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Instructions (continued)

Item 7

Answer Yes if legal entity has changed. Types of legal entity appear in Part A, Item 2, of this form. A New York State Employer

Registration Number is assigned to an employer who is liable to pay Unemployment Insurance tax. It is used to identify an

individual account for recording tax payments due and Unemployment Insurance benefits paid.

Part C

Item 1

Enter the first calendar quarter and year in which you paid (or expect to pay) total cash wages of $500 or more to your household

employees. Do not go back beyond 3 years from January of the current year. Do not include as cash wages payments to:

household employees for carfare or other travel expenses; your spouse or your child under 21 years of age; elementary or

secondary school students who attend school in the daytime; children under 14 years of age; babysitters under age 18, or casual

laborers under age 21.

Item 3

Withholding of New York State, New York City, or Yonkers income tax from household employees performing domestic services is

voluntary. Answer Yes to this question only if there is a voluntary agreement in effect between you and the domestic employee to

withhold New York State, New York City, or Yonkers income tax.

Part E

Item 2

Describe (1) principal activity or (2) product which produces greatest gross sales value. Examples:

(C - E)

Manufacturing

State type of establishment (e.g., sawmill, vegetable cannery, printing and publishing). Show principal

products, percent of total sales value, and principal raw materials used. Specify principal products (e.g.,

upholstered household furniture, ladies' sweaters hand knit from yarn).

Trade

State principal product distributed. If sold to businesses (wholesale) or general public (retail), indicate

which is primary.

Construction

Specify general or special trade contractor and show usual type of work (e.g., general

contractor-apartment houses or trade contractor-plumbing).

Warehousing

State type of storage (e.g., refrigerated, general, self-storage units for the public).

Transportation

Includes establishments in railroading; local and suburban transit; interurban highway passenger

transportation; motor freight transportation; water transportation (deep sea foreign transportation,

lighterage, etc.); transportation by air, etc. Be specific.

Computer services

State primary activity (e.g., computer analysis and design, custom programming, Internet access or data

processing, etc.).

Educational services

Includes all schools (e.g., elementary, colleges, universities, vocational schools). Be specific in Section E.

Health & social

Includes health referral agencies, operation of clinics, hospital or homes, etc. Be specific.

services

Real estate

Include owners/operators of real estate and agents. If owner/operator, specify type of property (e.g.,

commercial or residential building).

Scientific/professional

Includes lawyers, accountants, business consultants (contractors), architects, engineers, doctors,

& technical services

surveyors, etc. Be specific in Section E.

Finance & insurance

Includes bank and trust companies, credit agencies other than banks, insurance carriers. State if national

or commercial banks, charter, and if accepting deposits from the general public. Insurance underwriters

are classified by type of insurance (e.g., life, accident and health, etc.)

Arts, entertainment &

Includes theater operation, entertainers, commercial parks, casinos, professional athletes, sports

recreation

recreational facilities, etc. Be specific.

Food service, drinking

State type of service rendered (e.g., operation of hotel, sports camp, restaurant, full or limited service,

& accommodations

taverns or catering service). Be specific.

Corporate, subsidiary

Includes administrative, management consultant, and human resource consultants. Be specific.

managing office

Other activities

Indicate type of activity not covered by above paragraphs (e.g., agriculture, forestry, fisheries, mining,

motion picture or television production, etc.).

Privacy Notification

Personal information, including social security account number, requested on Form NYS-100, New York State Employer Registration for Unemployment

Insurance, Withholding, and Wage Reporting, is required to be provided to the Unemployment Insurance Division of the Department of Labor and the

Department of Taxation and Finance pursuant to the authority of Section 575 of the Labor Law (Unemployment Insurance Law). Part 472 of 12 NYCRR

(Unemployment Insurance Regulations), Articles 8, 22, 30, 30-A, and 30-B of the Tax Law, Article 2-E of the General City Law, and 42 USC 405(c)(2)(C)(i).

This information will be used in the administration of the Unemployment Insurance program, to process tax refunds and collect taxes, and for any other purpose

authorized by law. Failure to provide such information may subject you to civil or criminal penalties, or both under the Unemployment Insurance Law, the Tax

Law, or the Penal law. This information will be maintained by the Director of Registration and Data Services Bureau, NYS Tax Department and the

Unemployment Insurance Division, W A Harriman State Campus, Albany NY.

NYS-100 (10/02) (Page 4)