INFORMATION FOR COMPLETING STATUS APPLICATION
Enclosed is a Report to Determine Status/Application for Employer Number. The Tennessee Employment Security
Law and Regulations requires each employing unit in Tennessee to file this report with the Department of Labor and
Workforce Development for the purpose of determining status. If you answer “Yes” to question 6(d) or any one of the
questions in items 7, 8 or 9 on the status application, you are liable for unemployment insurance coverage with this
department. Please complete and submit the enclosed form as soon as you have paid wages for services performed in
The requirements for liability are:
REGULAR BUSINESS EMPLOYERS
Items 7 A and B on the status application do not pertain to farm or household employees.
During some part of a day in each of twenty calendar weeks of a calendar year, did you
employ or do you expect to employ one or more persons? (The weeks need not be consecutive
and both full and part-time workers are counted.)
Have you paid or do you expect to pay wages of $1,500 or more in any calendar quarter?
Did you have or do you expect to have a calendar quarter in which you paid household
employee(s) $1,000 or more in cash wages? If so, you are liable for all wages paid during
that year and the following calendar year.
During some part of a day in each of twenty weeks of a calendar year did you employ or do
you expect to employ ten or more persons? (The weeks need not be consecutive and both full
and part-time workers are counted.)
Have you paid or do you expect to pay wages of $20,000 or more in any calendar quarter?
Leave the space under Item 1 for Federal Number blank if you have not yet been assigned a FEIN (Federal Employer
Identification Number). You will receive a letter asking for this number after we establish your state account. Return the letter
with your FEIN when you receive the number from the Internal Revenue Service.
If you are completing quarterly reports and/or the Application for Transfer of Experience Rating (LB-0483), please return
them in the same envelope with this application. DO NOT write in the box titled State Account Number if you are submitting
quarterly Premium (LB-0456) and Wage (LB-0851) Reports along with this application. Your new number will be recorded
here when assigned.
Anyone who is paid for personal services by a corporation is considered to be an employee of the corporation even if that
person is an officer and/or owns stock in the corporation.
NOTE: PLEASE BE SURE TO SIGN YOUR STATUS APPLICATION at the bottom and include the appropriate information.
Also, complete both pages of your Status Application form.
Failure to complete both pages of the application or to provide sufficient information upon which to
correctly classify the industry code will result in the highest new employer rate being assigned.
LB-0441 (Revised 04-11)