Form 309-6701 - Contractor Registration Application/renewal Form/form 60-0126 - Report To Determine Liability Page 7

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Report to Determine Liability
60-0126 (03-12)
Week
Jan
Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Year:
1st
2nd
Enter an "X" or enter the number
3rd
of employees for each week.
4th
5th
Week
Jan
Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Year:
1st
2nd
Enter an "X" or enter the number
3rd
of employees for each week.
4th
5th
Week
Jan
Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Year:
1st
2nd
Enter an "X" or enter the number
3rd
of employees for each week.
4th
5th
Wages Paid in Another State
Has this business been determined to be liable for unemployment insurance tax in another state?
Yes
No
If Yes, which state?
Federal Liability
Is this business required to file the Federal Unemployment Tax (FUTA) Return in either the current or preceding year?
Yes, current year
Yes, preceding year
No
Voluntary Election to Become an Employer
If your business is determined to be exempt from filing quarterly reports and paying unemployment insurance tax, do you wish to become
voluntarily subject to Iowa Unemployment Security Law?
If Yes, you must complete the Voluntary Election to Become an Employer (68-0598) form and return it
Yes
No
to Iowa Workforce Development.
Page 3 of 4

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