Uia Form 1028 – Fill Out and Use This PDF

UIA Employer Account No: ______________________________

FEIN: _______________________________________________

Quarter Ending Date (mm/dd/yyyy):________________________

SECTION 2

List only employees who had wages during this quarter

Provide the number of all full-time employees plus part-time employees who worked during or received pay for the pay period that includes the 12th of the month:

1st Month	2nd Month	3rd Month

Family

Owned

Enter

“F”

Delete

“X”

Social Security No.

Employee Last Name

Employee First Name

.

Gross Wages Paid

This Quarter

Family

Owned

Enter

“F”

Delete

“X”

Social Security No.

Employee Last Name

Employee First Name

M.

Gross Wages Paid

This Quarter

If you have more than 25 employees and/or out-of- state wages, You must use MiWAM to file on-line.

	Total Gross Wages paid this quarter:
SECTION 3	Excess
	Wages:
	Taxable Wages:
	UI Tax Rate (ABC +CBC + NBC):
UI Tax Due (UI Tax Rate x Taxable Wages) Round to Nearest $:
	Obligation Assessment (OA) Rate:
	OA Due (OA Rate x Taxable Wages) Do Not Round:
	Total Amount Due (UI Tax Due + OA Due):
	Prior Balance:
Check this box if this is the Final Report for this business.
(Prepare and submit form UIA 1772)	Amount Enclosed:

Taxable Wage Limit

DUE DATE:

x

x

REPORTING REQUIREMENTS

All liable employers are required by Section 13 of the Michigan Employment Security (MES) Act, (MCL 421.13) and Administrative Rule 121 of the Unemployment Insurance Agency (UIA), to disclose their tax liability by filing a quarterly tax report. State law will require all employers to file thru MiWAM. We encourage you to log on to WWW.Michigan.gov/UIA to create your MiWAM account.

PENALTY/INTEREST CHARGES FOR LATE FILING OF THIS REPORT

For All Employers: A penalty of $50 is assessed for the first quarter that the information in Section 2 is received by the UIA after the due date. A penalty of $250 is charged for each subsequent quarter that the information remains un-submitted. These penalties may be included in the Prior Account Balance shown on this report. Interest accrues at the rate of 1% per month (computed on a daily basis) on all taxes or reimbursements remaining unpaid after the due date as provided by Section 15(a) of the MES Act.

For Contributing Employers: A penalty of 10% of the tax due for the quarter, minimum charge of $5 and a maximum charge of $25, is assessed for each quarter that the information in Section 3 is received by UIA after the due date.

Employer Type: Indicate if you are a Contributing or

Reimbursing employer by checking the appropriate box.

SECTION 1: Completed By All Employers

Amended Reports: Indicate “Amended” if this report is being filed to correct a previously filed report.

UIA Account Number: Enter your 10-digit UIA account number with no spaces. If you recently filed

Form 518, Registration for Michigan Business Taxes, and have not yet received, or don’t know, your UIA Account Number call the Office of Employer Ombudsman (OEO) at 1-855-4UIAOEO (855-484- 2636) to request your account number.

FEIN: Enter your 9-digit Federal Employer Identification Number (FEIN).

Quarter Ending Date: Quarter ending dates are 03/31, 06/30, 09/30 and 12/31, plus the appropriate year.

Number of full-time or part-time employees for 1st,

2nd, and 3rd month of the quarter being reported: Include in the count all employees (full-time or part- time) who worked, or received pay during the payroll period that includes the 12th of the month. Do this for each month of the quarter for which you are filing. Include those employees who are on leave without

pay. Include employees who earned wages in excess of the taxable wage limit.

SECTION 2: Completed By All Employers

Family Owned Enter “F”: Does the employee, alone or in combination with his/her child or spouse, own the business? OR, does the parent(s) of the employee who is under the age of 18 own the business? If the answer to this question is "Yes", enter F. If "No", leave blank. For more information on family employment, see Section 43(g) of the MES Act.

Delete “X”: Place an X for any employee who had zero wages and no longer works for you.

Social Security Number (SSN), Employee Last

Name, Employee First Name, Employee Middle Initial: Enter all the information requested. If amending or correcting previously-submitted employee or wage information, enter the information in Section 2 the way it should have been reported originally. Also, include information for employees that you are not correcting. This corrected report will replace the report originally filed for the quarter/year. If reporting information for multiple quarters, file one complete form for each quarter that you are correcting.

Gross Wages Paid This Quarter:

Report These Wages	Do NOT Report These
	Wages
Wages paid in cash	Wages that were earned but
	not actually paid during the
	calendar quarter
Wages in any medium other	Sick pay paid under an
than cash, such as the cash	employer plan, if paid on
equivalent of meals	account of sickness
furnished on the employer's
premises or lodging
provided by the employer as
a condition of employment
Commissions and bonuses,	Profit-sharing
awards, and prizes
Vacation, severance, and	The employer's pre-tax
holiday pay	contributions to a retirement
	plan
Sick pay when it is paid to	Wages of an employee
liquidate an employee’s	whose services are excluded
balances at the time of	from coverage under Section
separation from employment	43 of the MES Act
The cash value of a	Reimbursements to
cafeteria plan, if the	employees of expenses
employee has the option	incurred on behalf of the
under the plan to choose	employer
cash
An employee’s pre-tax	Premiums for life insurance,
wages to a retirement plan	pre-paid legal services,
	health insurances
Tips actually reported by the	Wages of elected official or
employee to the employer	volunteer firefighters
Discounts on purchases
from the employer

For more information regarding wage reporting, refer to Section 44 of the MES Act or Employer Handbook Chapter B.

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Total of Gross Wages from Pages 1 and 2: Enter the total of “Gross Wages Paid This Quarter.”

SECTION 3: Completed By Contributing Employers Only

Excess Wages: Determine how much of each employee’s wages reported under “Gross Wages Paid This Quarter” is in excess of the annual taxable wage limit of $9,500. Wages paid to an individual by a single employing unit that exceed the taxable wage limit for that year are not taxable. For example: An employee is paid $3,250 per quarter, and the taxable wage limit for that year is $9,500. Quarterly wages are reported as follows:

Wages	1st Qtr	2nd Qtr	3rd Qtr	4th Qtr	TOTAL
Gross	$3,250	$3,250	$3,250	$3,250	$13,000
Excess	0	0	$250	$3,250	$ 3,500
Taxable	$3,250	$3,250	$3,000	0	$ 9,500

NOTE FOR SUCCESSOR EMPLOYERS. Include the employee’s wages previously reported by a predecessor employer when determining excess wages within the same calendar year.

MULTI-STATE EMPLOYERS whose employees work in two or more states in one year should include all of an individual’s wages previously reported in another state when determining excess wages reportable to the UIA in the calendar year.

Taxable Wages: Total Gross Quarterly Wages minus Excess Wages equals Taxable Wages. This is the current amount of each employee’s wages that is taxable for unemployment tax purposes.

UI Tax Rate: The tax rate will be indicated on pre- printed reports. If you do not know your tax rate, see the CONTACT US section of these instructions.

UI Tax Due (Rounded): Multiply “Taxable Wages” by “UI Tax Rate.” For example, if your tax rate is 3%, multiply your Taxable Wages by .03. Add that amount to any “Prior Balance” to calculate the total Tax Due. Please refer to Fact Sheet 152, available at www.michigan.gov/uia, for information on rounding of tax due.

Obligation Assessment (OA) Rate: The Obligation Assessment Rate will be indicated on pre-printed reports. Please refer to Fact Sheet 146, available at www.michigan.gov/uia, for information on the Obligation Assessment.

OA Due: Multiply “Taxable Wages” by “OA Rate.” Do not round this figure.The calculation of the OA takes into consideration the employer’s current tax rate, the OA ratio, a base assessment, and the taxable wage base. (Tax rate x OA ratio) + (base assessment ÷ taxable wage base)

Total Tax Due: This figure is the sum of the Rounded Tax Due and Non-Rounded Tax Due figures.

Prior Balance: Indicates any prior balance for which you are responsible. Specific details can be viewed on your MiWAM account or by calling the telephone numbers shown below in the Contact Us section.

Amount Enclosed: Enter amount of the payment being submitted. If no tax is due or no remittance is being submitted, enter 0.

Taxable Wage Limit: The current taxable wage limit is $9,500. Wages paid to an individual by a single employing unit that exceed the taxable wage limit for the year are not taxable.

Due Date: This report is due on the 25th of the month following the end of each calendar quarter.

Is this the Final Report for this business?: Selecting ‘YES,’ indicates there will no longer be any employment reported for this UIA account. You must also submit a completed Form UIA 1772,

Discontinuance or Transfer of Payroll or Assets in Whole or Part. This report can be found and filed through your MiWAM account.

I meet the requirements to apportion my payments and elect this option: Effective in 2013 if you had 25 or fewer employees on January 12th of the prior tax year and 50% or more of your total previous year’s contributions were payable with your first quarter report, you can elect to distribute your tax due for first quarter in four equal payments (25% due with each quarterly report). See Section 13(3) of the MES Act for more information.

SECTION 4: Must Be Completed By All Employers

Complete all requested information.

PAYMENT INSTRUCTIONS:

Make checks payable to: STATE OF MICHIGAN- UNEMPLOYMENT INSURANCE AGENCY and write your UIA ACCOUNT NUMBER on the face of your check.

MAIL COMPLETED REPORTS AND PAYMENTS

TO: Unemployment Insurance Agency

Tax Office

PO Box 33598

Detroit, Michigan 48232-5598

CONTACT US:

UIA forms are available on our website at www.michigan.gov/uia. Your questions can be directed to the Office of Employer Ombudsman (OEO) at 1-855-4UIAOEO (855-484-2636). Outside of Michigan, please call 1-313-456-2300. Questions may also be emailed to OEO@michigan.gov.

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