Dol 1A Form – Fill Out and Use This PDF

The DOL-1A form, commonly known as the Georgia Employer Status Report, is a document required by the Georgia Department of Labor. It is designed for businesses to report their employment status, including information on the type, nature, and structure of the organization, as well as details regarding employees and payroll. For those navigating employment reporting requirements in Georgia, properly completing and submitting this form is crucial.

To ensure compliance with Georgia's employment laws, click the button below to fill out the form accurately and submit it within the specified timeframe.

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Dol 1A Form PDF Details

Initiating a business in Georgia involves various steps, among which a significant early task is completing the Department of Labor 1A Form, commonly known as the Employer Status Report. This critical form serves multiple functions: it helps determine an employer's liability for federal unemployment tax, facilitates the assignment of a Georgia Department of Labor Account Number, and gathers specific information about the business, including but not limited to the type of organization (e.g., individual, partnership, corporation), trade name, primary business location, and the nature of the business activities. Additionally, the form addresses various employment situations, querying whether the employer has engaged in private, agricultural, domestic employment, or operates as a nonprofit organization. This comprehensive approach not only aids in classifying the business for state labor records but also in ensuring compliance with state law regarding employment and payroll. Employers are prompted to provide detailed information about their operation, including the date they began employing workers in Georgia, if and when they acquired another business, and projections on employee numbers. The nuanced details requested underscore the form's importance in establishing a new or acquired business's legal and operational framework within the state.

Question	Answer
Form Name	Dol 1A Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	SHEETOR, DOL-1, exempting, R-5

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GEORGIA DEPARTMENT OF LABOR

SUITE 850 - 148 ANDREW YOUNG INTERNATIONAL BLVD NE - ATLANTA, GA 30303-1751

EMPLOYER STATUS REPORT

READ INSTRUCTIONS ON REVERSE SIDE

BEFORE COMPLETION OF FORM

1.ENTER OR CORRECT BUSINESS NAME AND ADDRESS

RETURN ORIGINAL WITHIN 10 DAYS

GEORGIA DOL

ACCOUNT NUMBER

(If already assigned)

3. TRADE NAME

2. TYPE OF ORGANIZATION

Individual

Partnership

Corporation

Nonprofit org.

4. PRINCIPAL BUSINESS,

Street Address

Limited Liability CO. (LLC)

FARM OR

HOUSEHOLD

Other (specify)

LOCATION IN

GEORGIA

City

Zip Code

County

Telephone Number

(Do not use a

(

)

P. O. Box number)

5. DATE FIRST BEGAN

DATE OF

6. ARE YOU LIABLE

Yes

FEDERAL

EMPLOYING WORKERS

FIRST GA.

FOR FEDERAL

I.D.

WITHIN STATE OF GA.

PAYROLL

UNEMPLOYMENT TAX?

NUMBER

7. HAVE YOU...

DATE ACQUIRED

DID YOU ACQUIRE...

OR CHANGED

Acquired another business?

Yes

All of Georgia operations?

PREDECESSOR’S

Merged with another business?

Yes

GEORGIA DOL

Substantially all of Georgia operations

ACCOUNT NUMBER

(90% or more)

DOES THE FORMER OWNER

Part of Georgia operations (less than 90%)

CONTINUE TO

Formed a corporation or

Yes

HAVE EMPLOYEES?

partnership?

Yes

Made any other change in the

ownership of your business?

Yes

If yes, explain

FROM WHOM? (Organization name, including trade name)

ADDRESS

8. IF YOU HAD PRIVATE BUSINESS EMPLOYMENT:

9. IF YOU HAD DOMESTIC EMPLOYMENT:

Did you, or do you expect to employ at least one worker

Did you, or do you expect to pay cash wages

of $1,000 or more in any calendar quarter?

Yes*

in 20 different calendar weeks during a calendar year?

Yes *

* If yes, show date the 20th week first occurred:

* If yes, show date this first occurred:

10. IF YOU HAD AGRICULTURAL EMPLOYMENT:

Yes*

Did you, or do you expect to have a

Did you, or do you expect to employ 10 or more agricultural

quarterly payroll of $1,500 or more?

Yes *

workers in 20 different calendar weeks during a calendar year?

* If yes, show date this first occurred:

* If yes, show date the 20th week first occurred:

11. IF YOU ARE A NONPROFIT ORGANIZATION EXEMPT

Did you, or do you expect to have a gross cash agricultural

FROM INCOME TAX UNDER IRS CODE 501(C)(3):

Yes *

payroll of $20,000 or more in any calendar quarter?

Yes*

Did you, or do you expect to employ four or more

* If yes, show date this first occurred:

workers in 20 different calendar weeks during a

calendar year? (ATTACH COPY OF 501(C)(3) EXEMPTION LETTER)

12. HOW MANY EMPLOYEES do you have, (or anticipate

* If yes, show date the 20th week first occurred:

when in full operation)?

Name

INFORMATION

ABOUT

OWNER,

Social Security

PERSON

Number

OR FIRM

Address

ALL

WHO

PARTNERS,

MAINTAINS

Residence Address

OR PRINCIPAL

FINANCIAL

City

OFFICER

RECORDS

(ATTACH

OF BUSINESS

City

ADDITIONAL

State

Zip Code

Telephone

SHEET,OR

(

)

SHEETS, IF

State

Zip Code

CERTIFICATION: I hereby certify under penalties of perjury, that the foregoing statement and those contained

NECESSARY)

in any attached sheets signed by me are true and correct, and that I am authorized to execute this report on

behalf of the employing unit. This report must be signed by owner, partner or principal officer.

Telephone

Signature

Title

Date

( )

PLEASE COMPLETE INDUSTRY INFORMATION ON REVERSE SIDE.

DOL-1A (R-5/05)

TA489A

Dol 1A Form – Fill Out and Use This PDF

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