Form Nys-100a - New York State Employer Registration For Unemployment Insurance, Withholding, And Wage Reporting For Agricultural Employment
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4Department of Taxation and Finance and
NYS-100A (02/13)
Department of Labor-Unemployment Insurance Div. Reg. Sec
State Office Campus, Bldg. 12
New York State Employer Registration
Albany, N.Y. 12240-0339
for Unemployment Insurance,
Withholding, and Wage Reporting for
┌
┐
Agricultural Employment
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
└
┘
Need Help? Call 1-888-899-8810
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):
1. FEIN (Federal Employer Identification Number
(
)
-
(
)
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2. Phone no.:
Fax no.:
3. Check type of organization:
Individual
Partnership
Corporation
Other. Specify below
(includes Sub-Chapter S)
4. Legal name:
5. Trade name (doing business as):
6. Enter date you began business in New York State:
(mmddyy)
7. Enter the date of the first payroll from which you withheld or will withhold
NYS Income Tax from your employees’ pay:
(mmddyy)
8a. If you have paid cash remuneration of $20,000 or more in
Jan.1 –
Apr. 1 -
Jul.1 -
Oct. 1 -
Year
total during any calendar quarter (or if you expect to pay
Mar.31
Jun. 30
Sep. 30
Dec. 31
this amount during any quarter this year), check one box to
indicate the first calendar quarter and enter the year.
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2
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b. If you employed or expect to employ 10 or more persons on at least one day in each
of 20 different weeks during a calendar year enter the date such employment began:
(mmddyy)
c. If you are liable under FUTA for agricultural employment, enter the first
such year
and the date employment began in New York State during or that year.
Y Y
(mmddyy)
d. Do persons work for you whom you do not consider employees?
Yes
No
If “Yes,” explain the services performed and the reason you do not consider these persons employees:
9. If you are not liable under the Unemployment Insurance Law for agricultural
Yes
No
Employment, do you want to elect voluntary coverage?
10. Have you acquired all or part of the business of another employer liable for UI contributions?
Yes
No
If “Yes,” complete the following information:
a. Check one:
All was acquired
Part was acquired
b. Date of acquisition
(mmddyy)
c. Previous owner information:
1) Business name:
2) Business address:
3) Unemployment Insurance registration no.:
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