Fill Out a Valid South Dakota From 21C Form Access Document Now

Fill Out a Valid South Dakota From 21C Form

The South Dakota Form 21C is a document used to correct information that has been previously submitted to the South Dakota Department of Labor and Regulation regarding unemployment insurance. This form ensures that any inaccuracies in reported wages or employee data are amended, helping employers maintain compliance with state regulations. If you need to correct any information, take the first step by filling out the form below.

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Table of Contents

The South Dakota Form 21C is a vital document for employers who need to amend previously submitted information regarding unemployment insurance. This form serves as a statement to correct errors related to wages, employee details, and other crucial data that may have been inaccurately reported in prior submissions. It’s important to note that a separate report is required for each year, ensuring clarity and organization in your records. Employers will find sections dedicated to reporting corrected amounts for total wages, wages paid, and excess amounts, broken down by quarter. The form also requires an explanation for the corrections, allowing for transparency and accountability. Additionally, it includes a certification statement where the employer affirms that all provided information is accurate and complete. With clear instructions and a structured layout, Form 21C simplifies the process of rectifying any discrepancies, helping employers maintain compliance with South Dakota's unemployment insurance regulations.

Document Example

Form 21C (rev. 4/12)

Statement to Correct Information Previously Submitted

South Dakota Department of Labor and Regulation, Unemployment Insurance Division

 

 

PO Box 4730 • Aberdeen, SD 57402-4730 • Phone 605.626.2312 • Fax 605.626.3347 • www.sdjobs.org

 

Account Number

 

 

 

UI Rate

 

%

 

 

Employer

 

 

 

Year

 

 

IF Rate

%

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A separate report is required for each year.

 

Surcharge Rate

Q1

Q2 Q3

Q4

 

 

 

 

 

 

 

 

____%

_____% ____% ____%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount Reported on Original Report

Correct Amount

 

 

 

 

 

 

 

Qtr/Yr to

Total Wages

Wages Paid in

Total Wages

Wages Paid in

 

Social Security #

 

Employee Name

be Corrected

Paid This Quarter

Excess of $________

Paid This Quarter

Excess of $________

1

 

 

 

 

 

 

/

 

 

 

 

 

2

 

 

 

 

 

 

/

 

 

 

 

 

3

 

 

 

 

 

 

/

 

 

 

 

 

4

 

 

 

 

 

 

/

 

 

 

 

 

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8

 

 

 

 

 

 

/

 

 

 

 

 

Explanation:

 

 

 

 

 

 

 

 

 

Annual taxable wage base:

 

 

 

 

 

 

 

 

 

 

 

 

 

2009 = $9,500

2013 = $13,000

 

 

 

 

 

 

 

 

 

 

 

 

2010 = $10,000

 

 

 

 

 

 

 

 

 

 

 

 

2014 = $14,000

 

 

 

 

 

 

 

 

 

 

 

 

2011 = $11,000

 

 

 

 

 

 

 

 

 

 

 

 

2015 & later = $15,000

 

 

 

 

 

 

 

 

 

 

 

 

2012 = $12,000

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

office

Quarter

 

 

Quarter

Quarter

Quarter

 

Make a copy of

 

 

 

coding

3/31/____

 

6/30/____

9/30/____

12/31/____

Total

this report for your

Net Change in Total Wages

 

 

 

 

 

 

 

 

 

 

records. Send

 

 

 

 

 

 

 

 

 

 

original to the

Net Change in Excess Wages

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Unemployment

Net Change in Taxable Wages

 

 

 

 

 

 

 

 

 

 

Insurance Division

Additional Contribution Due

9

 

 

 

 

 

 

 

 

 

of South Dakota.

 

 

 

 

 

 

 

 

 

 

Reduction in Contribution

8

 

 

 

 

 

 

 

 

 

 

Adjustments

 

 

 

 

 

 

 

 

 

 

 

Interest (1.5% per month from due date)

7

 

 

 

 

 

 

 

 

 

 

Penalty

7

 

 

 

 

 

 

 

 

 

 

Total Payment/Refund

 

 

 

 

 

 

 

 

 

 

 

I certify all information on this report is complete and correct.

 

 

 

 

 

 

 

 

 

Signature

 

 

 

Title

 

 

 

Phone

 

Date

 

Form 21Cc (rev. 4/12)

Statement to Correct Information Previously Submitted

South Dakota Department of Labor and Regulation, Unemployment Insurance Division

PO Box 4730 • Aberdeen, SD 57402-4730 • Phone 605.626.2312 • Fax 605.626.3347 • www.sdjobs.org

 

Account Number

 

 

 

Employer

 

 

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount Reported on Original Return

Correct Amount

 

 

 

Qtr/Yr to

Total Wages

Wages Paid in

Total Wages

Wages Paid in

 

Social Security #

Employee Name

be Corrected

Paid This Quarter

Excess of $_________

Paid This Quarter

Excess of $_________

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Document Overview

Fact Name Description
Form Title Form 21C is titled "Statement to Correct Information Previously Submitted."
Governing Body This form is managed by the South Dakota Department of Labor and Regulation.
Division The Unemployment Insurance Division oversees the processing of this form.
Mailing Address The form must be sent to PO Box 4730, Aberdeen, SD 57402-4730.
Contact Information For inquiries, you can call 605.626.2312 or fax 605.626.3347.
Website More information is available at www.sdjobs.org.
Account Number An account number is required to properly identify the employer.
Annual Taxable Wage Base The taxable wage base varies yearly, with recent figures being $15,000 for 2015 and later.
Quarterly Reporting A separate report is necessary for each quarter of the year.
Certification The form requires a signature certifying the accuracy of the information provided.
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