The Illinois UI Ha form is a document used by household employers to report unemployment insurance contributions for their employees. It requires specific information, such as the employer's account number, employee details, and total wages paid for each quarter. Completing this form accurately is essential for compliance with state regulations.
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The Illinois UI Ha form is an essential document for household employers who are required to report unemployment insurance contributions. This form collects critical information, including the Illinois Unemployment Insurance Account Number and the Federal Employer's Identification Number (FEIN). Employers must provide their personal details, including their name and address, as well as the names and Social Security numbers of their household employees. The form requires a detailed accounting of wages paid to each employee for every quarter of the year, including salaries, bonuses, and other forms of compensation. Employers must also indicate if any wages exceeded the taxable wage base amount, which for 2012 was set at $13,560 per worker. If there are more than eight household employees, additional sheets may be necessary to capture all required information. The form includes calculations for taxable wages and the total unemployment insurance contributions due, which must be submitted along with payment to the Illinois Department of Employment Security. Accurate completion of this form is vital, as failure to file correctly or on time may result in penalties and interest. Additionally, the form must be signed by the employer or an authorized representative, ensuring accountability in the reporting process.
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This form applies to both full-time and part-time household employees. All employees who performed services and received pay during the relevant payroll periods must be reported.
If no wages were paid during a quarter, you must still enter "0" for that quarter. This ensures accurate reporting and compliance with state requirements.
The taxable wage base can change annually. For 2012, it was set at $13,560. Always check for updates for the current year.
The report must be signed by the person named in the form. If someone else signs it, a Power of Attorney must be attached to validate the submission.
Each household employee’s Social Security number must be included on the form. This information is necessary for accurate reporting and compliance.
Each employee's wages must be reported separately. This includes entering their total wages for each quarter individually.
Filing online requires prior registration with the Illinois Department of Employment Security. Ensure you complete this step before attempting to file electronically.
Actual wages must be reported. Estimates can lead to discrepancies and potential penalties, so accurate records are essential.
Previous payments must be accounted for when determining your current contribution due. This ensures accurate reporting and compliance with state regulations.
UI-HA Report for Household Employers Instructions
You may file on-line at https://taxnet.ides.state.il.us
Step 1
Line 1a Enter your 7-digit Illinois Unemployment Insurance Account Number.
Line 1b Enter the nine digit Federal Employer's Identification number (FEIN) assigned to you by the Internal Revenue Service.
Line 2 Enter your first name, middle initial and last name.
Line 3 Enter the street address including the city, state and zip code where you want to receive this form.
Step 2
Lines 6 through 14 - use one line for each employee
Column A
Print the last and first name(s) of your household employee(s).
Column B
Complete this item by copying your employee’s social security number from his or her Social Security card.
Columns C through F (quarters)
Enter the total wages paid to each employee for each quarter of the year. If no wages were paid for that quarter, please enter "0".
Wages include (a) salaries, commissions and bonuses, tips reported to the employer, separation pay, vacation pay, prizes, sick pay, payments on account of retirement; (b) the reasonable cash value of remuneration paid other than cash, such as goods, meals and lodging; and (c) any remuneration for services performed within the State which is considered wages under the Federal Unemployment Tax Act.
Line 15 If you had more than eight household employees during 2012, use an additional sheet of paper and include the information in Step 2 for each additional worker. Total each Column C through F on the attachment, and write the totals on Line 15 in the appropriate column.
Line 16a Add Lines 6 through 15 within each column. This is the total wages paid for each quarter.
Step 3
Line 16b Copy totals from line 16a above.
Line 17 Write in the total wages paid in excess of the unemployment insurance taxable wage base amount for each worker. For 2012, the taxable wage base amount is $13,560 for each worker.
An employer must pay unemployment insurance contributions on only the first $13,560 in wages for each employee.
Example: You have one household employee that you pay $5,000 each quarter. During the first and second quarter, the wages paid to the employee total $10,000, so you would enter “0” in each column for the first and second quarters. During the third quarter, the total amount paid to the employee reaches $15,000 which exceeds the $13,560 unemployment insurance taxable wage base by $1,440. So the amount to be entered on Line 17 for the third quarter, is $1,440 ($15,000-$13,560). The fourth quarter wages of $5,000 must be entered on Line 17 for the fourth quarter since the wage base was met during the third quarter.
1st quarter
2nd quarter
3rd quarter
4th quarter
Ex Line 17
$ 0
$1,440
$5,000
UI-HA instructions (12/12)
Step 3 continued
Line 18 Subtract Line 17 from Line 16b and enter the result on Line 18. These are your taxable wages.
Lines 19 and 20
For each quarter, calculate your unemployment insurance contribution. Within each column, complete either Line 19 or 20, whichever is applicable.
Line 21 Quarter totals: Enter the amount from Line 19 or 20 in each column. This is your contribution due for each quarter.
Line 22. Grand total. Add the quarterly totals from Line 21 (Columns C, D, E and F) and enter the result on Line 22. This is your 2012 total
unemployment insurance contributions due.
Step 4
Line 23-26 Enter the total number of employees (full or part time) who are covered by unemployment insurance and who performed services during or received pay for the payroll period including the 12th of
each month of the quarter. Include workers who have earned more than $13,560 in the calendar year and those on vacation or paid
sick leave. Exclude workers on strike.
Step 5
Line 27 Write the amount shown on line 22. This is your total 2012 unemployment insurance contribution.
Line 28 Write the amount of any previous payment made to the Illinois Department of Employment Security for the liability shown on Line 27.
Line 29 Subtract Line 28 from Line 27.
This is the amount of unemployment insurance contribution due.
Make your check payable to the Illinois Department of
Employment Security.
Step 6
Line 30 If you have stopped employing workers, write the date of the last day you employed workers.
Step 7
Line 31 This report must be signed by the person named in Step 1, Line 2. If signed by any other person, a Power of Attorney must be attached.
MAIL YOUR COMPLETED REPORT ALONG WITH YOUR CHECK TO:
ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY PO BOX 3637
SPRINGFIELD IL 62708-3637
General Instructions
What if I do not file or pay by the due date?
If you do not file a processable return or pay the tax you owe by the due date, you will owe penalty and interest.
What if I need to correct information I reported? Where may I obtain help or more information?
For other related forms or help with questions regarding unemployment insurance, please call the Unemployment Insurance Hotline toll-free at 1 800 247-4984 (option 2).
The TTY number for the hearing impaired is (866) 212-8831.
State of Illinois
Form UI-HA Report for Household Employers
Step 1: Tell us about yourself
Illinois Department of Employment Security
File on-line at https://taxnet.ides.state.il.us
1a ________________________________ b ___ ___–___ ___ ___ ___ ___ ___ ___
Illinois account number (Unemployment Insurance)
Federal employer’s identification number
2___________________________________________________________________
Your name (first, middle initial, last)
3___________________________________________________________________
Street Address
___________________________________________________________________
City
State
Zip
Step 2: Report your household employee information
5For unemployment insurance reporting, complete Columns A-F
6
A
B
C
D
E
F
Name
Social
1/2012
2/2012
3/2012
4/2012
(last, first)
Security No.
QTR. ending Mar. 31
QTR. ending June 30
QTR. ending Sept. 30
QTR. ending Dec. 31
•
7
_____________________________
8
9
10
11
12
13
14
15
Other (attach) ________________________
16a Column totals: Add Lines 7 through 15 in each column
Step 3: Figure your unemployment insurance
contribution due for each quarter
16b Column totals: Copy totals from line 16a above.
______________________
_____________________
17Write the total wages paid in excess of the taxable
wage base amount ($13,560 per employee for 2012).
18
Subtract Line 17 from Line 16b.
19
If Line 16a is less than $50,000, multiply Line 18 by
your 2012 contribution rate or 5.400%, whichever is less.
20
If Line 16a is $50,000 or more, multiply Line 18 by
your 2012 contribution rate.
21
Quarter totals: Enter the amount from Line 19 and/or 20.
22
Grand total: Add the quarter totals from Line 21 (Columns C, D, E and F) and write the result on Line 22.
_________________
UI-HA front 1 of 2 (12/12)
PLEASE RETURN THIS PAGE AND PAGE 2 OF THIS FORM
Step 4: Number of employees who are covered for unemployment insurance
Write the total number of covered workers (full and part time) who performed services during or received pay for the payroll period including the 12th of each month of each quarter. If none, write “0”
23
January 12
__________
February 12
March 12
___________
24
April 12
May 12
June 12
25
July 12
August 12
September 12
26
October 12
November 12
December 12
Step 5: Figure your total unemployment insurance contribution due
27
Write the amount from Line 22.
____________I ____
28
Write the amount of any previous payment to the Illinois Department of Employment Security for the liability shown on Line 27.
29
Subtract Line 28 from Line 27. Make your check payable to the Illinois Department of Employment Security.
Step 6: Complete if you are no longer employing workers
30
Write the date you stopped employing workers.
____/_____/____
month day year
Step 7: Sign below
Under penalties of perjury, I state that I have examined this report and, to the best of my knowledge, it is true, correct, and complete.
31 ____________________________________________________________
____/____/__________
(_____) ______________
Household employer’s signature (full name)
month day
year
Daytime telephone number
Filing deadline: April 15, 2013
You may file and pay on-line at https://taxnet.ides.state.il.us
Mail your completed report along with your check to:
ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY
PO BOX 3637
UI-HA back 2 of 2 (12/12)
This state agency is requesting information that is necessary to accomplish the statutory purpose as outlined under 820 ILCS405/100-3200. Disclosure of this information is REQUIRED. Failure to disclose this information may result in statutorily prescribed liability and sanction, including penalties and or interest. This form has been approved by the Forms Management Center.
PLEASE RETURN THIS PAGE AND PAGE 1 OF THIS FORM
When filling out the Illinois UI-HA form, there are some important dos and don'ts to keep in mind. Following these guidelines will help ensure that your submission is accurate and complete.
Completing the Illinois UI-HA form is essential for reporting unemployment insurance contributions for household employees. Follow these steps to ensure you fill out the form correctly.
After completing the form, ensure that all information is accurate before mailing it. This will help avoid any penalties or interest due to errors or late submissions.