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Form - WDE

Domestic Employer Application to Withdraw from Annual Wage and Contribution Reporting

South Dakota Department of Labor and Regulation
Reemployment Assistance
PO Box 4730
Aberdeen, SD 57402-4730
Phone 605.626.2312 • Fax 605.626.3347

Invalid Account Number, Please format account number as: 12345.6-7

Employer name must be filled out

Address (PO Box/Street) is required

City is required

State is required

Invalid Zip Code: Make sure the zip code is in the standard US or Canadian format

The above domestic employer applies to withdraw their Domestic Employer Election to Report Quarterly Wages and Pay Contributions Annually. The employer understands a timely application must be submitted before the method of reporting wages and payment of contributions may again be changed.

The employer understands quarterly wage and contribution reports will become due and are required to be filed and paid by the employer no later than the end of the month following the end of the calendar quarter for which the contributions become due. Penalty and interest may apply if quarterly reports are not filed and contributions paid timely. If the employer is no longer liable, the employer is responsible to timely notify the RA Division.

  • Calendar Quarter:
  • January 1 to March 31
  • April 1 to June 30
  • July 1 to September 30
  • October 1 to December 31
  • Due Date:
  • Postmarked by April 30
  • Postmarked by July 31
  • Postmarked by October 31
  • Postmarked by January 31

The effective date of this election is the first day of January, Invalid year, please type correct year format. example: 2019. 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.

You must provide your Title.

You must provide your Name.

Invalid Phone Number, format number as: 605-555-1234

Invalid Email, please format your email as: johndoe@example.com

- For SD DLR Use Only -