Form makes calculations automatically as you fill in employee information. While this option works best with a high speed capability, it can be downloaded over any internet connection.
A 56K modem and telephone connection may require more than a minute to complete this process. If you experience any difficulty with this automated form, please try the version below.
This form is identical but does not include any automatic calculation function.
With either version, we recommend you save the Wage and Contribution Adjustment form to your computer after you download it and before you fill it out. Leave your internet connection active if you want to read instructions or view the sample form.
Print two copies of the form. The completed form cannot be saved. Keep one copy for your records. Mail the completed form to PERF. Include any additional payment required.