DE 9ADJ: Quarterly Contribution and Wage Adjustment Form

Check the box that applies. If only adjusting the DE 9, complete Sections I, II, III, and V.

Check the box that applies. If only adjusting the DE 9C, complete Sections I, II, IV, and V.

Check the box that applies. If adjusting DE 9 and DE 9C, complete all sections.

Section I: Employer Information. Complete all fields (Please print): Quarter, Business Name, Employer Account Number, Street Address and City, State, ZIP Code.

Section II: Reason for Adjustment. Enter a detailed reason for the adjustments requested. (Required)

Section III: Request to Adjust the DE 9. Complete all fields. If requesting a credit (decrease) to SDI or PIT, you must also complete Line O.

(1) is Amounts Reported on DE 9 or Most Recent Adjustment Form, (2) is Amounts That Should Have Been Reported and (3) is Difference Debit/(Credit).

Line A is Total Subject Wages, Line B is Unemployment Insurance (UI) Taxable Wages and Line C is State Disability Insurance (SDI) Taxable Wages.

Line D is Employer's UI Contributions (UI rate _____% times B).

Line E is Employment Training Tax (ETT rate _____% times B). Line F is SDI Withheld (SDI rate _____% times C) (Includes Paid Family Leave).

Line G is Personal Income Tax (PIT) Withheld. Line H is Subtotal (Add amounts on Lines D, E, F, and G).

Line I is Plus: Erroneous SDI Deductions Not Refunded (Refer to Note).

Line J is Less: Contributions and Withholdings Paid for the Quarter. Line K is Total Taxes Due or Overpaid (H2 + I - J). (If balance is due, complete L, M, and N)

Line L is Penalty (If balance is due, calculate 15% of the amount on Line K).

Line M is Interest (Refer to the DE 9ADJ-I for instructions). Line N is Total Due (Lines K + L + M).

O. SDI and PIT overpayments. If requesting a credit (decrease) to SDI or PIT, you must answer the following questions.

SDI Deductions and PIT Deductions, answer Yes or No to the following questions: 1. Was the credit claimed in column (3) withheld from the wages of employee(s)? 2. If yes, has this amount been refunded to the employee(s)?

PIT Deductions, answer Yes or No to the following question: 3. Was the correct PIT reported on the Form W-2 issued to the employee(s)?

SDI and PIT deductions are employee contributions. The EDD cannot refund these amounts unless you first refund the erroneous deductions to the employee(s). If you have issued Form(s) W-2, do not refund PIT overwithholdings or change the amount reported on the employee(s) Form W-2.

If you are requesting a PIT credit for a prior year because you paid the EDD more than the amount withheld from the employee(s), attach a copy of Form(s) W-2 filed for each affected employee.

Section IV: Request to Adjust the DE 9C. Complete Item A for all DE 9C adjustments. Complete Item B only for wage plan code corrections to all employees. Complete Item C to request adjustments to individual employee information.

A. DE 9C Grand Totals for the Quarter. A1. Enter the correct grand totals for all employees for the quarter: Total Subject Wages, Total PIT Wages and Total PIT Withheld.

A2. Enter the number of employees full-time and part-time who worked during or received pay subject to UI for the pay period which includes the 12th of the month, for the 1st Month, 2nd Month and 3rd Month.

A3. Enter the correct total number of wage lines for all employees for the quarter as the Wage Item Count.

B. Wage Plan Code Corrections for All Employees. Leave blank if not correcting all wage plan codes. Enter Number of Employees, Prior Plan Code and Correct Plan Code. (Item C is not required if only adjusting wage plan codes for all employees.)

C. Individual Wage Line Adjustments. Identify the adjustment type for each affected employee and complete the fields indicated. Include only the wage lines that need to be corrected. Make corrections to the quarter(s) in which the information was originally reported. Do not report negative amounts.

Add employee(s) not previously reported: C1 - C6. Leave C7 - C9 blank.

Remove employee(s) reported in error: C1 - C6. Enter 0.00 in C3 - C5.

Adjust wages or PIT amounts previously reported: C1 - C6. Leave C7 - C9 blank.

Correct employee name(s): C1 - C6 and C7. Leave C8 - C9 blank.

Correct a Social Security number (SSN): C1 - C6 and C8. Leave C7 and C9 blank.

Correct wage plan code for one or more employees but not all: C1 - C6 and C9. Leave C7 and C8 blank.

Multiple adjustments: C1 - C6 and C7 - C9 if they apply to adjustment.

For name, SSN, or plan code corrections, enter the information previously reported in fields C7 - C9. Leave these fields blank for all other adjustment types.

Enter the information that should have been reported in fields C1 - C6. If a correction reduces wages or withholdings amount to zero, enter 0.00 in the field.

Please attach additional pages if reporting more than 3 wage line adjustments.

Section V: Declaration. I declare that the information herein is true and correct to the best of my knowledge. Signature, Title, Date, Print Name, Phone and Email.

The DE 9 is the Quarterly Contribution Return and Report of Wages. The DE 9C is the Quarterly Contribution Return and Report of Wages (Continuation).

A claim for refund must be filed within 3 years of the last timely date of the quarter being adjusted, 6 months after an assessment becomes final, or 60 days from the date of the overpayment, whichever date occurs later.

Sign and mail to: Employment Development Department, PO Box 989073, West Sacramento, CA 95798-9073.