Amended Tax & Wage Report(Form 5208D) - Employment Security ... 2026

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The Amended Tax & Wage Report (Form 5208D) is a form used to report corrections for one quarter of tax and wage information for businesses. It requires details such as federal ID number, UBI number, business name, employee information, and adjustments to reported wages. The form also includes sections for calculating total gross wages, taxable wages, and any taxes due or penalties. It must be submitted via fax or mail to the Employment Security Department.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your Federal ID Number (9-digit) and UBI Number (12-digit) in the designated fields.
Input the Effective Quarter Ending Date using the format MM/DD.
Fill in your Business Name, First Name, Last Name, and contact information including phone number and email address.
Provide the ES Reference Number (9-digit) and Preparer’s Information as required.
For each employee listed, enter their name, correct hours worked, and wages. Ensure you also report the amounts as previously reported for comparison.
Complete sections for Total Gross Wages, Excess Wages, Taxable Wages, UI Tax Due for this quarter, and any penalties or interest applicable.
Finally, indicate the Reason for Adjustment in the mandatory field before submitting your form.

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