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Form Nys 100 - New York State Employer Registration For Unemployment Insurance, Withholding, And Wage Reporting

New York State Department of Taxation

NYS 100 (5/17)

and Finance

and New York State Department of Labor

New York State Employer Registration

Unemployment Insurance Division

for Unemployment Insurance,

Registration Section

Withholding, and Wage Reporting

Harriman State Office Campus, Bldg. 12

Albany, NY 12240-0339

For office use only:

U.I. Employer Registration No.

Return completed form (type or print in ink) to the

address above, or fax to (518) 485-8010, or apply online at

Need Help? Call the Employer Hotline at (888) 899-8810

Do Not use this form to register a Nonprofit IRC 501 (c) (3), Agricultural, Governmental Employer, or Indian Tribe.

Call (888) 899-8810 to request applicable form or visit .

Part A – Employer Information

1. Type (check one):

Business (complete parts A, B, D, and E)

Household Employer of Domestic Services (complete A, C, D, and E-1)

2. Legal Entity (check one – do not complete if household employer):

Sole Proprietorship

Partnership

Corporation (includes Sub-Chapter S)

Limited Liability Company (LLC)

Limited Liability Partnership (LLP)

Other (please describe):_______________________________________

3. FEIN (Federal Employer Identification Number):

(

)

4. Phone No.:

(

)

5. Fax No.:

6. Legal Name of Business: _________________________________________________________________________

7. Trade Name (doing business as), if any: _____________________________________________________________

8. Business E-mail: ________________________________ 9. Website: _____________________________________

Part B – Liability Information

1. Enter date of first operations in New York State:

(mm/dd/yyyy)

2. Enter the date of the first payroll you withheld (or will withhold) NYS Income Tax from your employees’

pay:

(mm/dd/yyyy)

3. Do persons work for you whom you do not consider to be employees?

Yes*

*If yes, what services do they perform?

__________________________________________________________________________________________

* Refer to NYS – 100 I for instructions.

Form Nys 100 - New York State Employer Registration For Unemployment Insurance, Withholding, And Wage Reporting

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