65 5300 Form PDF Details

The Iowa Workforce Development Employer's Contribution and Payroll Report (form 65-5300) is the standard document for quarterly unemployment insurance reporting. Each filing must include your legal business name, Federal Employer Identification Number (FEIN), and UI account number. The form outlines your quarterly financial obligations, including total wages paid, taxable wages, and calculated contribution amounts.

Iowa employers must certify the accuracy of all information and submit by the quarterly due date. Late or incorrect submissions may result in interest charges and penalties. For other state quarterly contribution reports, see the Maryland Quarterly Contribution Report and the Alaska Quarterly Contribution Report. Iowa businesses may also need the Employer Status Report for new employer registration.

QuestionAnswer
Form Name65 5300 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesiowa state tax form 65 5300, 65 5300 pdf, iowa unemployment quarterly return, form 65 5300 printable

Form Preview Example

Iowa Workforce Development

Employer's Contribution & Payroll Report

65-5300 (08-12)

UI Account #

Filing Quarter Filing Year

Unemployment Insurance Tax Bureau

 

 

 

 

 

 

 

Filing Quarter

Due Date

PO Box 4846

 

 

 

 

 

 

 

1st - Jan, Feb, Mar

Apr 30

Des Moines IA 50306-4846

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2nd - Apr, May, Jun

Jul 31

Phone: 888-848-7442 option #3 then option #7

 

 

 

 

 

 

 

 

 

 

3rd - Jul, Aug, Sep

Oct 31

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Information

 

 

 

 

 

 

 

4th - Oct, Nov, Dec

Jan 31

 

 

 

 

 

 

 

 

 

 

 

 

FEIN:

 

Phone:

 

 

 

Ext:

 

 

 

 

Legal Business Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

DBA:

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address 1:

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address 2:

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

State/Province:

 

 

 

Zip+4/Postal Code:

 

 

 

Payment Calculation

If no wages were paid this quarter, enter 0.00 in lines 1 & 2.

1.

Total Wages (All Pages):

$

2.

Taxable Wages (All Pages):

$

3.

State Experience Owed

 

 

(Line 2 x State Experience Rate):

$

4.

Reserve Fund Owed

 

 

(Line 2 x Reserve Fund Rate):

$

5.

Surcharge Owed

 

 

(Line 2 x Surcharge Rate):

$

6.

Contribution Owed (Lines 3 + 4 + 5):

$

7.

Interest Owed:

$

8.

Penalty Owed:

$

9.

Total Owed (Line 6 + 7 + 8):

$

10. Previous Amount Due:

$

11. Previous Credit Available:

$

12. Amount Due (Line 9 + 10 - 11): $

13. Amount Paid:

$

Taxable Wage Base: $

 

State Experience Rate:

%

 

 

 

 

 

 

 

 

 

 

 

 

 

+ Reserve Fund Rate:

%

 

 

 

 

 

 

 

 

 

 

 

 

 

+ Surcharge Fund Rate:

%

 

 

 

 

 

 

 

 

 

 

 

 

 

= Contribution Tax Rate:

%

 

 

 

 

 

 

 

 

 

 

 

 

Calculate Contribution Owed:

How to Calculate Interest Due:

1.Multiply line 6 by 0.0003333 (round to 2 decimals)

2.Then multiply that number by the number of days late.

How to Calculate Penalty Due:

1.Pay the greater of $35.00 or (Penalty Rate X Total Wages)

2.Use the table to the right to determine the Penalty Rate.

Days

1-60

61-120

121-180

181-240

241+

Delinquent

Penalty

0.001

0.002

0.003

0.004

0.005

Rate

 

 

 

 

 

Make checks payable to Iowa Workforce Development. If Amount Due is $1 or less, no payment is required.

I CERTIFY that this report is true and correct and that no part of the contribution was deducted from any employee's wages.

Authorized Signature:

 

Print Preparer's Name:

 

 

Print Signer's Name:

 

 

Preparer's Title:

 

 

Signer's Title:

 

 

 

Preparer's Phone Number:

 

Date Submitted:

 

 

Email:

 

NOTE: Information collected from employers by the Unemployment Insurance Services Division of Iowa Workforce Development may also be provided to various federal and state agencies as required or permitted by federal and state law.

Equal Opportunity Employer/Program

Auxiliary aids & services are available upon request to individuals with disabilities. For deaf and hard of hearing, use Relay 711.

Page __ of ___

Employer's Contribution & Payroll Report

65-5300 (08-12)

UI Account #

Filing Quarter Filing Year

If you need more wage lines or have additional reporting units, copy this page.

Reporting Unit Number:

 

Total Wages for this reporting unit: $

Worksite Address 1:

 

 

 

 

 

 

 

 

Worksite Address 2:

 

 

 

 

 

 

 

 

City:

 

 

 

State/Province:

 

Zip/Postal Code:

 

Wage Information

Enter the wage information for each employee of this Reporting Unit. To get credit for taxable wages paid in another state, you must file

this report online at www.myiowaui.org.

Social Security Number

Employee Name (Last, First, MI)

Total Wages Paid Taxable Wages Paid

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

Totals For This Page:

Labor Market Information for this Reporting Unit

If you have any questions about Labor Market Information, call (800) 532-1249 or fax (515) 281-8195.

1. Enter the number of employees (workers) who worked during or

1st Month:

2nd Month:

3rd Month:

received pay for the pay period that includes the 12th of the month:

 

 

 

2.

Enter amount of pay which exceeds regular and recurring payments

$

 

to employees such as bonus, executive pay, severance pay, etc:

 

 

 

 

 

 

3.

If the number of workers increased or decreased

1.

Seasonal Change

 

during the quarter for any of the following reasons,

 

2.

Labor Dispute

 

check the box(es) to indicate the reason(s).

3.Layoff

4.Recall

5.Worksite Opening

6.Worksite Closing

Page __ of ___

Administrative Use Only

FD:

 

LD:

 

Batch #:

 

Delinquent After Date:

 

 

 

How to Edit 65 5300 Form Online for Free

FormsPal provides a free online PDF editor to fill out and download the 65 5300 form. Follow these steps to complete your Iowa employer contribution and payroll report.

Step 1: Click the 'Get Form' button at the top of this page to open the 65 5300 PDF in the FormsPal editor.

Step 2: Fill in the required fields using the editor. You can add text, adjust existing content, and add a signature.

Start by completing the employer information section:

form 65 5300 printable writing process detailed (portion 1)

Next, fill in the financial calculation fields: Surcharge Owed, Contribution Owed Lines, Interest Owed, Penalty Owed, Total Owed, Previous Amount Due, Previous Credit Available, Amount Due, and Contribution Tax Rate.

The way to prepare form 65 5300 printable part 2

Complete the signature section: Authorized Signature, Signer Name and Title, Date Submitted, Preparer Name and Title, Preparer Phone Number, and Email address.

Stage 3 in completing form 65 5300 printable

Then complete the employer contribution and payroll section: UI Account Number, Filing Quarter, Filing Year, Reporting Unit Number, Total Wages, Worksite Address, Social Security Numbers, and Employee Names.

Step 4 for filling in form 65 5300 printable

Finally, complete the labor market information section: Totals for This Page and Number of Employees.

Filling out part 5 in form 65 5300 printable

Step 3: Click Done to finalize the form. Create a free FormsPal account to save and download your completed ia 65 5300. Your data is saved automatically for future edits.

Iowa employers also file related payroll and tax forms. The IRS Form 941 covers federal employer quarterly payroll tax reporting. The Employer Status Report is another form used by Iowa businesses. For similar state quarterly filings, see the Maryland Quarterly Contribution Report and the Alaska Quarterly Contribution Report.

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