DC-1 (Internet) Employer's Quarterly Report of Contributions Under the R

PROPOSED
Complete Form then click on Submit Button to Process
UNITED STATES OF AMERICA
RAILROAD RETIREMENT BOARD

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Employer's Quarterly Report of contributions under
the Railroad Unemployment Insurance Act
This Report is Required By Law - 20 C.F.R. 345.5

Co. Name

r

Address

r

Check/Money Order

Ii Electronic

Electronic Form DC-1 will be filed with:

CHIEF FINANCIAL OFFICER
U.S. RAILROAD RETIREMENT BOARD

xxxx 1275
844 N Rush Street, Chicago, Illinois 60611-2092

I
1. Current Reporting
Period
2. Compensation Adj.
Reported on Form BA-4

Address 2

City I

Amount of Compensation
subject to contribution
(c)

Month BA-4
Prepared
(a)

Calendar Quarter and Year

Employer Number

Check appropriate box for report status/method of payment
Final Report

FORM APPROVED
O.M.B. No. 3220-0012

Contribution Rate
(d)

I
I

0.00

3. Total
4. Corrections to prior
Form DC-1

1.
2.
3.

5. Total
IMonth

Year

, - - - - - - - - - 7.
6b. liP Total

Report Total

0:00
0.00

9. Preparer's Name

L

Telephone No.
I CERTIFY THAT I HAVE EXAMINED THIS REPORT, THAT IT IS MADE IN GOOD FAITH AND THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF ALL ENTRIES MADE
HEREIN ARE TRUE AND CORRECT, AND IN ACCORDANCE WITH THE LAW AND REGULATIONS APPLICABLE HERETO. I UNDERSTAND THAT PROVIDING FALSE OR
FRAUDULENT INFORMATION OR FAILING TO PROVIDE REQUIRED INFORMATION IS A VIOLATION OF FEDERAL LAW PUNISHABLE BY FINE, IMPRISONMENT OR
BOTH.

It

SIGNATURE

TITLE

FORM DC-1 (12-11)
xxx DESTROY PRIOR EDITIONS

DATE

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INSTRUCTIONS

PAPERWORK REDUCTION ACT NOTICE

We ask for this infonnaIion to carry out !he provisions of!he Rairoad
Unemployment Insurance Ad. We need it to ensure that milroad employers
are campIying lIIilh !he AI;t and to allow us to compute IIIId collect !he CXlmItt
amount of conIribuIion&. You are required to giw us this infoI:mation.
We estimate this form takes 811 8'\/8r8Q8 of 25 minutes per response to
comp/eIe, including !he Une for nwie.wiag !he instrudioos,. gelling !he
needed data, and reviewing !he ccrnpIeted form. Federal agencies may not
aJnduct or &ptlI'\IiQI', and respondents are not required to Jespand to, 8
collection of infonnaIion unless it displ8ya 8 valid 064B number. If you lIIish,
68nd comments regarding !he IICCl.IIlq of our estimate or any other aspea
of this form, including suggeIItians for reducing !XlIIIJ.ietion time. to !he
Chief of Information Resources Management, Raimad ReIirement BoanI,
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxx 1275
844 N. Rush St., Chicago.IL 60611-2092.

Associate
Chief
Information
Officer for
EMPLOYER'S CONTRIBUTIONS AND CONTRIBUTION REPORTS
Policy and
Compliance GeaenII requn-otsEvery emPoyerlJllder!he RaiJmad
Unemployment Insurance AI;t is required to pay a consribution equal to 8
peccantage of!he COIIlperIII8tio earned by any employee. All 8I'I'lIlIoyera
are notitied aoouaIly of!he c:ooIJibution rata lIIilh FonuID-4Or. Annual NoIice
to Employer- RUI AI::L In 0dDber. The.monthly ~ base i&
established e.-y November Ilia a sepande notic&
Reporting requn-ots EvelY emPOYer must file a repon IIIId pay
contributionr. for each calendar quaI1Br In lIIhich ~ is earned by
one or II1CIoI8 employee&.

The repon for each quaI1Br must be filed and !he canIIiluIions must be paid
on or before !he due dale ahcNin below:
QUARlER ENDED

DUE ON OR BEFORE

Uarc:h31

April 30

June 30

July 31

September 30
December 31

Qdober31
.lanualy31

1taIIIl1- Cummt repodiD.g period No enlJy requin.d In columns (8)
IIIId (b). EnIsr In column (e) !he toIaI COIIlperIII8tio sutlject to
CXIIlIribuIion for !he aJmlIIt repod/ng period. In coIUINI (d)!he
conUibutian nde Indicated in !he annual notice and In column (e) !he
amount ofcantribulion 00e.

1taIIIl2- Compe.nutioR Adj~ EnIsr In coIUINI (a) !he monIh
indicatsd on Fonu BA-4. Report of CnIditabIe Compensation
Adjustrneota. EnIsr In column (b) !he calendar yearlllhich .... ~
by1he Fonu BA-4 (8 BA-4 that adiU&ta moralh8n 1 calendar year
I1IQI.Iire6 a separate line for each ya.'). Enlurin column (e) on !he
appRlpI'iata line !he amount of!he net inaease or deaease nIIIIUIIing
from c:ompenaation ~ applicable to prior periods 81$ repartad
on !he Fonu BA-4 filed during !he period CIIMInId by !he report. The erdIy ,
is to be made in !he lIpace provided for !he period aIfect8d by !he
adiU*nent EnIsr In column (d)!he COIiIbIIian rata applicable (8.0%)
for yeara from 1J1J19811hrough 1213111890,; see sadion 345 of!he
RRB's regulation for yeara priorto 1981. EnIsr In column (e) !he amount
of CXlntributions 00e.
If any amount i& a decrease, it should be IICIted by Inserting !he 1etIsr"D"

aIsr!he amount

.

Item 3- ToaaI- EnIsr!he toIaI oflle c:ompensaIion amounts ahcNin for

itema 1 and 2 in column (c) and !he toIaI of!he alI'IIribuIion amounts In

column (e). The toIaI c:ompensaIion repartad on line 3 for !he feu

quarteIS of each year should be !he same 81$ !he total c:ompensation

reponed on Fums BA-3" Annual Report of CredilaIJIe CompensaIion,

and BA-41D!he Chief of ComperlIIIIIion and EmPOYer SeNicu Cedar

Iftbey do not 8f,JfBI&. please aI:tac:h a aratementthat explains !he

reason(s) for !he diIarence in toIaI c:ompensaIion reponed here and

separal8ly repartad 1D!he
Chief of Compensation and l:IIIpIoyer

SeNces Center • The toIaI compenI8tion to be Iisled on tis CDIIIribuIion

repon is to be deriIIed from payroll& or other cisbtnament doc.umeIds

, for lID appRlpI'iata quaI1Br.

If the due dale falls on Saturday, Sunday, or a national legal hQIiday, the
report must be filed and !he payment made on or before !he next tiloMng
business day. The repon must be postmarked on or before !he data on
lIIhich the repcxt is required to be filed. PaymenIs by electronic medium
must be effadiIIa on or before the dale on lIIhich'!he DC-1 repon is
requin.d to be filed.
.

Item 4- Conectioa to prior Forma QC..1EnIer COIfIIdiana,
\IIIderpaymerIt or overpayments of CDIlribution not iIM:tvIng BA-4
~appicatlIeto priorcompenaation ~ On line 11n column
(8) anter!he caleooar quaI1Br and year of!he Fonn DC-1l11tJich requirea

c:orrection. EnIsr in column (b) !he calendar year IId,iu:sUM1 EnIriea In

columns (c) Ihrough (e) should be !he IIIIR18Infonna1ion ulndicaled on

Fonn DC-1 to be CXIIIIIIdad. EnIur on line 2 in c:oIurMa (c) tlvough (e).!he

CCI11I!Ct infoImaion. AddiIionaI COI'I1IdicrIa to Fums DC-1 should be

doaJmented on an aIt.achmant In !he _ _ fonIrIat 81$ !he Ir8l ccrrection.
On line 3 of coIUIIIIl8 (c) and (e) 1he net COI'RICIion toIaI is enI8nId.

Penaltiea - For failure to file a report on or before !he dale on lIIhich it is

and _ _ !he totals.

unless !he employer estabIi!Ihea to !he Balisfadian of!he Railroad
ReIirement Board (RRB) 1hala reasonable C8UIS8 ems for !he cIeIirIquency.

bema k & b-I~ Indic:aIe!he quaI18rand year
applicable in item 6& EnIsr!he amount of/ntenlllllpenllin item 6b.

IDtanIIst- If any contribution is not paid \!/hen due, interest lIIiII acaua
1heraon at !he nde of one pen:ent per monIh orfradion of a monIh from !he
data on lIIhich it beaIma due until it is paid. A tadionaI part of1he monIh
lIIiI be treated !he 881118 81$ a full mIlI\Ih, e.g, a c:ontribuIion posSmarked one
day eAer!he due data will be assessed a full monIb's inlarest.

1taIIIl7 - Report TotaI- EnIur!he toIaI amount of lie remittance requin.d
by this report. Add !he amounts atIOIoWl in iIsms Sa and 6b.

Reeorda- Every employer under !he Raimad ~ 1nsI.IIaooeAd.
must keep accurate records containing sufIicient informaIion to enable !he
RR8 to deIermine lIIheIher!he ccntribuIions have been tomIdIy computed
and paid. Such records shall be maintained for a period of at least fNe years
eAer!he data !he contribution to lIIhich they relata becomes due or !he data
!he contribution is paid, \IIhk:hever is later, and shall be open at all Unes to
!he inspedion of!he RRB or any of its otIi.ceIa or employees.

ItaIIIl 9 - Enter lie name and telephone nI.IIIber of ihe IndivicIIJaI preparing
!he form.

due, section 34S of!he regulations proIIides a penally of iwl to t.Wenty..6ve
pen:ent of!he contJibution. dependiIlg upon !he duration of!he delinquency,

COMPLETING FORM QC..1
Identifying Information - Enter the employer number used In reporting
compensation to the RRB'& alief of Compensation and EmPOYer SeNiaIs
Center, !he calendar quarter and yeac covered, and !he full name and
addI'6Ii& of!he empIOYBr. lfilturB repod& are not requin.d please chedc
"FINAL REPORT.' Also chedc!he baxto Indicel& method of payment.

Item 5 - ToaaI- Add columns (e) and (el ofitem 3 and line 3 of item 4

Item I-Amount of Remittance- EnIsr,incolumn (e). the total amount
remiIIed for this report. It should be !he amount atIOIoWl in lam 7.

Sigaabn- Eadl repon must be aigned by (1) 1he indMduaI if!he
empIQYer is lID indNiduaI, (2) !he pr8Ilident, vice president. or other duly
auIhoriZIId oIicer if the employer is a fXlI1lQI'8Iion. or (3) a f8SIlONlibIe or
duly auIhorized member or ofIicer haWlg kni:NdedQe of ita allllira,lthe
employer is a partner&bip or other incorporated crganization. The title of
!he officer must be Indicat&d ulllflllu!he data sig.necl

xxxx
DC-1 (12-11)