Employer Status Report Form PDF Details

Employers in the US are required to file an employer status report form every quarter. The purpose of this form is to report the number of employees at your company and their corresponding wages. This information is used by the IRS to ensure that employers are paying their employees correctly and in compliance with federal wage laws. Filing this form is important, as it can help you avoid penalties and fines from the IRS. In this blog post, we will walk you through how to complete the employer status report form. Stay ahead of the curve and stay compliant by filing your form today!

QuestionAnswer
Form NameEmployer Status Report Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesgeorgia 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

 

 

 

 

 

 

GA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P. O. Box number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. DATE FIRST BEGAN

 

 

 

DATE OF

 

6. ARE YOU LIABLE

Yes

 

 

 

 

No

 

 

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

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All of Georgia operations?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PREDECESSOR’S

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Merged with another business?

Yes

No

 

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

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HAVE EMPLOYEES?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

partnership?

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Made any other change in the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ownership of your business?

Yes

No

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*

No

 

in 20 different calendar weeks during a calendar year?

 

 

 

Yes *

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* If yes, show date this first occurred:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. IF YOU HAD AGRICULTURAL EMPLOYMENT:

 

Yes*

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 *

 

 

 

No

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 *

 

 

 

No

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

 

Yes*

No

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

 

 

 

 

 

 

 

 

 

INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ABOUT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

(CONTINUED)

NATURE OF BUSINESS: Information is required on all items. Attach additional sheets, if necessary.

A. How many Georgia locations do you operate?

 

C. Enter in order of importance and indicate

 

 

 

 

 

 

Provide the following information for each location, attaching additional

 

 

approximate % of total annual income derived

 

 

 

 

 

 

sheets if necessary.

 

 

 

 

 

 

 

from each:

 

 

 

 

 

 

 

 

 

 

B. Check the box that best describes the industry that relates to your

 

 

Principal Service(s)

OR

Principal Product(s)

 

 

 

 

 

 

business activities:

 

 

 

 

 

 

 

Rendered*

Mfg.

 

Grown

Sold

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agriculture

 

 

 

 

 

 

Manufacturing

 

 

 

 

 

 

 

 

 

 

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

 

Forestry

 

 

 

 

 

 

Transportation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

 

Fishing

 

 

 

 

 

 

Communication

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* If Transportation - Trucking, indicate if interstate carrier

 

 

 

 

 

 

Mining

 

 

 

 

 

 

Public Utilities

 

 

 

 

 

 

Construction (specify):

 

 

 

 

Wholesale Trade

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

General Contractors Industrial

 

 

%

 

Retail Trade

D. If this report includes establishment(s) that only

 

 

 

 

 

 

Residential

 

% Commercial

 

 

%

 

Finance

 

 

 

 

 

 

 

 

 

 

 

perform services for other units of the company,

 

 

 

 

 

 

Speculative Building

 

 

 

 

Insurance

 

 

 

 

 

 

 

 

 

 

 

 

indicate the primary type of service or support

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Special Trade Contractor (specify plumbing,

Real Estate

 

 

 

 

 

 

 

 

provided. Check as many as apply:

 

 

 

 

 

 

 

 

 

etc.,)

 

 

 

 

 

 

 

 

Services

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

 

Central Administration

3.

Storage (warehouse)

 

 

 

Heavy Construction (specify cable, highway,

Public Administration

 

 

 

 

etc.,)

 

 

 

 

 

 

 

Private Household

2.

 

Research, development,

4.

Other: (specify)

 

 

 

 

 

 

 

 

 

 

 

 

and testing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOR ASSISTANCE, call the Industry Classification Unit, (800) 338-2082

 

 

 

 

 

 

 

 

 

IMPORTANT - This report must be filed! The law provides that all employing units shall file a report of its employment during a calendar year. For the purpose of aiding you in complying with OCGA Section 34-8-121 of the Employment Security law, this form has been prepared to assist you in furnishing the required information. Answer all questions fully and if additional space is necessary under any item, attach signed and dated sheets which bear the words Supplement to Form DOL-1.”

Each false statement or willful failure to furnish this report is punishable as a crime. Each day of such failure or refusal constitutes a separate offense.

The Georgia Employer Status Report is required of all employers having individuals performing services in Georgia regardless of number or duration of time.

The filing of this form is required at the time your business first had individuals performing service in Georgia, or when you acquired another legal entity, and may also be required again upon request.

NOTE: Disclosure of your social security number is mandatory. It will be used for the purpose of identification and it is required under the authority of 42 U.S.C. Section 405(2)(c) and OCGA Section 34-8-121(a).

INSTRUCTIONS

(NUMBERS CORRESPOND TO ITEMS ON FORM)

1.Enter or correct name and address of individual owner, partners, corporation or organization. This is the address to which you authorize us to mail all reports, correspondence, etc. If you have already been assigned a Georgia Department of Labor Account Number (Ga. DOL Acct. No) by this Department, please insert the number.

2.Indicate by check mark type of organization. If a nonprofit organization, attach copy of I.R.S. letter exempting the organization from Federal Income Tax under Section 501(c)(3)of Internal Revenue Code.

3.Trade name by which business is known if different than 1.

4.Physical location of business, farm or household in Georgia if different than 1. Please include telephone number with area code.

5.Enter the first date of employment in Georgia and the first date of Georgia payroll.

6.If you are subject to the Federal Unemployment Tax Act, and are required to file Federal Form 940, answer this question “yes”. Be sure to enter your Federal Employer Identification Number whether answered “yes” or “no”.

7.Answer this question if you acquired this business from another employer or if after you began employing workers you have acquired other busi- nesses; merged with other businesses; formed or dissolved partnerships, corporations, professional associations; or if any other change in the ownership of the business has occurred. Indicate the date of acquisition or change and provide all information concerning the previous owner’s name, trade name, address and DOL Account Number. Indicate by checking the appropriate block the portion of the previous owner’s business involved in the acquisition or change. No transfer of experience rating history can be made unless information concerning the previous owner is provided.

8.Private Business Employment - Most employment is considered private business employment. This includes all types of work except domestic service such as maids, gardeners, cooks, etc., agricultural service and service performed for governmental or nonprofit organizations.

9.Domestic employment includes all service for a person in the operation and maintenance of a private household, local college club or local chapter of a college fraternity or sorority such as chauffeurs, cooks, babysitters, gardeners, maids, butlers, private and/or social secretaries, etc. If you had such employment, consider only cash payments made to all individuals performing domestic services to determine if $1,000 or more cash wages were paid in any calendar quarter during 1977 and subsequent quarters.

10.Consider only cash payments made to all individuals performing agricultural services to determine if $20,000 or more cash wages were paid in any calendar quarter during 1977 and subsequent quarters.

11.Answer this question only if this business is a nonprofit organization exempt from Federal Income Tax under Section 501(c)(3) of the Internal Revenue Code. Attach a copy of the I.R.S. letter granting this exemption. Nonprofit organizations with tax exemptions other than under Section 501(c)(3) should answer question 8, Private Business Employment.

12.Self-explanatory.

FOR ASSISTANCE, call the Adjudication Section, (404) 232-3301.

Please RETAIN a copy for your files.

RETURN ORIGINAL WITHIN TEN (10) DAYS TO:

Georgia Department of Labor

 

 

P. O. Box 740234

The enclosed envelope requires postage.

 

Atlanta, GA 30374-0234

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Stage no. 1 for filling out georgia employer

2. When the last section is completed, you're ready to insert the required particulars in Part of Georgia operations less, Formed a corporation or partnership, Yes, DOES THE FORMER OWNER CONTINUE TO, Yes No, Made any other change in the, Yes, If yes explain, FROM WHOM Organization name, ADDRESS, IF YOU HAD PRIVATE BUSINESS, If yes show date the th week, Did you or do you expect to have a, If yes show date this first, and Yes in order to proceed further.

Filling out segment 2 in georgia employer

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.

Learn how to fill in georgia employer stage 3

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.

Writing part 4 in georgia employer

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