Form UI-HA "Report for Household Employers" - Illinois

What Is Form UI-HA?

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

Form Details:

  • Released on January 1, 2020;
  • The latest edition provided by the Illinois Department of Employment Security;
  • 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 UI-HA by clicking the link below or browse more documents and templates provided by the Illinois Department of Employment Security.

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Download Form UI-HA "Report for Household Employers" - Illinois

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UI-HA
Report for Household Employers Instructions
You may file on-line at https://mytax.illinois.gov
Line 15
If you had more than eight household employees during 2019, use
an additional sheet of paper and include the information in Step 2
Step 1
for each additional worker. Total each Column C through F on the
attachment, and write the totals on Line 15 in the appropriate
Line 1a
Enter your 7-digit Illinois Unemployment Insurance Account Number.
column.
Line 1b
Enter the nine digit Federal Employer's Identification number (FEIN)
assigned to you by the Internal Revenue Service.
Add Lines 7 through 15 within each column. This is the total
Line 16a
wages paid for each quarter.
Line 2
Enter your first name, middle initial and last name.
Line 3
Enter the street address.
Step 3
Line 4
Enter the city, state and zip code
.
Line 16b
Copy totals from line 16a above.
Step 2
Line 17
Write in the total wages paid in excess of the unemployment
insurance taxable wage base amount for each worker. For 2019,
Lines 7 through 15
- use one line for each employee
the taxable wage base amount is $12,960 for each worker.
Column A
An employer must pay unemployment insurance contributions on
only the first $12,960 in wages for each employee.
Print the last and first name(s) of your household employee(s).
Example:
You have one household employee that you pay
Column B
$5,000 each quarter. During the first and second quarter, the
Complete this item by entering your employee’s social security
wages paid to the employee total $10,000, so you would enter “0”
number.
in each column for the first and second quarters. During the third
quarter, the total amount paid to the employee reaches $15,000
Columns C through F (quarters)
which exceeds the $12,960 unemployment insurance taxable
Enter the total wages paid to each employee for each quarter of the
$2,040
wage base by
. So the amount to be entered on Line 17 for
year. If no wages were paid for that quarter, please enter "0".
the third quarter, is $2,040 ($15,000-$12,960). The fourth quarter
wages of $5,000 must be entered on Line 17 for the fourth
Wages include (a) salaries, commissions and bonuses, tips reported
quarter since the wage base was met during the third quarter.
to the employer, separation pay, vacation pay, prizes, sick pay,
payments on account of retirement; (b) the reasonable cash value
of remuneration paid other than cash, such as goods, meals and
1st quarter
2nd quarter
3rd quarter
4th quarter
lodging; and (c) any remuneration for services performed within the
Ex Line 17
$
0
$
0
$5,000
State which is considered wages under the Federal Unemployment
$2,040
Tax Act.
UI-HA instructions (1/2020
UI-HA
Report for Household Employers Instructions
You may file on-line at https://mytax.illinois.gov
Line 15
If you had more than eight household employees during 2019, use
an additional sheet of paper and include the information in Step 2
Step 1
for each additional worker. Total each Column C through F on the
attachment, and write the totals on Line 15 in the appropriate
Line 1a
Enter your 7-digit Illinois Unemployment Insurance Account Number.
column.
Line 1b
Enter the nine digit Federal Employer's Identification number (FEIN)
assigned to you by the Internal Revenue Service.
Add Lines 7 through 15 within each column. This is the total
Line 16a
wages paid for each quarter.
Line 2
Enter your first name, middle initial and last name.
Line 3
Enter the street address.
Step 3
Line 4
Enter the city, state and zip code
.
Line 16b
Copy totals from line 16a above.
Step 2
Line 17
Write in the total wages paid in excess of the unemployment
insurance taxable wage base amount for each worker. For 2019,
Lines 7 through 15
- use one line for each employee
the taxable wage base amount is $12,960 for each worker.
Column A
An employer must pay unemployment insurance contributions on
only the first $12,960 in wages for each employee.
Print the last and first name(s) of your household employee(s).
Example:
You have one household employee that you pay
Column B
$5,000 each quarter. During the first and second quarter, the
Complete this item by entering your employee’s social security
wages paid to the employee total $10,000, so you would enter “0”
number.
in each column for the first and second quarters. During the third
quarter, the total amount paid to the employee reaches $15,000
Columns C through F (quarters)
which exceeds the $12,960 unemployment insurance taxable
Enter the total wages paid to each employee for each quarter of the
$2,040
wage base by
. So the amount to be entered on Line 17 for
year. If no wages were paid for that quarter, please enter "0".
the third quarter, is $2,040 ($15,000-$12,960). The fourth quarter
wages of $5,000 must be entered on Line 17 for the fourth
Wages include (a) salaries, commissions and bonuses, tips reported
quarter since the wage base was met during the third quarter.
to the employer, separation pay, vacation pay, prizes, sick pay,
payments on account of retirement; (b) the reasonable cash value
of remuneration paid other than cash, such as goods, meals and
1st quarter
2nd quarter
3rd quarter
4th quarter
lodging; and (c) any remuneration for services performed within the
Ex Line 17
$
0
$
0
$5,000
State which is considered wages under the Federal Unemployment
$2,040
Tax Act.
UI-HA instructions (1/2020
Step 3
continued
Step 6
Line 18
Subtract Line 17 from Line 16b and enter the result on Line 18.
These are your taxable wages.
Line 30
If you have stopped employing workers, write the date of the last
day you employed workers.
Lines 19 and 20
For each quarter, calculate your unemployment insurance
contribution. Within each column, complete either Line 19 or 20,
Step 7
whichever is applicable.
Line 31
This report must be signed by the person named in Step 1, Line 2.
Line 21
Quarter totals: Enter the amount from Line 19 or 20 in each column.
If signed by any other person, a Power of Attorney must be
This is your contribution due for each quarter.
attached.
Line 22.
Grand total. Add the quarterly totals from Line 21 (Columns C, D, E
and F) and enter the result on Line 22. This is your total
unemployment insurance contributions for 2019.
MAIL YOUR COMPLETED REPORT ALONG WITH YOUR CHECK TO:
ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY
PO BOX 19300
Step 4
SPRINGFIELD IL 62794-9300
Line 23-26
Enter the total number of employees (full or part time) who are
covered by unemployment insurance and who performed services
during or received pay for the payroll period including the 12th of
General Instructions
each month of the quarter. Include workers who have earned more
than $12,960 in the calendar year and those on vacation or paid
sick leave. Exclude workers on strike.
What if I do not file or pay by the due date?
If you do not file a processable return or pay the tax you owe by the due
date, you will owe penalty and interest.
Step 5
Write the amount shown on line 22. This is your total
Line 27
What if I need to correct information I reported?
unemployment insurance contribution for 2019.
Where may I obtain help or more information?
Line 28
Write the amount of any previous payment made to the Illinois
For other related forms or help with questions regarding unemployment
Department of Employment Security for the liability shown on
insurance, please call the Unemployment Insurance Hotline toll-free at
Line 27.
(800) 247-4984.
The TTY number for the hearing impaired is (866) 212-8831.
Line 29
Subtract Line 28 from Line 27.
This is the amount of unemployment insurance contribution due.
Make your check payable to the
Illinois Department of
Employment Security.
UI-HA instructions (1/2020)
State of Illinois
Illinois Department of Employment Security
Form UI-HA 2019
Report for Household Employers
File on-line at https://mytax.illinois.gov
Step 1: Tell us about yourself
1a
________________________________
b
___ ___–___ ___ ___ ___ ___ ___ ___
Federal employer’s identification number
Illinois account number (Unemployment Insurance)
2
___________________________________________________________________
Your name (first, middle initial, last)
3
___________________________________________________________________
Street Address
4
___________________________________________________________________
City
State
Zip
Step 2: Report your household employee information
5
For unemployment insurance reporting, complete Columns A-F
6
A
B
C
D
E
F
2/2019
4/2019
1/2019
3/2019
Name
Social
(last, first)
Security No.
QTR. ending June 30
QTR. ending Dec. 31
QTR. ending Mar. 31
QTR. ending Sept. 30
7
_____________________________ ______________ __________________ __________________ _________________
_________________
8
_____________________________ ______________ __________________ __________________ _________________
_________________
9
_____________________________ ______________ __________________ __________________ _________________
_________________
10
_____________________________ ______________ __________________ __________________ _________________
_________________
11
_____________________________ ______________ __________________ __________________ _________________
_________________
12
_____________________________ ______________ __________________ __________________ _________________
_________________
13
_____________________________ ______________ __________________ __________________ _________________
_________________
14
_____________________________ ______________ __________________ __________________ _________________
_________________
15
Other (attach)
________________________ __________________
______________________
______________________
______________________
_____________________
16a
Column totals: Add Lines 7 through 15 in each column
______________________
______________________
______________________
_____________________
Step 3: Figure your unemployment insurance
contribution due for each quarter
1st quarter
2nd quarter
3rd quarter
4th quarter
16b
Column totals: Copy totals from line 16a above.
______________________
______________________
______________________
_____________________
17
Write the total wages paid in excess of the taxable
wage base amount ($12,960 per employee for 2019).
______________________
______________________
______________________
_____________________
18
Subtract Line 17 from Line 16b.
______________________
______________________
______________________
_____________________
19
If Line 16a is less than $50,000, multiply Line 18 by
______________________
______________________
______________________
_____________________
your 2019 contribution rate or 5.400%, whichever is less.
If Line 16a is $50,000 or more, multiply
20
______________________
______________________
______________________
_____________________
Line 18 by your 2019 contribution rate.
21
Quarter totals: Enter the amount from Line 19 and/or 20.
______________________
______________________
______________________
_____________________
22
22
_________________
Grand total: Add the quarter totals from Line 21 (Columns C, D, E and F) and write the result on Line 22.
PLEASE RETURN THIS PAGE AND PAGE 2 OF THIS FORM
UI-HA front 1 of 2 (1/2020)
Step 4: Number of employees who are covered for unemployment insurance
Write the total number of covered workers (full and part time) who performed services during or received pay for the payroll period including the
12th of each month of each quarter. If none, write “0”
23
1st quarter
A
January 12
__________
B
February 12
__________
C
March 12
___________
24
2nd quarter
A
April 12
__________
B
May 12
__________
C
June 12
___________
25
3rd quarter
A
July 12
__________
B
August 12
__________
C
September 12 ___________
26
4th quarter
A
October 12
__________
B
November 12 __________
C
December 12
___________
Step 5: Figure your total unemployment insurance contribution due
27
Write the amount from Line 22.
27
____________I ____
28
Write the amount of any previous payment to the Illinois Department of Employment Security for the liability shown on Line 27.
28
____________I ____
29
Subtract Line 28 from Line 27. Make your check payable to the Illinois Department of Employment Security.
29
____________I ____
Step 6: Complete if you are no longer employing workers
Write the date you stopped employing workers.
30
30
____/_____/____
month
day
year
Step 7: Sign below
Under penalties of perjury, I state that I have examined this report and, to the best of my knowledge, it is true, correct, and complete.
31
____________________________________________________________
____/____/__________
(_____) ______________
Household employer’s signature (full name)
month
day
year
Daytime telephone number
April 15, 2020
Filing deadline:
You may file and pay on-line at https://mytax.illinois.gov
Mail your completed report along with your check to:
ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY
PO BOX 19300
SPRINGFIELD IL 62794-9300
This state agency is requesting information that is necessary to accomplish the statutory purpose as outlined under 820 ILCS405/100-3200.
Disclosure of this information is REQUIRED. Failure to disclose this information may result in statutorily prescribed liability and sanction,
including penalties and or interest. This form has been approved by the Forms Management Center.
UI-HA back 2 of 2 (1/2020)
PLEASE RETURN THIS PAGE AND PAGE 1 OF THIS FORM