Rt 6 Form Details

When filling out the Rt 6 form, it is important to be as accurate and detailed as possible. This will ensure that your claim is processed efficiently and accurately. The Rt 6 form can be accessed on the Workers' Compensation Board website, and must be completed within 30 days of the accident or injury. The information on the form will help workers' compensation determine if you are eligible for benefits. Be sure to include all of the relevant details about your accident or injury, including when it occurred, what type of work you do, and how your injury has affected your ability to work. If you have any questions about completing the form, consult a workers' compensation lawyer for assistance.

You'll find information regarding the type of form you need to fill out in the table. It can tell you the time it will need to fill out rt 6 form, exactly what parts you will need to fill in and a few other specific facts.

QuestionAnswer
Form NameRt 6 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdepartment of revenue florida forms, florida rt 6 form, florida department of revenue employer's quarterly report, rt 6 form

Form Preview Example

Use black ink. Example A - Handwritten Example B - Typed

 

Example A

Example B

0 1

2 3 4

5 6 7 8 9

0123456789

QUARTER ENDING

DUE DATE

/ /

Florida Department of Revenue Employer’s Quarterly Report

Employers are required to ile quarterly tax/wage reports regardless of employment activity or whether any taxes are due.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RT-6

Use Black Ink to Complete This Form

 

 

 

 

R. 01/15

PENALTY AFTER DATE

 

TAX RATE

RT ACCOUNT NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do not make any changes If you do not have an account number, you

to the pre-printedare required to register (see instructions).

information on this form. F.E.I. NUMBER If changes are needed,

request and complete an

Employer Account

Change Form (RTS-3). FOR OFFICIAL USE ONLY POSTMARK DATE

Name

Mailing

Address

City/St/ZIP

Location

Address

City/St/ZIP

Reverse Side Must be Completed

 

 

 

/

2.Gross wages paid this quarter (Must total all pages)

3.Excess wages paid this quarter (See instructions)

4.Taxable wages paid this quarter (See instructions)

5.Tax due

(Multiply Line 4 by Tax Rate)

/

1. Enter the total number

 

 

 

 

 

 

 

 

 

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of full-time and part-time

1st Month

 

 

 

 

 

 

 

 

 

 

covered workers who

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

performed services during

2nd Month

 

 

 

 

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

or received pay for the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

payroll period including the

 

 

 

 

 

 

 

 

 

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12th of the month.

3rd Month

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check if inal return:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date operations ceased.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check if you had out-of-state wages. Attach Employer’s Quarterly Report for Out-of-State Taxable Wages (RT-6NF).

6.Penalty due (See instructions)

7.Interest due (See instructions)

8.Installment fee (See instructions)

9a. Total amount due (See instructions)

9b. Amount Enclosed

(See instructions)

RT-6

If you are iling as a sole proprietor, is this for domestic (household) employment only?

Yes No

Under penalties of perjury, I declare that I have read this return and the facts stated in it are true (sections 443.171(5), Florida Statutes).

 

 

 

 

 

Title

 

 

 

 

 

Sign here

 

 

 

 

 

 

 

Signature of oficer

Date

Phone

(

)

Fax

(

)

 

 

 

Preparer’s

 

Preparer check

 

Preparer’s

 

 

Paid

signature

 

if self-employed

 

SSN or PTIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

preparers

Firm’s name (or yours

Date

FEIN

 

 

 

 

 

only

if self-employed)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and address

 

ZIP

 

 

Preparer’s

(

)

 

 

 

 

 

phone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DO NOT

DETACH

TC

Rule 73B-10.037

Florida Administrative Code

Effective Date 11/14

Florida Department of Revenue

Employer’s Quarterly Report Payment Coupon

 

 

RT-6

 

 

 

 

 

 

 

 

 

 

 

 

R. 01/15

COMPLETE and MAIL with your REPORT/PAYMENT.

 

 

DOR USE ONLY

 

 

 

Please write your RT ACCOUNT NUMBER on check.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Make check payable to: Florida U.C. Fund

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POSTMARK OR HAND-DELIVERY DATE

 

 

 

 

 

 

 

 

 

 

RT ACCOUNT NO.

F.E.I. NUMBER

RT-6

GROSS WAGES

(From Line 2 above.)

U.S. Dollars

Cents

Name

Mailing Address

City/St/ZIP

AMOUNT ENCLOSED

 

(From Line 9b above.)

 

PAYMENT FOR QUARTER

-

ENDING MM/YY

Check here if you are electing to pay tax due in installments.

Check here if you transmitted funds electronically.

9100 0 99999999 0068054031 7 5009999999 0000 4

QUARTER ENDING

/ /

10. EMPLOYEE’S SOCIAL SECURITY NUMBER

 

 

 

 

 

Florida Department of Revenue Employer’s Quarterly Report

 

 

 

RT-6

 

 

 

 

 

Employers are required to ile quarterly tax/wage reports regardless of employment activity or whether any taxes are due.

 

 

R. 01/15

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Use Black Ink to Complete This Form

 

 

 

 

EMPLOYER’S NAME

 

 

 

RT ACCOUNT NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. EMPLOYEE’S NAME (please print irst twelve characters of last name and irst

 

12a. EMPLOYEE’S GROSS WAGES PAID THIS QUARTER

 

 

 

 

 

eight characters of irst name in boxes)

 

12b. EMPLOYEE’S TAXABLE WAGES PAID THIS QUARTER

 

 

 

 

 

 

 

 

Only the irst $7,000 paid to each employee per calendar year is taxable.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

- -

- -

- -

- -

- -

- -

- -

- -

Last

Name

First

Name

Last

Name

First

Name

Last

Name

First

Name

Last

Name

First

Name

Last

Name

First

Name

Last

Name

First

Name

Last

Name

First

Name

Last

Name

First

Name

Middle Initial

Middle Initial

Middle Initial

Middle Initial

Middle Initial

Middle Initial

Middle Initial

Middle Initial

12a.

12b.

12a.

12b.

12a.

12b.

12a.

12b.

12a.

12b.

12a.

12b.

12a.

12b.

12a.

12b.

13a. Total Gross Wages (add Lines 12a only). Total this page only. Include this and totals from additional pages in Line 2 on page 1.

13b. Total Taxable Wages (add Lines 12b only). Total this page only. Include this and totals from additional pages in Line 4 on page 1.

DO NOT

DETACH

Mail Reply To:

Reemployment Tax

Florida Department of Revenue

5050 W Tennessee St Bldg L

Tallahassee FL 32399-0180

Social security numbers (SSNs) are used by the Florida Department of Revenue as unique identiiers for the administration of Florida’s taxes. SSNs obtained for tax administration purposes are conidential under sections 213.053 and 119.071, Florida Statutes, and not subject to disclosure as public records. Collection of your SSN is authorized under state and federal law. Visit our website at www.mylorida.com/dor and select “Privacy Notice” for more information regarding the state and federal law governing the collection, use, or release of SSNs, including authorized exceptions.

Please save your instructions!

Quarterly Report instructions (RT-6N/RTS-3) are only mailed with new accounts or when there are changes. If you misplace your instructions, you can download them from

www.mylorida.com/dor