MODES-4A-2 (02-20)
Instructions for Preparation of Contribution and Wage Adjustment Report
This adjustment report is to be used for the purpose of adjusting summary total and wage data previously reported. A separate report is to
be used for each quarter to be adjusted and for each separate account number assigned.
It is recommended Items 13 through 19 be completed prior to completing Items 5 through 12.
1. Type or print employer’s name and address.
2. Enter the 10-digit Missouri Division of Employment Security employer account number.
3. Enter the contribution rate for the calendar quarter being adjusted.
4. Enter the full facts to support the claim for adjustment. Example: Do not say “reported in error.” Explain why the wages were reported
in error. Mark Quarter and Enter Year for report being adjusted.
5-10. Column A. Enter the totals previously reported on the employer’s Quarterly Contribution and Wage Report, or
latest Contribution and Wage Adjustment Report for the quarter.
Column B. Enter the correct totals which should have been reported for the quarter.
Column C. Enter the difference between Column A and Column B.
The taxable wage base in Missouri for 2018 is $12,500, 2019 is $12,000, and 2020 is $11,500. Based on the current taxable wage base,
the first $11,500 in wages paid to a worker by an employer is taxable.
SAMPLE WORKSHEET FOR COMPUTING EXCESS WAGES (Sample based on $11,500)
FIRST QUARTER SECOND QUARTER THIRD QUARTER FOURTH QUARTER
Security
of
Taxable
of
Taxable
of
Taxable
of
Taxable
111-111-
222-222-
John Doe
Mary Doe
13,500.00
5,000.00
2,000.00
-0-
11,500.00
5,000.00
14,000.00
5,000.00
14,000.00
-0-
-0-
5,000.00
13,000.00
5,000.00
13,000.00
3,500.00
-0-
1,500.00
13,000.00
5,000.00
13,000.00
5,000.00
-0-
-0-
Totals for
Quarter
Enter on Line:
18,500.00
(4)
2,000.00
-5
16,500.00
(6)
19,000.00
(4)
14,000.00
-5
5,000.00
(6)
18,000.00
(4)
16,500.00
-5
1,500.00
(6)
18,000.00
(4)
18,000.00
(5)
-0-
-6
11. If this report indicates additional contributions are due, this figure would be Item 10, Column B less Column A. (Make remittance
payable to the Division of Employment Security.)
12. If this report indicates a credit is due, this figure would be Item 10, Column A less Column B.
13. Enter the worker’s Social Security Number.
14. Enter the worker’s name (first name, middle initial and last name) whose wages are being adjusted.
15. Enter the Total Wages Paid previously reported for the worker for the quarter.
16. Enter the correct Total Wages Paid to the worker for the quarter.
17. Mark the box for each employee your business reported to another state’s employment security agency during the calendar year. You
may use these wages to compute the wages paid in excess of the taxable wage base.
18. Enter the total of all entries made in Items 15 & 16.
19. Enter the difference between Items 15 & 16. If Item 15 is more than Item 16, a minus sign should precede the difference. If Item 15 is
less than Item 16, a plus sign should precede the difference.
20. This form must be signed by a responsible and duly authorized person.
If there are more than seven workers’ wages to be adjusted, a separate page with the additional information using the same format as
above, including employer name and account number, should be completed. For assistance in completing this form, please call
573-751-1995 then select option 2.
Mail original of this form to: ATTN: Employer Account Unit
Division of Employment Security
P.O. Box 59
Jefferson City, MO 65104-0059
IMPORTANT: If needed, call 573-751-1995 for assistance in the translation and understanding of the information in this document.
¡IMPORTANTE!: Si es necesario, llame al 573-751-1995 para asistencia en la traducción y entendimiento de la información en este documento.
Missouri Division of Employment Security is an equal opportunity employer/program. Auxiliary aids and service
are available upon request to individuals with disabilities. TDD/TTY: 800-735-2966 Relay Missouri: 711
