Alaska Employer Registration Form For Daycare Services (Page 2 of 3) in pdf

INSTRUCTIONS FOR NEW EMPLOYERS

Check the box on the top left of Page 3 to indicate if this is a new or update registration. Complete the following if you are a new

employer. See below for update instructions.

1) Mark the item that describes the type of employer

RESPONSIBLE PARTY INFORMATION:

you are. If you are married you may be registered

as a sole proprietor or partnership.

Sole Proprietor:

List your name, residence address,

telephone number, title and Social

2) List your Federal Employer Identification Number

Security Number. Your title should

(FEIN). If you have employees, you must have an

reflect your relationship to the

FEIN. Do not use your Social Security Number.

individual the daycare services are

being provided for.

3) If you were previously assigned an account

number by the Employment Security Division in

Partnership:

List the requested information for

the last three years, indicate that number.

each partner.

4) Indicate the month, day, and year your business

Other:

List the requested information for

first paid or anticipates to first pay wages in

principals or responsible parties.

Alaska.

5) 5a) Indicate if you anticipate paying wages

Responsibility Codes

totaling $1,000 or more in a calendar quarter.

1. File contribution reports

2. Pay contributions due

5b) Indicate if you paid wages totaling $1,000 or

3. Person determines which creditor is paid

more in a calendar quarter in the previous year.

first.

4. Check signing authority.

6) List your mailing address.

5. Hire/Fire authority

6. All of the above

7) List your telephone number.

8) List a physical worksite address in Alaska if

CERTIFICATION and SIGNATURES:

different than Item 6. If you do not have a

This Registration form must be signed by the SOLE

physical worksite in Alaska, please explain. The

PROPRIETOR, ALL PARTNERS of a partnership,

physical worksite should be a private home where

ALL principals or responsible parties.

the domestic service is performed.

Contact Person:

9) List your FAX number.

If you have a business contact person, such as an

accountant, bookkeeper, or tax preparer, provide their

10) Indicate if you are enrolled in a daycare assistance

name, phone number and e-mail address.

program under the Child Care and Development

Block Grant Act of 1990 or similar program.

11) Indicate whose home the service is provided in

and if the care provider is a relative and the

relatives age. Some services performed by family

members may be excluded from coverage. Also

provide the name and social security number of

the caregiver.

Alaska Employer Registration Form For Daycare Services Page 2

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