Form MODES-4 "Quarterly Contribution and Wage Report" - Missouri

What Is Form MODES-4?

This is a legal form that was released by the Missouri Department of Labor and Industrial Relations - a government authority operating within Missouri. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on January 1, 2019;
  • The latest edition provided by the Missouri Department of Labor and Industrial Relations;
  • 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 MODES-4 by clicking the link below or browse more documents and templates provided by the Missouri Department of Labor and Industrial Relations.

ADVERTISEMENT
ADVERTISEMENT

Download Form MODES-4 "Quarterly Contribution and Wage Report" - Missouri

Download PDF

Fill PDF online

Rate (4.5 / 5) 10 votes
MISSOURI DIV. OF EMPLOYMENT SECURITY
UNEMPLOYMENT INSURANCE TAX
573-751-1995
QUARTERLY CONTRIBUTION
2. MO EMPLOYER ACCOUNT NO.
YEAR
AUDIT
AND WAGE REPORT
(DO NOT
USE)
EAU4
File online at uinteract.labor.mo.gov
3. CALENDAR QUARTER
Date Paid
1. EMPLOYER NAME AND ADDRESS
1st
2nd
3rd
4th
MUST HAVE AMOUNTS IN 4, 5, & 6, EVEN IF ZERO
4. TOTAL WAGES PAID
5. WAGES PAID IN EXCESS OF
PER WORKER
PER YEAR (See Instruction Sheet)
6. TAXABLE WAGES
(Item 4 Minus Item 5)
7. TAXES DUE (Multiply Item 6
by Your Rate)
14. FEDERAL ID NUMBER _____________________________________
8. INTEREST ASSESSMENT DUE
TO FEDERAL ADVANCES
If mailing, return this page with remittance to:
9. INTEREST CHARGES OF
Division of Employment Security
PER MONTH IF
P.O. Box 888
PAID AFTER
Jefferson City, MO 65102-0888
Make check payable to Division of Employment Security
10. LATE REPORT PENALTY
CHARGES (See Item 15 to the Left)
or pay online at uinteract.labor.mo.gov
15.THIS REPORT IS DUE BY
11. OUTSTANDING AMOUNTS
AS OF
GREATER OF 10% OR $100 PENALTY AFTER
GREATER OF 20% OR $200 PENALTY AFTER
12. TOTAL PAYMENT
Place X in applicable box and complete “Employer Change Request.”
13. FOR EACH MONTH, ENTER THE NUMBER OF COVERED WORKERS
Business
Employment
Change of
WHO WORKED OR RECEIVED PAY FOR THE PERIOD THAT INCLUDES
Sold
Ceased
Address
THE 12TH OF THE MONTH.
1st
2nd
3rd
I certify that the information contained in this report,
(Please Print)
including name and address in Item 1, is true and correct.
TAXPAYER
OR PREPARER _______________________________________________ TITLE ___________________________________ PHONE _____________________
16.
17.
18.
19.
20. Probationary
First
Middle
Last
Total
Multi-
Check
Start
End
SSN
Name
Initial
Name
Wages
state
If Yes
Date
Date
21. PAGE
OF
PAGES
TOTAL THIS PAGE
MODES-4 (01-19)
UITax
THIS FORM IS READ BY A MACHINE. PLEASE TYPE OR PRINT THIS REPORT.
Missouri Division of Employment Security is an equal opportunity employer/program. Auxiliary aids and services
are available upon request to individuals with disabilities. TDD/TTY: 800-735-2966 Relay Missouri: 711
MISSOURI DIV. OF EMPLOYMENT SECURITY
UNEMPLOYMENT INSURANCE TAX
573-751-1995
QUARTERLY CONTRIBUTION
2. MO EMPLOYER ACCOUNT NO.
YEAR
AUDIT
AND WAGE REPORT
(DO NOT
USE)
EAU4
File online at uinteract.labor.mo.gov
3. CALENDAR QUARTER
Date Paid
1. EMPLOYER NAME AND ADDRESS
1st
2nd
3rd
4th
MUST HAVE AMOUNTS IN 4, 5, & 6, EVEN IF ZERO
4. TOTAL WAGES PAID
5. WAGES PAID IN EXCESS OF
PER WORKER
PER YEAR (See Instruction Sheet)
6. TAXABLE WAGES
(Item 4 Minus Item 5)
7. TAXES DUE (Multiply Item 6
by Your Rate)
14. FEDERAL ID NUMBER _____________________________________
8. INTEREST ASSESSMENT DUE
TO FEDERAL ADVANCES
If mailing, return this page with remittance to:
9. INTEREST CHARGES OF
Division of Employment Security
PER MONTH IF
P.O. Box 888
PAID AFTER
Jefferson City, MO 65102-0888
Make check payable to Division of Employment Security
10. LATE REPORT PENALTY
CHARGES (See Item 15 to the Left)
or pay online at uinteract.labor.mo.gov
15.THIS REPORT IS DUE BY
11. OUTSTANDING AMOUNTS
AS OF
GREATER OF 10% OR $100 PENALTY AFTER
GREATER OF 20% OR $200 PENALTY AFTER
12. TOTAL PAYMENT
Place X in applicable box and complete “Employer Change Request.”
13. FOR EACH MONTH, ENTER THE NUMBER OF COVERED WORKERS
Business
Employment
Change of
WHO WORKED OR RECEIVED PAY FOR THE PERIOD THAT INCLUDES
Sold
Ceased
Address
THE 12TH OF THE MONTH.
1st
2nd
3rd
I certify that the information contained in this report,
(Please Print)
including name and address in Item 1, is true and correct.
TAXPAYER
OR PREPARER _______________________________________________ TITLE ___________________________________ PHONE _____________________
16.
17.
18.
19.
20. Probationary
First
Middle
Last
Total
Multi-
Check
Start
End
SSN
Name
Initial
Name
Wages
state
If Yes
Date
Date
21. PAGE
OF
PAGES
TOTAL THIS PAGE
MODES-4 (01-19)
UITax
THIS FORM IS READ BY A MACHINE. PLEASE TYPE OR PRINT THIS REPORT.
Missouri Division of Employment Security is an equal opportunity employer/program. Auxiliary aids and services
are available upon request to individuals with disabilities. TDD/TTY: 800-735-2966 Relay Missouri: 711