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.
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.
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
Social Security #
Employee Name
be Corrected
Paid This Quarter
Excess of $________
1
/
2
3
4
5
6
7
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
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
Adjustments
Interest (1.5% per month from due date)
Penalty
Total Payment/Refund
I certify all information on this report is complete and correct.
Signature
Title
Phone
Date
Form 21Cc (rev. 4/12)
Amount Reported on Original Return
Excess of $_________
10
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