Form UI-3/40 "Employer's Contribution and Wage Report" - Illinois

What Is Form UI-3/40?

Form UI-3/40, Employer's Contribution and Wage Report, is an Illinois state one-page form filed quarterly by each employer subject to the Illinois Unemployment Insurance Act. All employers are to file who have one or more employees located in Illinois who worked any day during each of 20 or more weeks within a calendar year. Local government employers and some non-profit organizations are exempt from filing this form.

This form is issued by the Illinois Department of Employment Security and the latest revision took place in October 2017. A fillable Illinois UI-3/40 Form is available for download below.

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Illinois Form UI-3/40 Instructions

Follow these IL Form UI-3/40 instructions below. No form adjustments for prior quarters on the current quarter's report are permitted. A supplemental report should be filed whenever there are underreported and/or omitted wages for a quarter.

  • At the top of the form, enter the employer's name, address, Illinois account number, and other information as indicated.
  • Check the 'Change in Status' if you no longer have workers in Illinois and want your account terminated. For this change in status or a change of business address, Form UI-50A also needs to be completed.
  • On Line 1, enter the total number of covered workers (full and part-time) for the payroll period including the 12th of each month of the quarter.
  • On Line 2, enter all wages paid in the quarter for covered employment including wages paid to workers who already received wages in excess of $12,960 during the calendar year.
  • On Line 3, enter wages included in Line 2 in excess of the $12,960 taxable for each worker. Do not include excess wages from prior quarters.
  • On Line 4, deduct Line 3 from Line 2 and enter the net amount on this line.
  • Enter an amount for either Line 5A or Line 5B, not both, by following the applicable instructions listed on the form by lines 5A and 5B.
  • For Line 6A, for any contributions not paid by the interest due date, enter the amount of interest at the rate of 2% per month computed at 12/365 or 2% per day.
  • For Line 6B, for any reports filed after the penalty date, enter the amount of the penalty.
  • For Line 6C, if payment for any previous underpayment is included with the remittance for this report, enter the amount of this underpayment including interest.
  • Enter on Line 6D, enter any previous overpayment amount as credit that may be deducted from the contribution due this quarter.
  • Enter on Line 7 the sum of Line 5A or 5B plus Lines 6A, 6B, and 6C less any amount on line 6D. This is the total payment due.
  • The owner, partner, officer, or authorized agent of the employer is to sign and other information completed as indicated.
  • On the second side of the form, under Column 8, enter the complete social security number of each worker.
  • Under Column 9, enter the workers' names.
  • Under Column 10, enter total wages paid to each worker during the quarter. Total wages include both taxable and non-taxable wages paid in excess of $12,960.
  • On Line 11, enter the total wages reported in Column 10.
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Download Form UI-3/40 "Employer's Contribution and Wage Report" - Illinois

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EMPLOYER’S CONTRIBUTION AND WAGE REPORT
STATE OF ILLINOIS Department of Employment Security
Page No. 1 of ________ Pages
33 South State Street, Chicago, IL 60603-2802
Do Not include wage corrections for a prior quarter in this report.
(Employers with 25 or more employees in the previous calendar year must file via electronic media.)
Please Return This Sheet to PO Box 19300, Springfield, Illinois 62794.
Worker’s Social Security
NAME OF WORKER
TOTAL Wages Paid
Name
Account Number
(Type or Print)
(Include wages in excess of
taxable wage base amount)
Address
8.
9.
10.
City, State Zip
000
00
0000
Dollars
Cents
-
PENALTY ($50 MIN.)
INTEREST DUE
ILLINOIS ACCOUNT NUMBER
YR. / QTR.
QUARTER ENDING
(SEE 6B)
(SEE 6A)
Your Federal Employer Identification Number
CHANGE IN STATUS
If a change has occurred in the status of your business, complete form UI-50A.
Check this box to indicate that you no longer have workers in Illinois and want your account terminated. Also, complete the UI-50A.
1. ENTER 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 the quarter. If none, enter “0”.
1st Month _______________ 2nd Month _______________ 3rd Month _______________
2. TOTAL WAGES PAID for covered employment
IMPORTANT — SEE INSTRUCTIONS
3. LESS WAGES in excess of the taxable wage base amount per covered worker.
4. TAXABLE WAGES ( line 2 minus line 3 )
Use this space if TOTAL WAGES (line 2) are less than $50,000 this quarter
5A. CONTRIBUTION DUE
Use this space if TOTAL WAGES (line 2) are $50,000 or more this quarter
5B. CONTRIBUTION DUE
6A. Add Interest at 2% ( .02) per month for late payment
6B. Add Penalty for late filing ( $50.00 minimum )
6C. Add Previous Underpayment PLUS interest
6D. Deduct Previous Overpayment
7. TOTAL PAYMENT DUE
MAKE CHECK PAYABLE TO:
DIRECTOR OF EMPLOYMENT SECURITY
(If Less than $2.00 — Send Report Only)
I hereby certify that the information contained in this
This agency is requesting both disclosure of
report and in all accompanying schedules is true and
information and payment of contributions that are
correct to the best of my knowledge and belief; and
necessary to accomplish the statutory purpose as
that no part of the contribution reported was or is to
outlined under 820 ILCS 405/100-3200.
be deducted from workers’ wages.
Disclosure of information and payment of
Signed ...........................................................
contributions are REQUIRED. Failure to provide
information or pay contributions may result in this
Title ...............................................................
form not being processed and may result in
(
AREA
)
statutorily prescribed sanctions, including
CODE
Telephone .......................................................
penalties and/or interest.
Date ..............................................................
This report MUST be signed by owner, partner, officer or authorized agent within the employing enterprise.
If signed by any other person, a Power of Attorney must be on file.
(See instructions)
11. TOTAL WAGES FOR THIS QUARTER
$
UI-3/40 (Rev. 01/12)
IL 427-0018
If more space is needed to list workers, use continuation sheets, Form UI-40A.
EMPLOYER’S CONTRIBUTION AND WAGE REPORT
STATE OF ILLINOIS Department of Employment Security
Page No. 1 of ________ Pages
33 South State Street, Chicago, IL 60603-2802
Do Not include wage corrections for a prior quarter in this report.
(Employers with 25 or more employees in the previous calendar year must file via electronic media.)
Please Return This Sheet to PO Box 19300, Springfield, Illinois 62794.
Worker’s Social Security
NAME OF WORKER
TOTAL Wages Paid
Name
Account Number
(Type or Print)
(Include wages in excess of
taxable wage base amount)
Address
8.
9.
10.
City, State Zip
000
00
0000
Dollars
Cents
-
PENALTY ($50 MIN.)
INTEREST DUE
ILLINOIS ACCOUNT NUMBER
YR. / QTR.
QUARTER ENDING
(SEE 6B)
(SEE 6A)
Your Federal Employer Identification Number
CHANGE IN STATUS
If a change has occurred in the status of your business, complete form UI-50A.
Check this box to indicate that you no longer have workers in Illinois and want your account terminated. Also, complete the UI-50A.
1. ENTER 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 the quarter. If none, enter “0”.
1st Month _______________ 2nd Month _______________ 3rd Month _______________
2. TOTAL WAGES PAID for covered employment
IMPORTANT — SEE INSTRUCTIONS
3. LESS WAGES in excess of the taxable wage base amount per covered worker.
4. TAXABLE WAGES ( line 2 minus line 3 )
Use this space if TOTAL WAGES (line 2) are less than $50,000 this quarter
5A. CONTRIBUTION DUE
Use this space if TOTAL WAGES (line 2) are $50,000 or more this quarter
5B. CONTRIBUTION DUE
6A. Add Interest at 2% ( .02) per month for late payment
6B. Add Penalty for late filing ( $50.00 minimum )
6C. Add Previous Underpayment PLUS interest
6D. Deduct Previous Overpayment
7. TOTAL PAYMENT DUE
MAKE CHECK PAYABLE TO:
DIRECTOR OF EMPLOYMENT SECURITY
(If Less than $2.00 — Send Report Only)
I hereby certify that the information contained in this
This agency is requesting both disclosure of
report and in all accompanying schedules is true and
information and payment of contributions that are
correct to the best of my knowledge and belief; and
necessary to accomplish the statutory purpose as
that no part of the contribution reported was or is to
outlined under 820 ILCS 405/100-3200.
be deducted from workers’ wages.
Disclosure of information and payment of
Signed ...........................................................
contributions are REQUIRED. Failure to provide
information or pay contributions may result in this
Title ...............................................................
form not being processed and may result in
(
AREA
)
statutorily prescribed sanctions, including
CODE
Telephone .......................................................
penalties and/or interest.
Date ..............................................................
This report MUST be signed by owner, partner, officer or authorized agent within the employing enterprise.
If signed by any other person, a Power of Attorney must be on file.
(See instructions)
11. TOTAL WAGES FOR THIS QUARTER
$
UI-3/40 (Rev. 01/12)
IL 427-0018
If more space is needed to list workers, use continuation sheets, Form UI-40A.
computed at 12/365 of 2% per day. Payments received more than 30 days after the due date
GENERAL INSTRUCTIONS
are deemed to have been received on the last day of the month preceding the month in which
Filing Reports
the payment was received (Exception: For the first thirty days past the due date, interest is
Quarterly contribution and wage reports, Form Ul-3/40, must be filed by each employer subject to
computed on a daily basis.)
the Illinois Unemployment Insurance Act. The original report must be filed, and the contribution
payment made, no later than the last day of the month following the end of the quarter, April 30, July
Line 6B. Penalty
31, October 31 and January 31. Reports and remittances personally delivered or postmarked after
On reports filed after the penalty date, the penalty is the lesser of $5 for each $10,000 or
that date will be subject to penalty and/or interest. An employer who paid no wages during a quarter,
fraction thereof of the total wages or a maximum of $2,500 for the first month the report is late. The
but has not permanently ceased being an employer, must file a signed report showing “No Wages
second month the report is late the penalty is the lesser of $10 for each $10,000 or fraction thereof
Paid This Quarter”.
of total wages or a maximum of $5,000. The minimum penalty is $50.00.
Non-profit organizations and local governmental entities which elected to make payments in lieu of
Line 6C. Previous Underpayment
contribution must file the contribution and wage report (Ul-3/40) quarterly even though contributions
If payment for any previous underpayment is included with the remittance for this report,
are not required.
enter the amount of the underpayment including interest.
Adjustments
Line 6D. Previous Overpayment
Make no adjustments for prior quarters on the current quarter’s report. Request the proper form from
Credit shown on this line may be deducted from the contribution due this quarter.
the Employer Hot Line Section, Revenue Division, 33 South State Street, Chicago, Illinois 60603-
2802, or visit the IDES website for forms, at http://www.ides.illinois.gov/forms. Phone numbers are
listed at the Contact IDES page, http://www.ides.illinois.gov/SitePages/ContactIDES.aspx. Reporting
Line 7. Total Payment Due
errors should be corrected even if the contribution for the quarter remains unchanged.
Enter the sum of Line 5A or 5B plus Lines 6A, 6B and 6C less amount on Line 6D.
Supplemental Report
Signature
Should be filed whenever there are underreported and/or omitted wages for a quarter. Please note
on the report whether it is a Supplemental or Amended Report.
This report must be signed by owner, partner, officer or authorized agent within the employing
enterprise. If signed by any other person, a Power of Attorney must be on file.
LINE ITEM INSTRUCTIONS FOR PREPARATION OF Ul-3/40 REPORT
Column 8. Worker’s SSA Number
Show complete Social Security Number of each worker.
Line 1. Number of Covered Workers
Enter the total number of covered workers (full and part time) who performed services during or
Column 9. Name of Workers
received pay for the payroll period including the 12th of each month of the quarter. Include workers
Type or print the workers’ names.
who have earned more than the taxable wage base amount* in the calendar year and those on
vacation or paid sick leave. Exclude workers on strike.
Column 10. Total Wages Paid
Line 2. Total Wages Paid
Enter total wages paid to each worker during the quarter regardless of when services were
performed. Total wages include both taxable and non-taxable wages paid in excess of the taxable
Enter all wages paid in the quarter for covered employment including wages paid to workers who
wage base amount*.
have already received wages in excess of the taxable wage base amount* during the calendar year.
Wages include (a) salaries, commissions and bonuses; tips reported to the employer; separation
If you use Continuation Sheets, you may begin listing your workers on the continuation
pay, vacation pay, prizes, sick pay, payments on account of retirement; (b) the reasonable cash
sheets; enter the total number of pages and complete Line 11.
value of remuneration paid other than in cash, such as goods, meals and lodging, and (c) any
remuneration for services performed within the State which is considered wages under the Federal
Page No. 1 of Pages
Unemployment Tax Act.
Enter the total number of pages contained in the report. Continuation sheets should be
Line 3. Less Wages in Excess of the taxable wage base amount*
numbered consecutively beginning with page number 2.
Enter wages included on Line 2 in excess of the taxable wage base amount* for each worker. Do
Mail This Report Along With Your Check To:
not include excess wages of prior quarters.
Illinois Department of Employment Security
Line 4. Taxable Wages
P.O. Box 19300
- Deduct Line 3 from Line 2 and enter the net amount on this line.
Springfield, Illinois 62794-9300
Lines 5A and 5B.
* Taxable Wage Base Amount
Calendar Year
Complete only one, whichever is applicable.
5A - Use this line if total wages are less than $50,000. Calculate your contribution due by multiplying
$11,000
2006
the taxable wages on Line 4 by your contribution rate. (NOTE: If your contribution rate is 5.5% or
$11,500
2007
higher, calculate your contribution due by multiplying the taxable wages on Line 4 by 5.4%.)
$12,000
2008
5B - Use this line if total wages are $50,000 or more. Calculate your contribution due by multiplying
S12,300
2009
the taxable wages on line 4 by your contribution rate.
$12,520
2010
$12,740
2011
Line 6A. Interest
$13,560
2012
On contributions not paid by the interest due date, add interest at the rate of 2% per month
$12,900
2013
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