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Employee Name: | 12. Employee Wages for the Quarter Ending: |  |  |  | 13. Employer Name: |\n| --- | --- | --- | --- | --- | --- |\n|  | Month/Year | Month/Year | Month/Year | Month/Year |  |\n| Claimant's Name | 0,000 | 0,000 | 0,000 | 0,000 | ABC CO |\n| 14. TOTALS: | 0,000 | 0,000 | 0,000 | 0,000 |  |","cbCaitK8nhAyuJyS","https://ap.wps.com/l/cbCaitK8nhAyuJyS","pdf",293562,"English","[{\"question\":\"What information does this form collect?\",\"answer\":\"This form collects employee name, employee wages for a specified quarter, and employer name.\"},{\"question\":\"What is the purpose of the 'TOTALS' section?\",\"answer\":\"The 'TOTALS' section is likely intended to sum up the wages reported for the quarter.\"},{\"question\":\"Which government department is this form associated with?\",\"answer\":\"This form is associated with the Employment Development Department of the State of California.\"}]","Employment Development Department - State of California | PDF"]