Mail To:
This form can be completed online at
Cashier - Texas Workforce Commission
P.O. Box 149037
Austin, TX 78714-9037
Status Report
Farm and Ranch Employment
Identification Section
1.
Account number assigned by TWC (if any)
2.
Federal Employer ID Number
3. Type of ownership (check one)
corporation/pa/pc
limited partnership
4.
Name
partnership
estate
individual (sole proprietor/domestic)
trust
5.
Mailing address
limited liability company
other (specify)
6.
City
7.
County
8. State
8(a). Zip code
9
Phone number
(
)
10. Business address where
Address
Phone number
payroll records are kept:
(
)
(if different from above)
City
State
Zip
11. Owner(s) or officer(s)
Name
Residence address, city, state, zip
Social Security No.
Title
12. Business locations in Texas
Trade name
Street address, city, zip
Kind of business
No. of employees
13. If your business is a corporation, enter:
Filing number
State incorporated
Date incorporated
Registered agent's name
Registered agent’s address
Original corporate name, if name has changed
Farm & Ranch Employment Section
Mo
Day
Year
14. Enter the date you first employed someone to perform farm and ranch labor in Texas. (do not use future date):
15. Enter the date you first paid wages to someone performing farm and ranch labor in Texas. (do not use future date):
th
16. Enter the Saturday date of the 20
week that three or more individuals were employed in Texas performing farm or ranch labor. (All weeks
should be in the same calendar year. Count a week if anyone performed any service for any portion of any day. The services do not have to
be performed on the same day of the week, in consecutive weeks or by the same employee. If you do not reach 20 weeks of employment
in the first calendar year of operation, begin again with the second calendar year and count until you reach 20 weeks in that year.) Do not
use future dates
17. Enter the ending date of the first quarter during the calendar year in which you paid total gross wages of $6,250 or more for farm and
ranch labor. (Include wages of seasonal, migrant and any other farm and ranch labor.)
18. Enter the date you first employed migrant workers in Texas.
19. Enter the date you first employed seasonal workers in Texas to perform work on a truck farm, orchard or vineyard.
20. Are you a crew leader?
Yes
Yes
Yes
If “Yes”, do you hold a valid
If “No”, do substantially all of the
certificate of registration under
members of the crew operate
(check one)
No
No
No
the farm labor contractor act?
equipment which you provide?
(check one)
(check one)
21. Enter the year(s) your organization was liable for taxes under the Federal Unemployment Tax Act.
(begin with the most recent year.)
(year)
(year)
(year)
(year)
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