount of taxes previously paid for this reporting year.
Line 7
Enter the difference between Lines 6 and 7.
Line 8
The sum of each quarter from Line 8.
Line 9
Interest is computed on the tax due (Line 9) from the due date (January 31) at the rate
Line 10
of 1.5% per month or fraction of a month. Interest accrues until all tax and
administrative assessments are paid.
Enter penalty if the report is filed after January 31. Penalty is $20 or .05% (.0005) of
Line 11
total wages whichever is greater, for each month the report is late. Compute penalty as
.05% (.0005) of total wages whenever total wages for the quarter are more than
$40,000.
Enter the sum of Lines 9 through 11.
Line 12
Changes in your business information should be reported in Sections A-D at the bottom of Part II.
For assistance with completing Sections A-D, call 404-232-3301. Sign and mail the report,
Parts I and II, no later than January 31.
Visit dol.georgia.gov for online payment options or make check or money order payable to
Georgia Department of Labor and provide your DOL account number on your check.
DOL-4A Instr. (R-12/16)
EL6103
COMPLETING PARTS I AND II OF ANNUAL TAX AND WAGE REPORT
FOR DOMESTIC EMPLOYMENT, FORM DOL-4A
Part I
Enter your DOL account number, the report year, employer name, mailing address, and email
address. Note: If you are a new employer and have not yet been assigned a DOL account
number, enter "Applied For" in the account number field and attach a DOL-1A, Employer
Status Report, if not previously submitted.
Enter the Social Security Number, last name, first name, and total covered wages paid in
each quarter separately. All wages paid to an employee must be reported by the employer
for the quarter in which payment was actually made.
Part II
Amount of total reportable gross wages paid for all employees. Show the amount paid
Line 1
for each quarter separately.
Subtract non-taxable wages (amount of wages above $9500 per employee per calendar
Line 2
year) as applicable for each quarter.
Enter the difference between Lines 1 and 2. This amount is used to calculate the
Line 3
amount of taxes to be paid.
In the area provided, enter the Contribution tax rate. To calculate the Contribution tax,
Line 4
multiply your Contribution tax rate by the amount in Line 3 for each quarter. Effective
January 1, 2017, new employers must use 2.64%. For tax periods prior to January 1,
2017, new employers must use 2.62%.
In the area provided, enter the Administrative Assessment rate. To calculate the
Line 5
Administrative Assessment tax, multiply the Administrative Assessment rate (.06% or
.0006 effective January 1, 2017) by the amount in Line 3 for each quarter. For tax
periods prior to January 1, 2017, the Administrative Assessment rate is .08% or .0008.
This applies to all employers except employers with the minimum rate or the maximum
rate and those employers who have elected to make payments in lieu of contributions as
provided by Code Section 34-8-158.
*The total tax rate is contribution + administrative assessment.
The sum of Lines 4 and 5 for each quarter.
Line 6
Enter the amount of taxes previously paid for this reporting year.
Line 7
Enter the difference between Lines 6 and 7.
Line 8
The sum of each quarter from Line 8.
Line 9
Interest is computed on the tax due (Line 9) from the due date (January 31) at the rate
Line 10
of 1.5% per month or fraction of a month. Interest accrues until all tax and
administrative assessments are paid.
Enter penalty if the report is filed after January 31. Penalty is $20 or .05% (.0005) of
Line 11
total wages whichever is greater, for each month the report is late. Compute penalty as
.05% (.0005) of total wages whenever total wages for the quarter are more than
$40,000.
Enter the sum of Lines 9 through 11.
Line 12
Changes in your business information should be reported in Sections A-D at the bottom of Part II.
For assistance with completing Sections A-D, call 404-232-3301. Sign and mail the report,
Parts I and II, no later than January 31.
Visit dol.georgia.gov for online payment options or make check or money order payable to
Georgia Department of Labor and provide your DOL account number on your check.
DOL-4A Instr. (R-12/16)
EL6103
ANNUAL TAX AND WAGE REPORT FOR DOMESTIC EMPLOYMENT -
48999
PART I
GEORGIA DEPARTMENT OF LABOR - P.O. BOX 740234 - ATLANTA, GA 30374-0234
Tel. (404) 232-3245
www.dol.state.ga.us
DOL Account Number
Year
(Employer's Name)
(Street Address)
Parts I & II of this report must always be
submitted.
(Street Address)
(City)
(State)
(Zip + 4)
(email Address)
For Quarter Ending
3. Total Individual
1. Social Security Number
2. Employee's Name (If blank, please enter.)
Reportable Gross Wages
$
March 31
Social Security Number
Full Last Name, Full First Name
$
June 30
$
September 30
$
December 31
$
March 31
Social Security Number
Full Last Name, Full First Name
$
June 30
$
September 30
$
December 31
$
March 31
Social Security Number
Full Last Name, Full First Name
$
June 30
$
September 30
$
December 31
$
March 31
Social Security Number
Full Last Name, Full First Name
$
June 30
$
September 30
$
December 31
$
March 31
Social Security Number
Full Last Name, Full First Name
$
June 30
$
September 30
$
December 31
TOTAL REPORTABLE GROSS
Page 1 of 1
Wage Sheets
$
WAGES PAID THIS YEAR
MESSAGE AREA
Print
Clear
DOL-4A (7/14)
EL6101
ANNUAL TAX AND WAGE REPORT FOR DOMESTIC EMPLOYMENT -
48999
PART II
GEORGIA DEPARTMENT OF LABOR - P.O. BOX 740234 - ATLANTA, GA 30374-0234
Tel. (404) 232-3245
www.dol.state.ga.us
ELECTRONIC FORM PROCESSING
DOL Account Number
Year
Total Tax Rate
Form must be Filed By
DO NOT staple any items to this page.
First Quarter
Second Quarter
Third Quarter
Fourth Quarter
1.
REPORTABLE GROSS WAGES
Total
Paid Each Quarter
2.
MINUS
Non-Taxable Wages Paid Each Quarter
3.
TAXABLE WAGES
Paid Each Quarter
4.
Contribution Tax Due:
X
taxable wages
(line 3)
5.
Administrative Assessment Due:
taxable wages
X
(line 3)
6.
Total Amount Due:
(
SUM of lines 4 and 5)
7.
Taxes Previously Paid (if any)
8.
BALANCE DUE:
(
Line 6 minus 7)
$
9. ANNUAL TAX DUE
:
(SUM of line 8 for all quarters listed on this report)
$
10.
If report is late, amount of Interest due
:(See instructions)
$
11.
11.
If report is late, amount of Penalty due
:(See instructions)
$
12. TOTAL AMOUNT DUE
(
SUM of lines 9 thru 11)
Return these forms (Parts I & II) with
check payable to GA DEPT of LABOR or
UNLESS PARTS I & II OF THIS REPORT ARE FILED AND THE TOTAL AMOUNT
visit
www.dol.state.ga.us
for outline
/
/
DUE IS PAID, A FI. FA. (TAX LIEN) WILL BE ISSUED AS REQUIRED BY LAW.
payment options.
FOR DEPT USE ONLY
EMPLOYER CHANGE REQUEST
ANY
- If
of the following items have changed, please complete the appropriate information below. Phone (404) 232-3301
B
A
. If your PHYSICAL LOCATION has changed or is incorrect, enter
. If your MAILING ADDRESS has changed, or is incorrect, enter
the correct information below:
the correct information below:
(Street Address)
(Street Address)
(Street Address)
(Street Address)
(City)
(State)
(Zip)
(City)
(State)
(Zip)
(
(
)
)
(Phone)
(Phone)
C
. If you no longer have domestic workers, please give us the last
E-mail address:
date you had such workers:
/
/
Effective Date (MM/DD/YY)
D
. If the Federal Identification number listed below is incorrect, list
the correct number in the spaces provided:
(Employer's Name)
(Street Address)
(Street Address)
(State)
(Zip + 4)
(City)
I certify that the information contained in this report and any
(email Address)
subsequent pages attached is true and correct and that no part of
the tax was or is to be deducted from the worker's wages.
Signature and title of individual responsible for information provided
Phone Number
Date
DOL-4A (8/14)
EL6102
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