The Texas C 5 form is an essential document used by employers to report corrections to previously submitted wage information on the Employer’s Quarterly Report, known as Form C-3. This adjustment report allows employers to rectify discrepancies in total and taxable wages for specific quarters, ensuring accurate tax contributions. Each submission requires careful attention to detail, as adjustments can impact both current and future tax liabilities.
The Texas C 5 form, officially titled the Adjustment Report, serves a crucial role for employers in maintaining accurate wage reporting to the Texas Workforce Commission (TWC). This form is specifically designed to correct previously reported amounts of total and/or taxable wages on the Employer’s Quarterly Report, known as Form C-3. Each adjustment necessitates a separate C 5 report for every calendar quarter that requires changes. Employers must provide essential details, including their TWC account number, name, and address, along with the quarter for which the adjustment is being made. The form also requires a breakdown of amounts originally reported and the corrected figures, ensuring transparency in wage reporting. Additionally, it addresses potential penalties for late submissions and outlines interest calculations for any additional tax due. Employers are reminded to indicate the reason for the adjustment and, if necessary, attach a Wages List Adjustment Schedule to account for changes affecting individual employees. Completing this form accurately is vital, as it certifies the truthfulness of the reported information and helps maintain compliance with state regulations.
TEXAS WORKFORCE COMMISSION
33333
PO BOX 149037
AUSTIN, TX 78714-9037
ADJUSTMENT REPORT
1.TWC Account number:
-
2.Employer’s Name and Address:
3.Adjustment for the Quarter Ended:
2
0
Month
Day
Year
PURPOSE:
This report shall be used to correct amounts of total and/or taxable wages previously reported on Employer’s Quarterly Report, Form C-3.
A separate report is required for EACH calendar quarter adjusted.
Individuals may receive, review, and correct information that TWC collects about the individual by emailing to:
open.records@twc.state.tx.us
or writing to:
TWC Open Records
101 East 15th St Rm. 266
Austin, TX 78778-0001
For TWC Use Only:
Result of Audit?
Yes /
No
Column A Verified?
Mo.
Postmark Date
Dollars
Cents
Amount Received
AE #
Inits.
Wages List Adjustment
Keyed by WRCE Keyed by B-27
Attached Not Attached Not Required
Please note: Lines 4 and 5 must be completed for columns A, B and C, even if no changes are made for one of the items.
(If no change for an item, please enter the same figure in columns A and B, and show $0.00 for column C.)
A
B
C
Amounts as Originally Reported on Form C-3 (or
Difference
ITEMS
previously adjusted on Form C-5) for this quarter:
Correct Amounts
Over Reported or Under
Reported
Dollars . Cents__
Dollars .
Cents__
[Column A - Column B]
4.
Total Wages Paid
$
5.
Net Taxable Wages
6.
Tax Contribution
at
%
% $
7.
Interest – If item 6C (Tax Contribution Difference) indicates additional tax due for this quarter, compute interest at 1.5%
of the additional tax due for each month after which the original payment became due.
8.
Penalty – If the original Employers Quarterly Report (Form C-3) was submitted more than 15 days late for this quarter,
and the taxable wages have changed (as shown in item 5C), calculate the difference in penalty amount due.
9.
Total for this
Underpayment: Attach remittance for the additional amount due.
Overpayment: Amount will be reflected on your next tax report and can be used to offset future
Quarter
liabilities.
IMPORTANT: This section must be completed for each form submitted
Indicate reason for adjustment:
If amounts reported on Form C-4 for any individual employee(s) are affected by the
Form C-7:
adjustment for this quarter, attach a Wages List Adjustment Schedule (Form C-7),
Submitted
Not Submitted
showing adjustment of the total wages reported for each affected employee.
I certify that all information in this Adjustment Report is true and correct:
Signature:___________________________________________________________________
Phone: ( )
Print Name:
Title:
Date:
(Owner, Officer, Partner, etc.)
Form C-5 (0507)
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