Idaho Department of Labor 
Unemployment Insurance Compliance Bureau 
Tax Support | Phone: (208) 332-3576 
Web: labor.idaho.gov 

                 AMENDED UNEMPLOYMENT  NSURANCE I                                                                                                             AX T EPORT R ORMF

This form only amends a single quarter. If additional quarters need to be amended, you will need to
complete one form per quarter. 

Please review the Amended Unemployment Insurance Tax Report form instructions                                                                                                  below on how to
complete this form. 

This form must be completed, signed, and returned to the Idaho Department of Labor as soon as the
error  is  identified.  You  may  return  the  form  via  Employer  Portal  secure  messaging,  fax  to 
208-334-6301, or mail to 317 W. Main St. Boise, Idaho 83735-0760 ATTN UI Compliance Bureau Tax 
Support.

                                                     Employer Information 
Unemployment Insurance Tax Account Number (EAN):  
Federal Employer Identification Number (FEIN):  
Legal Business Name:       
DBA:  

This is to amend the ______________ quarter of ______________ unemployment insurance tax report. 

                                                     Report Information 
                                                                                                                                                                            1        2 
                                                                                                                                                  As Reported      Net Change  As Corrected
  1. Total Gross Wages Paid in Quarter                                                                                                            $ 0.00             $ 0.00    $ 0.00
  2. Wages in Excess of $ 0.00                                                                                                                    $ 0.00             $ 0.00    $ 0.00
  3. Taxable Wages                                                                                                                                $ 0.00             $ 0.00    $ 0.00
  4. Tax Due at (line 3 x    %  )                                                                                                                 $ 0                $ 0       $ 0
  5. Total Prior Payments Applied to Tax Due                                                                                                                                   $ 0
  6. Credit (if line 5 exceeds line 4)                                                                                                                                         $ 0.00
  7. Additional Tax Due (line 4 minus line 5)                                                                                                                                  $ 0.00
  8. Late Payment Penalty
  The greater of 4% of Line 7  or$20 for each
  month or partial month past the due date.                                                                                                                                    $ 0.00
  9. Total Balance Due or Total Credit
  Balance                                                                                                                                                                      $ 0.00

12In the Net Change column, denote balance decreases In the As Corrected column, denote credit balances in parentheses ( ). with a negative sign. 

EAN: ____________________ Quarter: ____________________ Year: ___________________ 

                                        Employee Information 
                                                                                            Total Gross Wages 
 10. Employee’s SSN     11. Employee’s Name (Last, First)
                                                                12. As Reported                    13. As Corrected

 14. Totals                                                                                 $ 0.00   $ 0.00
                                                                                                   3 
 15. Difference (+or-): Column 13 total -  olumnC 12  otalt                                          $ 0.00
3In the Difference Line, As Corrected column, denote a balance decrease in parentheses ( ). 

The reason for the adjustment is: 
__________________________________________________________________________________ 

I, _______________________________________, am requesting the quarter listed above be amended. 
By signing below, you agree you are authorized to make amendments to the EAN listed above.  

___________________________________                   _________________________________________ 
Name                                                  Signature 

___________________________________                   _________________________________________ 
Title                                                 Date 

  AMENDED UNEMPLOYMENT  NSURANCE I                 AX T EPORT R ORM F   NSTRUCTIONSI           

The Amended Unemployment Insurance Tax Report Form only allows one quarter to be corrected at a 
time. If additional quarters need to be amended, you will need to complete one form per quarter.  

                              Amend Report Information  
   On Line 2 next to the “$”, enter the taxable wage base for the quarter that is being amended.  
            •  The wage base is applied on an individual basis and not to the total business wages.  
   On Line 4 before the “%”, enter the tax rate for the quarter that is being amended.  
   In the “As Reported” column, enter the originally reported values for Total Gross Wages, Wages in 
  Excess of the wage base, Taxable Wages, and Tax Due.  
   In the “As Corrected” column, enter the corrected values for Total Gross Wages, Wages in Excess 
  of the wage base, and Taxable Wages.  
   Calculate the corrected Tax Due value by multiplying your “As Corrected” Taxable Wages by the tax 
  rate for the quarter. Enter this value into the corresponding box in the “As Corrected” column.  
   Calculate the net change (increase or decrease) for the Total Gross Wages, Wages in Excess of the 
  wage base, Taxable Wages, and Tax Due. Enter these values into the corresponding boxes in the 
  “Net Change” column. This is calculated by xxx – xxx = xxx  
   On Line 5, enter the prior payments applied to the tax due for the corresponding quarter. Do not include 
  amounts that were applied to late payment penalty or interest.  
   If Line 5 is greater than Line 4, enter the value in Line 6. Leave Line 7 blank.  
   If Line 5 is less than Line 4, leave Line 6 blank and enter the value in Line 7.  
   Calculate the late payment penalty as instructed.  
   Add Lines 6, 7, and 8. Enter the value on Line 9.  
 
Payment is required if Line 9 results in a balance due. If the balance is not paid in full prior to or with 
the Amended Unemployment Insurance Tax Report Form, additional late penalties and interest may be 
charged.  
 
It is important to use the correct taxable wage base for the quarter that is being amended. Taxable wage 
bases are assigned on a yearly basis. To determine  the correct  taxable wage base,  refer  to your 
Unemployment  Insurance  Taxable  Wage  Rate  Notice  for  the  corresponding  year,  or  go  to 
Unemployment Tax Rates and select the tax array for the corresponding year.  
 
It is important to use the correct tax rate for the quarter that is being amended. To determine the correct 
tax rate, refer to your Unemployment Insurance Taxable Wage Rate Notice for the corresponding year, 
or login to Employer Portal, select “UI Tax Reporting and Payments”, and select the original report for 
the corresponding quarter. Amended Unemployment Insurance Tax Report Form Instructions  
                              Amend Employee Information  
 
Complete this section only if you are adding or changing wages for already reported employees.  
 •  Enter the Social Security Number (SSN) and Employee’s Name for each employee that needs to be 
  added or corrected.  
 •  Enter the originally reported wages for each employee in the corresponding boxes. 
            •  If the employee wasn’t originally reported and you are adding them, enter $0.  
 •  Enter the corrected wages for each employee in the corresponding boxes.  
 •  Add all the values in Column 12. Enter the total value on Line 14.  
 •  Add all the values in Column 13. Enter the total value on Line 14.  
 •  Calculate the difference between Column 12, Line 14 and Column 13, Line 14. Enter the value on Line 
  15. 
 Attach additional pages using the same format, if needed.