Ui 1 Form – Fill Out and Use This PDF

The UI-1 Form, provided by the Mississippi Department of Employment Security (MDES), serves as a critical document for businesses to register their status. It requires detailed information about the employer, including but not limited to the Federal Employer ID Number (FEIN), type of organization, and employment details within Mississippi. For those needing to complete or update their employment status registration, clicking the button below offers a direct path to compliance and clarity.

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Ui 1 Form PDF Details

Fulfilling the requirements of the UI-1 form is a critical step for employers in Mississippi, ensuring compliance with the Mississippi Department of Employment Security (MDES). This comprehensive document serves as a crucial tool for status registration, detailing an array of employer-specific information, starting from the foundational Federal Employer ID Number (FEIN) to intricate details about the business ownership structure, whether it be a corporation, partnership, non-profit, or other. It demands information on the state of incorporation, legal domicile, and operational specifics such as the types of employment provided, including agricultural work, domestic help, and more specialized categories like professional baseball concessionaires or participation under the Indian Tribal Law. Additionally, it extends into the realm of Federal Unemployment Tax Act (FUTA) compliance across states and solicits details regarding the physical presence of businesses in Mississippi, aiming at identifying the principal business activities through the number of employees and the nature of operations at each business location. Furthermore, it explores the employer's history with the MDES and previous business engagements, if any. The form also delves into recent financial data, requiring employers to outline total wages paid and workforce size across specified periods. The UI-1 form, therefore, stands as a testament to Mississippi's dedication to an organized and lawful employment landscape, ensuring that both the employers' and employees' rights and responsibilities are clearly mapped and adhered to.

Question	Answer
Form Name	Ui 1 Form
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	ms form ui 1, form ui 1, mdes login, ui 1 status registration

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UI-1

Mississippi Department of Employment Security | M | D | E | S |

STATUS REGISTRATION

Please type or print. Always complete entire form.

MDES OFFICIAL INFORMATION

Found Date (MM/DD/CCYY):

DO NOT WRITE ABOVE THIS LINE.

EMPLOYER ENTITY INFORMATION

Federal Employer ID Number (FEIN):

Organization Type:

Corporation

Partnership

Individual

Non-Profit Corp.

Corporate LLC

Partnership LLC

Individual LLC

Other (enter type):

IF A CORPORATION: a. State of Incorporation:

b. Date of Incorporation (MM/DD/CCYY):

c. State of Legal Domicile:

4. IF INDIVIDUAL OWNER:

Do you employ any individual(s) not including yourself, your spouse or your children under 21 years of age?

YES

Legal Entity Name:

6. Business Name (D/B/A):

Have you paid employees for work performed in Mississippi?

YES

7. a. If Yes, provide the date (MM/DD/CCYY) you first

employed someone in Mississippi:

Does this business consist solely of agricultural work?

YES

Does this business employ domestic help?

YES

(This includes housekeepers, sitters, or other domestic employment)

10.

Are you applying for reimbursable status under the Indian Tribal Law?

YES

11.

Is this organization a State College, State University or State Hospital?

YES

12.

Is this business FUTA (Federal Unemployment Tax) liable in another state? YES

13.

Are you a Professional Baseball Concessionaire?

YES

14.

Do you have a Third Party that handles your payoll and/or tax matters?

YES

a. If Yes, Third Party authorized to handle matters for Unemployment Tax:

b. Agent/Officer Phone:

Name:

(

)

ext.

Title:

15.

Do you have business location(s) in Mississippi?

YES

a. If Yes, list below your places of business in Mississippi and give a description of your operations at each place of business.

City

County

Number of Employees

Principal Business Activity

16.

Are you exempt as an IRS 501 (C) (3) Non-Profit Organization?

YES

a. If Yes, attach a copy of your 501(C) (3) exemption.

EMPLOYER CONTACT DETAILS

1. Physical Address

Address:

City:

State:

Country:

ZIP Code:

Phone:

(

)

2. Unemployment Tax Mailing Address

Same as previous

Attention:

Address:

City:

State:

Country:

ZIP Code:

Phone: (

)

Contact Name (First, MI, Last):

Phone:

(

)

ext.

3. Unemployment Claims Mailing Address

Same as previous

Address:

City:

State:

Country:

ZIP Code:

Phone:

(

)

FAX: (

)

	Mississippi Department of Employment Security is an equal opportunity employer.	UI-1 R-12/2006
Web Address: www.mdes.ms.gov	Auxiliary aids and services are available upon request to individuals with disabilities.	Page 1 of 3

UI-1

STATUS REGISTRATION

Payroll Mailing Address

Same as previous

Address:

City:

State:

Country:

ZIP Code:

Phone: (

)

FAX: (

)

Officer or Resident Agent authorized to furnish payroll information:

Name:

Title:

Preferred Mode of Correspondence:

USPS

E-Mail

Telephone

FAX

Other (enter type):

Employer E-Mail Address:

BUSINESS OWNERSHIP

List the Name, Title, Social Security Number and Address of the Proprietor, Partners or Corporate Officers.

NAME (First, MI, Last)

TITLE

SSN

ADDRESS

Beginning Date of Employment in Mississippi (MM/DD/CCYY):

3. Date Acquired (MM/DD/CCYY):

Did you acquire (purchase, inherit, etc) this business?

Yes

If yes, provide details about the previous owner below.

a. Name this business was operating under (Doing Business As):

b. Federal Employer Identification Number (FEIN)

c. Previous Owner’s Current Address:

d. MDES Employer Account Number (EAN):

e. Phone:

(

)

ext.

f. Does this BUSINESS continue to operate?

Yes

Have you ever been registered with the Mississippi Department of Employment Security?

Yes

a. If Yes, provide previous MDES Employer Account Number (EAN):

b. If Yes, provide previous Federal Employer Identification Number (FEIN):

LAST CALENDAR YEAR 20____

Indicate in each space the TOTAL WAGES you paid during each calendar quarter in the Last Calendar Year.

1st Quarter

2nd Quarter

3rd Quarter

4th Quarter

Each box represents a Calendar Week. Indicate by Calendar Week the number of people working for you during each week of the Last Calendar Year.

1st

2nd

3rd

4th

5th

6th

7th

8th

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52nd

53rd

CURRENT CALENDAR YEAR 20____

Indicate in each space the TOTAL WAGES you paid during each calendar quarter in the Current Calendar Year.

1st Quarter	2nd Quarter	3rd Quarter	4th Quarter

Each box represents a Calendar Week. Indicate by Calendar Week the number of people working for you during each week of the Current Calendar Year.

1st

2nd

3rd

4th

5th

6th

7th

8th

9th

10th

11th

12th

13th

14th

	Mississippi Department of Employment Security is an equal opportunity employer.	UI-1 R-12/2006
Web Address: www.mdes.ms.gov	Auxiliary aids and services are available upon request to individuals with disabilities.	Page 2 of 3

UI-1

STATUS REGISTRATION

15th

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I hereby certify that all the information contained above is true and correct to the best of my knowledge.

Date (MM/ DD /CCYY):

Firm Name:

Signature:

Title:

	Mississippi Department of Employment Security is an equal opportunity employer.	UI-1 R-12/2006
Web Address: www.mdes.ms.gov	Auxiliary aids and services are available upon request to individuals with disabilities.	Page 3 of 3

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