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                      UI 3/40 Employer’s Contribution and Wage Reporting 

To submit quarterly Contribution and Wage Reports for 2024: 

• Log on to the MyTax Illinois website at http://mytax.illinois.gov to establish your UI account, file your reports, and
  make payments, all electronically. This is preferred!

  Other features available on MyTax Illinois:

                Request refunds online                    View your new annual tax rates
                View your tax letters and correspondence  Request interest and penalty waivers
                Request interest and penalty waivers      Maintain Power of Attorney relationships
                                                            and much more…

• Or, complete and sign the interactive PDF form, and then PRINT and MAIL.
  Don’t forget to fill in your 7-digit UI Account number and your 9-digit FEIN number.

Visit our IDES Employer Update website, at http://mytax.illinois.gov for additional information.  Contact the IDES 
Employer hotline at 1-800-247-4984 if you have any questions about MyTax Illinois or the UI 3/40 form.      
The UI 3/40 Form starts on the next page. 

Revised: February 2024

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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           F                                               EMPLOYER’S
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Clear                                                                                                                                                                                                                          Print                                                                                                                                                                      Save

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of Attorney must be on file. enterprise. If signed by any other person, a Power     officer                                                      This                                          Date                                                                  Telephone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .               Title                                                                             Signed                                                                      was or is to be deducted from workers’ wages.     belief; and that no part of the contribution reported           true     this         herebyI       (If less than $2.00 - Send report only)                                            “ILLINOIS DIRECTOR OF EMPLOYMENT SECURITY”   MAKE CHECK PAYABLE TO: 7. TOTAL PAYMENT DUE     6D.   Deduct: Previous Overpayment       6C.   Add: Previous Underpayment PLUS interest       6B.   Add: Penalty for late filing ($50.00 minimum)       6A.   Add: Interest at 2% (.02) per month for late payment        5B.                                                Use this space if TOTAL WAGES ( Rate Determination" or 5.4%.                                                                            calculate at the lessor of your rate as shown on your "Annual Contribution                                                                  5A. If the quarter’s TOTAL WAGES (Line 2) are less than $50,000,     4.                                      year.                                                                                                                2.                                                                                                                                                                                                                                                                               1.                                                                                                                                                                             CHANGE IN STATUS                                                                          (If not shown or if incorrect enter correct number) Your Federal Employer Identification Number                                                                                                                                                                                                              FOR                                                           FORM UI-3/40      STATE
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    TAXABLE WAGES (line 2 minus line 3)                                                                               (If no wages were paid, see instructions.) TOTAL WAGES PAID for covered employment                                                                              If none, enter “0”. during or received pay for the payroll period including the 12th of each month of the quarter.                                          ENTER THE TOTAL NUMBER OF COVERED WORKERS
                                                                                                                                                 report                                        . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                                                                      . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                                                                                                                                                                                           and      report                                                                                                                                                                                                                                                                                                                                                                                                                               CONTRIBUTION DUE - Multiply line  4 by                                                                                                                                                                                                                                                                                                                                                                                                                                     3.                                                                                                                                                                                                                                                                                                                                                                                                                         Also, complete form UI-50A. Check this box to indicate that you no longer have workers in Illinois and want your account terminated.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         CONTRIBUTION
                                                                                    or                                                                                                                                                                                                                                                                                                                                                      . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                                                                                                             correct               certify                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            LESS:  Wages in                                                                                                                         1ST MONTH________________2ND MONTH_________________3RD MONTH______________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ACCOUNT NUMBER                                                      9999999
                                                                                                                                                 MUST                                                                                                                          (                                                                                                                                                                                                                                                                                                                                                                   and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    OF
                                                                                    authorized                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         IMPORTANT — SEE INSTRUCTIONS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               ILLINOIS
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 ILLINOIS
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
                                                                                                                                                 be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       the      all                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Rev. 
                                                                                    agent                                                        signed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   best     accompanying the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                excess of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       If a change has occurred in the status of your business, complete form UI-50A.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                information                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 calendar                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            2/
                                                                                    within                                                                                                                                                                                     )                                                                                                                                                                                                                                                                                                                                                          of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   L           ine 2) are                                                                                                                                                                                                                                                                                                                                                                                                      $13,590                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           YR/QTR                                                          00/020062                                                                                                                                                          202                                                                                    Department of Employment Security
(See Instructions)                                                                                                                               by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       my
                                                                                                                                                 owner,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   knowledge
                                                                                    the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            schedules    contained                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       4CONTRIBUTION RATE
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
                                                                                                                                                 partner,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               your rate.                                         $50,000                                                                                                                                                                                                                                                                                                                                                                                                                 per                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           L10ZZ-2006                                                                                                                                                                                                            
                                                                                    employing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              AND
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   covered worker per
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                PERIOD ENDING
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   is           in                                                                                                                                                                                                                                                                                                                                                                                                                                                                         or more this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    WAGE
                                                                                                                                                          including penalties and/or interest.   may                                                                 result                                                                 provide       of                                                                    3200.        purpose                                                          are                                                     information                                               This                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
                                                                                                                                                                                                                                                                                                                                                          contributions                                                                                                                                       necessary                                                                                                         agency                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            (full and part time) who performed services                                                                                                                                                                                                                                L09ZZZZZZZ                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                 result                                                              in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         quarter.
                                                                                                                                                                                                                                                                     this                                                                   information                                                                         Disclosure   as
                                                                                                                                                                                                 in                                                                                                                                                                                                                                          outlined                                                                                                                 and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 DUE AFTER ABOVE DATE         PENALTY ($50.00 MIN.)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               REPORT
                                                                                                                                                                                                 statutorily                                                         form                                                                                                                                                                                                                                                                                                                                                       is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 00-0000000
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                                                                                                                                                                                                                                                                                                                                                                                                                                of
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                                                                                                                                                                                                 prescribed                                                          being                                                                  pay
                                                                                                                                                                                                                                                                                                                                                                                                                                             820                                                                                                                      of
                                                                                                                                                                                                                                                                                                                                            contributions                                                                                                                                                                                                             contributions                                             both
                                                                                                                                                                                                                                                                     processed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            AFTER ABOVE DATE
                                                                                                                                                                                                                                                                                                                                                                                                                                and          ILCS                                                             the                                                                                                               disclosure                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             INTEREST DUE
                                                                                                                                                                                                 sanctions,                                                                                                                                               Failure                                                               payment      405/100-                                                         statutory                                                                                                                                                     . .                                       .                                                                                     .                        .                      . .                                  . . . .                                              . . . .                                                   . . . .                                                          . . . .                                       .                      .                    .                            .                                                                                                                                                     .                                                                                                                                 . . .                                   . .          .                               . .                            . .                                          .  .
                                                                                                                                                                                                                                                                     and                                                                    may                                                                                                                                                                                                                       that
                                                                                                                                                                                                                                                                                                                                                          to                                                                                                                                                                                                                                                                    of
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  (Enter all nine numbers, without hyphens)                                     8.                                                    must file electronically.                                                                   this form. If the employer has 25 or more employees, the employer                                                                                                                                   Employers that
                                                                                    1.1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         000                                                                                                                             Worker’s Social Security N
                                                                                                                                          Total
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
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                                                                                                                                          Wages                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                0000                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           umber
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            less than 

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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  , initial                                                                                                                                                                                                                                                                                                                                                                                                                           25
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  , then last                                                                                                                                                                                                                                                                                                                                                                                                                         employees

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    )

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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          (Type or Print)                              NAME OF WORKER
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      the
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      option
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Do NOT staple reports or payment.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      of
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            using 

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                                                                                     $. . . . . . . . . . . . . . . . . . . . . . . . . . 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Excess of                                         (Include Wages in
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Enter Dollars & Cents:                                                                                                                                 10.                                                                                                                                                                                                                                                                                                                                          Page No. 1 of_____Pages
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       TOTAL Wages Paid
                                                                                0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            $13,590
                                                                                                                                               :                                               :                                                                     :                                                                                                                                                                      :                                                                                                                                                                                             :                                 :                                                                                                                                                                             :                                          :                                                                                                          :                                                                  :                                                                                       :                                                                                                                                                                                                                                                                                                                        :                                                                                    :                                                                                                               :                                                                                                                                                                                                                                                                                 :                                                                                                                                                                                                                     :                                                                                                           :                                                                                :   :   :
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        in  )
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                           2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        in                                                                                                                                                                                                                                                                                                                                   is                                                                                                                                                                                                           of
                                                                                                                                        on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       the                                                                                                       less
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               have                                      days
                                                                            prior                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           at                                                                                                                                                                                                                                                                                                                                                                                                                               LATE                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 within                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      wages
                           line                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Payments                               month                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               included                                                                                                                                                                      from                                                                                                                                                                                                                                                                                                                                                                                        Attorney                                                                                                                                                                                                                                                worker.                                                                                                                                                quarter                                                                  excess
                                                                            of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 to                                                                                                                                                                                                                                                                                                                                                                                thereof                                                                                                                                                                                                                                                                                                                                                                                                                        6C 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         thirty                                                                                                                                                                                                                                                                                                                                              FOR                                                                                                                        is                                            amount                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              in
                                                                                                                                        amount                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              interest         day.                                   the                                                                                                                                                                                                                                                                                                                                  whichever                                                                                                                                                                                                                                                                                                                                                                                                                                              and                                                                                                                                                                               agent                                                                                           of                                                                                                                                                                                                                                                                                                                                                                                                             the                                                          Total
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          each 
                                                                            wages                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              deemed                                    first                                                                                                                                                                                                                                                                                                                                   fraction                                                                                                                                                                             the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 of                                                                                                                                                                                                                              paid
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                6B, 
                                                                                                                                        net
                           in                                                                                                           the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 add              per                                                                                                                                                                                                                                                                                                                                                                                                 or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Power                                                                                                                                                                                                                                                                                                                                                                                                          during 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          deducted 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               are                                                                                                                                                                                                                                                                                                                                                       month,                              PENALTY                                                                                                                                                                  enter                                                                                                                                                                                                                                     6A,                                                                                                                                                                                                                                                                               a 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      be                                                                                                                                                                                                                                                                                          authorized                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              wages
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            date,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Number                                                                                                                                                                                                              performed.
                                                                                                                                        enter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                of                date                                                                                                                                                                                                                                                                                                                                                                              $10,000     THE                                                                                                                        underpayment                                                                                                                                                                                                                                                                            Lines 
                                                                            excess                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           2%                                     preceding            For                                                                                                                                                                                                                                                                                                             per                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             worker 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      report, 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            due                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       may                                                                                                                                                                                                                                                                                                                                                                                         person,                                                                                                                                                                                                                                                                                                                                                                                                                                                                     were
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                plus 
                           included                                         include                                                     and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    due                  month                                                                                                                                                                                                                                                                                                                                                        each        less.                                                                                                                                                                    this                                                                                                                            line                                                                                                                                                                                                                                                                                        officer                                                                                                                                                                                                                                                                                                                                                 Security                                                                                                                                               each 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         $2,500 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             12/365                                                                                                                                                                                                                                                                                                                                                                                                          is                                                                                                                                                                                                                                                                                                                                                                                                                 5B                                                                                                                                                                                                                                                                                other                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   non-taxable
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               the                  the 
                                                                            not                                                         2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    at                                                          (Exception:                                                                                                                                                                                                                                                                                                     or                      for                                                                                                                                    previous                                      for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        to                                                                                                                                                                                                                                                                                                                                                                                                              UITaxRates
                                                                            Do                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                this                                                                                                      or 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            interest 
                           wages                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               after                                                                                                                                                                                                                                                                                                                                                                             $10                                                                                                                                    any                                                                                                                                                                                                                                                                                     5A                                                                                                                                                                                partner,                                                                                        any                                                                                                                                                                                                                                                     Social                                                                                                                                                                                                              services    and
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 paid 
                                                                                                                                        Line                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       on                                                                                                                                                                                                                                                                                                                                                                                          by 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    day                                                                                                                                                                                                                                                                                                                                  wages                   is 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            by                                                                           received.                                                                                                                                                                                                                                                                                                                                           whichever                                                                                                                  for                                                                                                                                                                                                                                                                                     line                                                                     line6D.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              when
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          taxable                                                                                                                                                                                                                                                                                                                                /employers/
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          complete 
                           Enter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      remittance                                                                                                                                                                                                                                of                                                                                                                                                                                owner,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         wages                                                        of
                           -                                                worker.                                                     from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 computed          days                 last                                                                                                                                                                                                                                                                                                                                 total                                                                                                                                                                                                                                                                                                                                        shown                                                                                                                                                                              on                                                                                                       by                                                                                              signed 
                                                       3,590                                                                            Line                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                not              month                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      payment                                                                                                                                                                                                                                                                                 sum                                                                                                                                                                                                                                                                               If                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      both                                                                                                                                                                                                                                                                                                                                   ides
                                                                                                                                        3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   paid                               30                                        was                                                                                                                                                                                                                                                                                                             of                      penalty                                                                                                                                                                              the 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    the 
                                                                            each                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             $5,000,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             total 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Show                                                                                                                                                                                                                                                                                                                                     – Enter the total wages reported in Column 10.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               than                 on                                                                                                                                                                                                                                                                                                                                                                       or                                                                                                                         If                                            with       the underpayment including interest.                                                                                 Credit                                     contribution due this quarter.                                 the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     – To obtain a Historical Table, use the 
                                                                            for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         -                                                                                                                                                                                                                                                                                                                                                                amount                                                                                                   signed                                                                                                                                                                                                                                                                                                                                                  -                                                                                                                                                                                                                                                                     $13,590.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             per                                                                                                                                                                                                                                                                                                                                                                         thereof                                                                                                                                                                                                                                                                                                                                      - 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         payment 
                                                                            taxable                                                     -                      -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             2%                more                                                                                                                                                                                                                                                                                                                                                                              maximum                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             - Enter                                                      regardless  include                            of 
                                                                                                                                        Deduct                 Complete only one, whichever is applicable.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   wages                                                                                                                                                                                                                                                                                                                                                                                                              Enter                                                                    any                                                                                                                                                                                                      enterprise.                                                                                                                                                                                                                                                                                                                 - Type or print the workers’ names.                                                                                                                                                                                                                                                                                                                                                                                                                                                                .illinois.gov/
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            contributions    of                                     received             the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Number                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 The                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              must 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         fraction                            total                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        SS 
                                                                                                                                                                                                           5A - If the quarter’s total wages are less than $50,000, calculate at the                                                                                                   lessor of your rate as shown on your "Annual Contribution Rate      Determination" or 5.4%.                                                                         5B - If the quarter’s total wages are $50,000 or more, calculate at the                 rate shown on your "Annual Contribution Rate Determination".                             On               rate              received             been                 which       past the due date, interest is computed on a daily basis.)                                                    On  reports  filed  after  the  penalty  date,  the  penalty  is  $5  for  each  $10,000                                                                                              or                      less.       of                                            FILING CAN IN NO INSTANCE BE LESS THAN $50.
                                                                            $13,590                                                     Wages                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               -                                                                                                                                                                                                      -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              report                                                                                          employing 
                                                                            the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   This                                                                                            the                                                                                          must be on file.                                                                                                                                           Worker’s                                                            Name of Workers                                                                    Total Wages Paid
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  -
                           Less Wages in  Excess of $1                       of                                                         Taxable                Line 5A and 5B                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Interest                                                                                                                                                                                               Penalty                                                                                                                                                                                                                                                                                                                                              Previous Underpayment                                                                                                                                                         Previous Overpayment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         8.                                                                                                                                                                                                                                                                                                                              Total Wages for this Quarter
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Total Payment Due
                                                                                                                                        4.                     line.
                           Line 3.                                          excess                    quarters.                         Line                   this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Line 6A.                                                                                                                                                                                               Line 6B.                                                                                                                                                                                                                                                                                                                                                          Line 6C.                                                                                                                                                                  Line 6D.                                                                                         Line 7.                                                                                                                                                                           Signature                                                                                                                                                                                                                                                                                                                                                        Column                                                     Column 9.                                                                          Column 10.                                                                                                                                                         Line 11.                                                                                                           For historical Illinois UI Tax Rates                                                                                      following link: http://www

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     is                                                                                                                                     of                                                                                                                                                                                                                                                                                                                                                                                                                is 
                                                             and                         your                                                                                                                                                                                                                                                                                                                                                         Act.                                                                                                                                                                                                                                                                                                            not                                     for                            give                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       part                                                                                                                                                                                                                                                                                                                                                                        the 
                                                                                                                                                                                                                                                                                                                                                                                                                                                           made, 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        already
                                                                                         for                    provided                                                                                                                                                                                                                                                                                                                                                           quarter;                                                                                                                                                                                                                                                                           has               showing                                                                                                                                                                                                                                                                                                                                                    though                                                                                                             report.                                                                                                                                                                                                                  omitted                           it                                                                                                                                              Illinois                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              pay,                                                                                                                                                     which 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             and                                                                                                                                                                                                                                                                                                                                                                                                                                               Revenue                                                                                                                                                                                                                                                                                                                                                                           in                                                                                                                                                                                                                                                                                                                                                                                    which                                                                              and                                                 month                                                              on                                                                                                                                                                    bonuses;                                                                       (b)  cash, 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
            through the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       liability                                                                                                                                                                                                                                                                                                                            even                                                                                                                                                                                                                                                                                                              unchanged.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      employment                                       calendar                                                                                                           than 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                be subject                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                (full 
                                                                                         a PIN                                                                                                                                                                                                                                                                                                                                                                                     of the                                                                                                                                          and remittances                                                                                                                    but                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      and/or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            received pay for             each                                                                                                                                                                                                      have                           and                                                                                                                                                                      State 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      quarter’s                                                                                                                                                                                                                                                  whether                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     any 
            payment                                                                                             clients are                                                                                                                                                                                                                                                                                                                                                        end                                                                                                                                                                                                                          will                                                                    a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Section,                                                                                                                                                                                                                                                                                                                                                                          workers                                                                                                                                                                                                                                                                                                                                                                               website                                                                                                                                of                                                                 those                                                                                                                                                the                              vacation                                                                          other 
                                                             taxable wages                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      the 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      quarter,  report                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        . For more information,                                                                                                                                                                            report                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   workers                                                                                                                                                                                                                    covered                                                                           pay,                                                           retirement;                            (c) 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Protested”                                                                                                                                                                                                                                                                                                                                                                                                                                        Line
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   quarterly 
                                                             your                        contain                                                                                                                                                                                                                                                                                                                                                                                   the                                                                                                                                             Reports                                                                      date                                                                    file                  contesting                                                                                                                                                                                                                                                                                                                                                                                                                                              current                                                                                                                                                                                                                                                                                                                                                                                                    have                                                                                                                                                                                                                                                                                                                                                                                  our                                                                                                                                    12th                                                               and                                                                                                                                    who           during                                                                                          of                 paid 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     for                                                                                                                                                                                     and                                                within 
            your                                                                                                your                                                                                                                                                                                                                                                                                                                                       contribution payment                                                                                                                                                                                                                                                                                       a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Hot                                                                                                                                                                                                                               the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   at                                                                                                                                     the                                                                year                                                                                                                                                                  commissions 
                                                                                         not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       31.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                the                                                                                                                                                                                                                      underreported                                                                                                                                                                     longer                                                                                                                                                                                                                                                                                                                                                                                                                                                                   covered 
                                                                                                                                                                                                                                                                                                                                                                                                                                                           the                                                                                                                                                                                                                                                  that                                                                    must                                                 “Liability                                                                                                                                                                                                                                                                                            (UI-3/40)                                                                                                                                                                                                                                                                                                                                                                     on 
            make                                                                                                assist                                                                                                                                                                                                                                                                                                                                                             following                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          on                                                                                                                                                                                                                       are                                                                                                                                                                               no                                                                                                                                                                                                                                                                                                                                                                                                                                                                       of                                                                                                                                                                                                                         quarter                            workers                $13,590                 separation                                                     account 
                                                                                         does                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                lodging, 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      during                                  employer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                of                                                                                              on 
            and  calculate                                                                                      to                                                                                                                                                                                                                                                                                                                                         and                                                                                                                                                                     January                                                                      after                                                                                                                                                                                                                                                                                                                                                                                                                              report                                                                                                                                      Employer                                                                                                                                                                                                                          note                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  obtained                                                                                                                                                                                                                                                                                                      the                                to                             salaries,                                                                                         remuneration                                                           performed                                      the Federal Unemployment Tax Act.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 you                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             calendar
                                                                                         form                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 An  write                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        there                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   be                                                                                 number                                                                                                                                                                                                                     in                                                                                                                                                                  of                  and                                                                                                                                 
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            report  will                                                                 this                                                                                                                                                                                                                                                                                                                                                              filed,                                                                                                                                                                  and                                                                                                                                wages             employer,                                                                                                                                                                                                                                                                                                                                                                                                                                                                     quarters                 the                                                                                                                                                                                                                                                                                                                                                                               that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            the                                                                                                                                    paid          excess                           employer;                                                                                                                                                                                               under
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             wage                                                                                                                                                                                                                                                                                                                                                                          Please                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         services
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                                                                                                                                                                                                                                                                                                                                                                                                                                                           be                      of                                                                                                                                              31                                                                                                                                 no                an                                                                                                                                                                                                                                                                                                                                                                                                                                                                            prior                    from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       total                  performed services during or                                                                                                    paid sick leave. Exclude workers on strike.                         paid                                                                              the                                                            payments           value               meals     
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 or
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                after completing all items and signing the report.                                                                                                                                                                                                 and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            in
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                postmarked                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      for 
                                                                                                                MyTax                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Quarter”.                                                                                                                                                                                                                                                                                                                                                                                                                                               for                      form                                                                                                                                                                                            whenever                                                                                                                                                                          indicate                                                                                                                                                                                                                                                                                                                                                                                                          and should be attached to your report.                 the                    who                                                                                                                                                                                                                                                                   include         to                                                             pay,
            quarterly  which                                                             preparer,  Illinois                                                                                                                                                                                                                                                                                                                                               must                    day                                                                                                                                                                                                                          or                                                    paid              being                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    quarter.                                                                                                                                        to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  wages                              wages in                                                                                                                         cash                                                                                                                  wages 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       forms                                                                                                                                  payroll period including
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      wages                                                                                                                                  goods,
                                                             application,                                                                                                                                                                                                                                                                                                                                                                                                          last                                                                                                                                            October                                                                                                                                                                    This                                                                              report                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         filed                             a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Enter                  time)                        the  quarter.  Include  workers  who  have  earned  more  than the         $13,590                 vacation                                                            all                                                                                                                                              sick 
            your                                                                                                Illinois                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           31,                                                                                                                                who                                                                                                                       the                                                                                                                                                                                                                                                contribution                                                                                                                                                                                                                                                                                                                                                                  for                                                                                                                                             box                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Wages           reported                                                                                              as                                                                                                                                                                  An employer who paid no wages during a quarter, but has not 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               proper                                                                                                                                                                                          be 
                                                                                                                                                                                                                                                                                                                                                                                                                                                           report                  the                                                                                                                                                                                                                                                                                                  ceased                Paid  contributions  should of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           These                                                                              -
            file                                             Illinois  tax                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      delivered                                                                                                                                                                       on                                                                                                                                                                                                                                                 the                                                                                                                adjustments              the                                                                                                                                                                                                                                                                                                                                                                               this                                                                                                                                                                                                                                                                                                                                                                                   
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Enter                              including     received         year.           tips                                                           prizes,            reasonable          such                                               remuneration                                   considered                                                  NOTE:                                                                  permanently ceased being an employer, must file a report showing                              “No Wages Paid This Quarter”.
            may                                                                          you  are a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                file                                                                                                               no                                                                                                                              be corrected even if the contribution for the quarter remains                            Should                            wages                          Supplemental or Amended Report.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      -
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           and/or interest. 
                                                             MyTax                       If                     for using                                                                                                                                                                                                                                                                                                                                  original                                                                                                                                                                30, July                                                                                                                           employer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 -                                                                                                                                                                                 Check            and  want  your  account  terminated.    For  a  change  in  status,  a  change            in  business  address  or  if  you  no  longer  have  workers  in  Illinois,  please             complete  form  UI-50A.    If  you  want  some  of  your  correspondence  to  be mailed  to  a  special  address,  please  complete  the “Special  Mailing”  form        UI-1M.                      www.ides.illinois.gov
            -   the                                                                                                                                                                                                                                                                                                                                                                                                                                   quarterlyThe                 noApril                                                                                                                                                         laterbypersonally                                                       eachpenalty                    thanemployerAn                permanently           “No Wagesthesubjectthepaymentreasontomust                                                                                                                                                                                                                                                                                                                   the IllinoisMake                                                                                                     Request                        Division,Unemploymentpleaseshould                                                                                                                 visit the33"ContactSouthIDES" pageInsuranceon theStateIDES website.-                                                                                                                                              Street,Reporting errorsChicago, Illinois 60603 
            You 

                                                                                         due.                                  website.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            -                                                                                                                                                                                                                                                                                                                             LINE ITEM INSTRUCTIONS FOR PREPARATION OF UI-3/40 REPORT
                                                                                                                                                 INSTRUCTIONS
                                                                                                                Instructions 
      Illinois                                                                                                    IDES                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    No. of Covered Workers                                                                                                                                                                                                     Total Wages Paid
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   contributions 
      MyTax                                                  internet using              contribution           client.        on the            GENERAL                                                                                                                             Filing Reports  -  The  Employer’s Contribution and Wage Report, IDES Form UI-3/40, must be filed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Nonprofit organizations and local government entities which elected to make payments in lieu           of                     contributions are not required.                                                                          Adjustments                                                                                                                                                                                                               Supplemental Report                                                                                                                                                 Change in Status                                                                                                                                                                                                                                                                                                                                                                                                                                                         Line 1.                                                                                                                                                                                                                                    Line 2.






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