New York State Employer Registration for Unemployment … - new york state employer registration number

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Department 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
1. FEIN (Federal Employer Identification Number): -
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. 1 2 3 4
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.:
NYS-100A (02/13) page 2
11. Required Addresses
11a. Mailing Address: This is your business mailing address where your Withholding Tax (WT) and Unemployment Insurance (UI)
mail will be delivered. However, if you elect to have your UI mail directed to an address other than your place of business,
complete number 11d below.
Street or PO Box: _______________________________________________________________________________
City: ______________________________________________________ State: _________ ZIP Code: ____________
11b. Physical Address: This is the physical location of your business, if different from the mailing address in 11a.
Street: ________________________________________________________________________________________
City: ______________________________________________________ State: _________ ZIP Code: ____________
11c. Location of Books/Records: This is the physical location where your Books and Records are maintained.
Same as 11a Same as 11b Other - please complete
C/O: _________________________________________________________________________________________
Street: ________________________________________________________________________________________
City: ______________________________________________________ State: _________ ZIP Code: ____________
Additional Addresses
11d. Agent Address (C/O): Complete this if your UI mail should be sent to an address other than your business address.
C/O: __________________________________________________________________________________________
Street or PO Box: _______________________________________________________________________________
City: ______________________________________________________ State: _________ ZIP Code: ____________
Telephone: ( ) - ext :________________
11e. LO 400 form - Notice of Entitlement and Potential Charges Address: If completed, this is where the LO 400 will be directed.
It is mailed each time a former employee files a claim for Unemployment Insurance Benefits.
Same as 11d Other - please complete
C/O: _________________________________________________________________________________________
Street: ________________________________________________________________________________________
City: ______________________________________________________ State: _________ ZIP Code: ____________
12. Complete the information requested below for the owner, partners (including partners of LLP or RLLP), members (of LLC or PLLC) or
Corporate officers.
Name Social Security Number Title Residential address
NYS -100A (03/12) page 3 Enter legal name
For office use only
13. For each of your establishments in New York State, answer 13a and 13b below. Use a separate sheet for each establishment.
a. Location:
No. and street City or town County Zip code
b. Approximately how many persons do you employ there?
14. Indicate below your principle activity or farm production which produces greatest gross sales. Check applicable box:
Fruit and/or nut trees; specify type:
Vegetable farm; specify type
Field crops and/or cash grain; specify type
Livestock (dairy, poultry, beef cattle); specify type
Animal specialty (horse, dog, etc.); specify type
Other; furnish details
I affirm that I have read the above questions and that the answers provided are true to the best of my knowledge and belief.
X _________________________________________________________________________ / /
Signature of Officer, Partner, Proprietor, Member or Individual (mm/dd/yyyy)
____________________________________________________________ Phone no.: ( ) -
Official Position
General Information
If you employ individuals who do not perform agricultural work, you may also need to complete Form NYS-100, New York State Employer
Registration for Unemployment Insurance, Withholding and Wage Reporting. Phone the Liability and Determination Section of the Department of
Labor at (518) 457-2635 if additional information is needed.
Employers of agricultural workers become liable for unemployment insurance contributions:
? At the beginning of any calendar year in which they employ 10 or more farm workers on each of 20 days, each day being in a different week
during a calendar year or the preceding year, or
? At the beginning of any calendar quarter in which they pay cash remuneration of $20,000 or more to farm workers, or
? On the first day on which they pay any remuneration to farm workers in this state if the employer is subject to FUTA.
A farm labor crew leader would also become liable if he/she meets any of the conditions above and:
? He/she is not the employee of the farm operator, and
? He/she holds a valid certificate of registration under the Farm Labor Contractor Registration Act of 1963, or substantially all of his/her crew
operates or maintains mechanized equipment which he/she provides.
Agricultural work is defined in the law as all services performed:
? On a farm, in the employ of any person, in connection with cultivating the soil, or in connection with raising or harvesting any agricultural or
horticultural commodity, including the raising, shearing, feeding, caring for, training and management of livestock, bees, poultry, and fur-
bearing animals, and wildlife.
? In the employ of the owner or tenant or other operator of a farm in connection with the operation, management, conservation, improvement,
or maintenance of such farm and its tools and equipment, or in salvaging timber or clearing land of brush and other debris left by a
hurricane, if the major part of such service is performed on a farm.
? In handling, planting, drying, packing, packaging, processing, freezing, grading, storing, or delivering to storage or to market or to market or
to a carrier for transportation to market, any agricultural or horticultural commodity, but only if such service is performed in the employ of an
operator of a farm (i) as an incident to farming operations or (ii) in the case of fruits and vegetables, as an incident to the preparation of such
fruits or vegetables for market. The provisions of this paragraph shall not apply to service performed in connection with any agricultural or
horticultural commodity after its delivery to a terminal market for distribution for consumption.
The term farm includes stock, dairy poultry, fur bearing animals, fruit and truck farms, plantations, nurseries, greenhouses or similar structures,
used primarily for the raising of agricultural or horticultural commodities and orchards.


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