Form 60-0126 - Report To Determine Liability - 2006 Page 3

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INSTRUCTIONS FOR COMPLETION OF FORM 60-0126
REPORT TO DETERMINE LIABILITY
(09-06)
The enclosed form is your application for an Iowa unemployment tax account. It must be completed, signed and returned
before your account will be established and your Iowa Unemployment Account Number will be assigned. The form is also
utilized to reflect the acquisition of existing Iowa business activity.
3. DATE ORGANIZATION REGISTERED: Provide the date of incorporation for corporations or the date organized for LLCs.
Sole proprietors and partnerships do not complete this question or number 4.
4. ORGANIZATION REGISTERED IN WHAT STATE: Provide the state in which incorporated or the state in which the LLC
was organized.
7. CORPORATION / LLC NAME: Provide the full legal name of the entity.
BUSINESS OR TRADE NAME: Provide the business or trade name if different from the corporate or LLC name. Those
businesses that are sole proprietors and partnerships list their business name on this line.
8. ADDRESS FOR MAILING TAX REPORTS: Provide the mailing address where the “Employer’s Contribution and Payroll
Report” and other unemployment tax and claim related documents should be mailed. Be sure to include your zip code +4
to ensure these documents are received timely.
10. DATE YOU BEGAN EMPLOYING WORKERS IN IOWA: Provide the first date you had work performed in Iowa by your
employees.
11. LOCATION WHERE WORK IS PERFORMED IN IOWA: Provide the address of the location or locations of employment
in Iowa. This includes construction job sites and/or client locations. In those instances in which the employee(s) do not
perform duties at a particular job site but work out of their residence, enter the residence address of the employee(s). THIS
SECTION MUST BE COMPLETED IN ORDER TO ESTABLISH AN IOWA UNEMPLOYMENT ACCOUNT NUMBER.
12. NATURE OF BUSINESS ACTIVITY IN IOWA: Enter the type of employment performed by the IOWA employees. See
the next page for more detail.
13. GROSS QUARTERLY WAGES PAID IN IOWA: If you are a newly liable employer in Iowa, enter the amount of gross
wages paid in the appropriate quarter up to the date the form is being completed. If you have acquired part or all of a business
that already has an Iowa Unemployment Account Number and has been reporting wages to Iowa, go directly to questions
14-17 (no entry is required in 13).
If you have questions about completing form 60-0126 which these instructions do not answer, you may call the Field Audit Bureau of Iowa
Workforce Development in Des Moines at the numbers listed below. You may also contact a field auditor at one of the following Workforce
Development Centers nearest you:
Atlantic
712-243-5793
Marshalltown
641-752-6435
Burlington
319-753-1671 ext. 231
Mason City
641-422-1520
Carroll
712-792-2708
Newton
641-792-3004
Cedar Rapids
319-365-9474 ext. 1209, 1210, 1211
Ottumwa
641-684-5401 ext. 104, 107
Council Bluffs
712-242-2120
Spencer
712-262-1971 ext. 129
Creston
641-782-2119 ext. 35
Sioux City
712-233-9032 or 712-233-9046
Davenport
563-445-3250 or 563-445-3252
Waterloo
319-235-9864 or 319-235-9672
Des Moines
515-281-7298 or 515-281-3823 or 515-281-8217
Dubuque
563-556-5800 ext. 125, 126
Fort Dodge
515-576-0741 ext. 3, 4 or 515-576-3131 ext. 215
Out-Of-State Employers 515-281-5339
Iowa City
319-351-1035 ext. 116, 117

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