Form Uce-151 - Employer Status Report Page 2
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3UCE-151
(Rev. 12/2016)
Page | 2
12. Please indicate which type of federal income tax form you filed last year or will be filing for the current year:
13. List ALL owners or corporate officers (e.g., sole proprietor, general partners, corporate officers or LLC members)
Name
SSN
Title
Percentage of
Home Address
Home Phone
Ownership
SECTION 3: Employment Information
14. Have you ever paid Federal Unemployment Tax (FUTA) or filed an IRS Schedule H?
☐ Yes
☐ No
14a. If yes, for what years?
14b. In which state(s)?
14c. What was your most recent quarter filing?
Year/Quarter:
15. Enter DATE of first S.C. wages paid to employees including corporate officers:
MM /
DD / YYYY
15a. Enter amount of First
16. Have you had a
16a. If yes, indicate the first quarter
17. Have you employed at least
S.C. wages paid:
quarterly payroll of
ending date when this occurred.
one employee in any portion
$1,500 or more?
of 20 or more weeks during
☐ Yes
______ /______ /______
a calendar year?
☐
☐ No
MM /
DD / YYYY
Yes
☐
No
18. Complete this section if your business falls into one of the categories below, otherwise select: ☐ N/A
☐
Have employed at least 10 workers in S.C. or had a quarterly payroll of $20,000 or more.
Agricultural Employer:
Yr/Quarter:
☐
Have paid $1,000 or more in wages during any calendar quarter for domestic service in a private
Domestic Employer:
home, college club, fraternity or sorority.
Yr/Quarter:
☐
Business is a Professional Employer Organization (PEO)
Leasing Company:
S.C. PEO registration number:
☐
Business is a 501(c)(3) exempt organization. (You must provide IRS 501(c)(3) exemption letter.)
☐
Nonprofit Organization:
If yes, Employed four or more workers in 20 different calendar weeks.
Yr/Quarter:
☐
Federal
☐
State
☐
Governmental Entity:
Local
☐
Political Subdivision
☐
Other:
☐
Currently not subject to UI liability but wish to voluntarily elect to become an employer and elect
Voluntary Election:
coverage for my workers performing “services that do not constitute employment.” (Please see
instructions for more information on voluntarily electing coverage and exclusions.)
19. Did or will your business obtain in full or part, through an acquisition, merger or transfer, the assets, the trade or business or workforce
of another company?
☐
Yes
☐
No
19a. If yes, enter the date of the acquisition, merger or transfer: ______ /______ /______ AND you MUST complete SECTION 4.
MM /
DD / YYYY
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