The above domestic employer elects to report quarterly wages and pay quarterly contributions annually, and agrees to provide wage figures at other times as necessary to establish wage records for claims purposes.

Quarterly wages and contributions will become due and are to be filed and paid by the employer no later than January 31 with respect to wages for employment paid in the preceding calendar year. Penalty and interest may apply if the report is not filed and contributions paid timely.

The effective date of this election is the first day of January, Invalid year, please type correct year format. example: 2019. except that the Department may terminate this election if the employer becomes liable under another category of employment. It is understood and agreed that this election must be received no later than December 31 to be effective at the beginning of the next calendar year. This election remains in place until the employer submits a request to withdraw this election on the form designated by the Agency for that purpose.

The employer understands and agrees that this election may be withdrawn by filing a written application requesting withdrawal with the Department no later than December 31 to be effective at the beginning of the next calendar year.