State Unemployment Tax (SUTA) Reporting Form

Employer Legal/Business Name

Trade Name / DBA (if different)

Employer Account / Reference Number

Primary Business Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Main Contact Name

First NameMiddle NameLast Name

Contact Title / Role

Contact Email

example@example.com

Contact Phone

Please enter a valid phone number.Format: (000) 000-0000.

Reporting quarter or filing period

Tax year

State or jurisdiction

Filing status

Report submission date

Date

Notes for special filing circumstances or corrections

Total Gross Wages Paid

Taxable Wages Subject to SUTA

Employee Count During Period

Employees With Wages Reported

Exempt or Non-Taxable Wages

Adjustments, Credits, or Prior-Period Corrections

Employee wage breakdown

Total employees reported

Total taxable wages reported

Additional notes on employee classifications or exemptions

Preparer Name

First NameMiddle NameLast Name

Preparer Title / Role

Preparer Email

example@example.com

Certification

Other