Employer Status Report Form – Fill Out and Use This PDF

The Employer Status Report form, issued by the Georgia Department of Labor, is a critical document for all employers operating within the state of Georgia. It captures essential data relating to the employment and organizational structure, including the type of organization, the principal business location within Georgia, and information concerning employees and payroll. This form is mandatory for any entity that has individuals performing services in Georgia and is pivotal for accurately determining federal unemployment tax liabilities. To ensure compliance and proper handling of your business's employment obligations, click the button below to fill out the Employer Status Report form.

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Employer Status Report Form PDF Details

Understanding the nuances of the Employer Status Report form is crucial for businesses operating within Georgia. This form, issued by the Georgia Department of Labor, serves multiple purposes including the establishment of an employer's account with the department, determination of liability for state unemployment insurance taxes, and ensuring compliance with federal and state employment regulations. Employers are mandated to complete this form upon either employing individuals in Georgia for the first time, acquiring another business, or when significant changes in ownership occur. The form encompasses various sections requiring detailed information about the business such as its legal name and address, type of organization (e.g., individual, partnership, corporation, nonprofit organization), principal business location in Georgia, federal employer identification number, and specifics regarding the types and dates of employment. It further delves into specifics regarding private, agricultural, and domestic employment, along with a particular emphasis on nonprofit organizations exempt under the IRS Code 501(c)(3). Filing this form is not just a bureaucratic step but a compliance necessity, with specific penalties for willful failure or refusal to submit the required information. The detailed instructions on the reverse side of the form assist employers in providing accurate information, helping avoid potential legal and financial repercussions.

Question	Answer
Form Name	Employer Status Report Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	georgia status report, how to claim unemployment in georgia, dol 1a, ga dol 1n

Form Preview Example

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

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3. Through this stage, look at INFORMATION ABOUT OWNER ALL, City, State, Zip Code, Telephone, INFORMATION ABOUT PERSON OR FIRM, City, State, Zip Code, Telephone, CERTIFICATION I hereby certify, Signature, Title, Date, and PLEASE COMPLETE INDUSTRY. These are required to be taken care of with utmost precision.

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4. All set to fill in the next portion! Here you have these Provide the following information, B Check the box that best, business activities, Agriculture Forestry Fishing, Manufacturing Transportation, Principal Services Rendered, Principal Products Mfg, Grown, Sold, If Transportation Trucking, D If this report includes, Central Administration Research, Storage warehouse Other specify, FOR ASSISTANCE call the Industry, and IMPORTANT This report must be form blanks to fill out.

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Employer Status Report Form – Fill Out and Use This PDF

Employer Status Report Form PDF Details

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