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UIA Schedule A - Liability Questionnaire

Issued under authority of the Michigan Employment Security Act of 1936, as amended, MCL 421.1 et seq. Filing is mandatory for all employers. You must

complete all items on this form accurately and completely. Failure to do so may subject you to the penalties provided under the MES Act.

UIA Account Number, if already assigned

Federal Employer Identification No. (required)

An employing unit becomes liable to pay Michigan unemployment taxes when the employing unit meets any of the following criteria:

•

Pays $1,000 or more in gross wages for covered employment in a calendar year.

•

Employs one or more employees in 20 different weeks within a calendar year.

•

Acquires all or part of an existing Michigan business.

•

Pays at least $1,000 in cash, not including room and board, for domestic service within a calendar quarter.

•

Pays at least $20,000 in cash, not including room and board, for agricultural service within a calendar quarter, OR

Employs at least 10 agricultural workers in each of 20 different weeks in the current or preceding calendar year.

•

Elects coverage under the terms of the Michigan Employment Security (MES) Act.

•

Is subject to federal unemployment tax.

When any one of the above criteria is met, you must submit Form 518, Registration for Michigan Taxes, and UIA Schedule A -

Liability Questionnaire and UIA Schedule B - Successorship Questionnaire. You must also begin quarterly filing of Form UIA

1028, Employer's Quarterly W a g e / Tax Report. Unemployment taxes are due and payable beginning with the first calendar quarter

in which you had payroll. Due dates for tax and wage reports are April 25, July 25, October 25 and January 25.

Providing inaccurate or incomplete information in this Registration, or UIA Schedules A or B, will be evidence of

intentional misrepresentation and may subject you to the civil and/or criminal penalties provided in Sections 54 and

54b of the Michigan Employment Security (MES) Act.

Month

Day

Year

On what date did/will you first employ anyone in Michigan?

Complete the appropriate sections below according to the type of employer being registered.

SECTION 1

EMPLOYERS OTHER THAN AGRICULTURAL OR DOMESTIC/HOUSEHOLD

(See instructions to determine if applicable)

Month

Day

Year

If Agricultural, skip to Section 2.

If Domestic/Household,skip to Section 3.

If you have had a gross payroll of $1,000 or more within a calendar year,

enter the date it was reached or will be reached.

Month

Day

Year

If you have had 20 or more calendar weeks in which one or more persons

performed services for you within a calendar year, enter the date the 20th

week was reached or will be reached. The weeks do not have to be

consecutive nor the persons the same.

If Employer is a NonProfit, a Governmental Agency / Indian Tribe/ Tribal Unit, a Federal Unemployment Tax Act (FUTA) Subjectivity, or is

selecting Elective Coverage, then complete only one of the following four employer types below that best describes the business.

1. NONPROFIT EMPLOYERS

Nonprofit organizations finance their unemployment liability by either (1) paying unemployment taxes on the taxable wages of

their employees (contributing) or (2) making a specific prior election to reimburse the UIA for any unemployment benefits paid to

their former employees (reimbursing). A nonprofit organization that does not elect to be reimbursing will be, by default,

contributing.

To elect contributing status, check this box:

and skip paragraphs A – D below.

To elect reimbursing status, see paragraphs A – D.

A. Nonprofit employers electing reimbursing status must provide the UIA with a copy of the documentation from the Internal

Revenue Service (IRS) granting 501(c)(3) status.

Check this box if you elect to be a reimbursing employer. Attach a copy of your IRS 501(c)(3) documentation.

Failure to check this box will result in the establishment of your liability as a contributing employer.

B. If you are a nonprofit employer electing reimbursing status, enter

the amount (or estimate) of your gross annual payroll

C. Bonding Requirements.

Section 13a of the Michigan Employment Security (MES) Act requires that nonprofit

employers electing reimbursing status on or after December 21, 1989, and that have, or expect to have, a gross payroll of

more than $100,000 during any calendar year must notify the UIA of that fact immediately and must provide a surety

bond, irrevocable letter of credit, or other banking device approved by the UIA, in an amount to be determined by the

UIA to secure the employer's obligations under the MES Act. If you exceed $100,000 in gross payroll in a later year, you

are obligated to notify the UIA, and provide the bond at that time.

If your organization is funded more than 50 percent by a grant, list the source and duration of the grant.

Source

Start Date

End Date

Form 518, Michigan Business Taxes Registration Booklet - Michigan Department Of Treasury Page 9

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