Uitl 100 – Fill Out and Use This PDF

Colorado Department of Labor and Employment, Unemployment Insurance Employer Services, P.O. Box 8789, Denver, CO 80201-8789

303-318-9100 (Denver-metro area) or 1-800-480-8299 (outside Denver-metro area)

www.colorado.gov/cdle/ui

Department Use Only

APPLICATION FOR UNEMPLOYMENT INSURANCE ACCOUNT

AND DETERMINATION OF EMPLOYER LIABILITY

Complete and mail this application to the address at the top of this page to register your business with us for unemployment insurance (UI) purposes. We will review your application and determine whether you must provide UI coverage for your employees. All items must be completed. If an item is not applicable (NA) to you or your business, enter “NA.” You can provide additional information at the bottom of page 4 of this application or attach additional sheets of paper.

1.First Date of Payroll in Colorado (Do not provide a future date. If the first date of payroll in Colorado has not occurred, do not complete this application.)

2.Provide the reason for filing this application.

Nonprofit as defined by section 501(c)(3) of the Internal Revenue Code (enclose a copy of your exemption letter from the Internal Revenue Service) Other Nonprofit

4. Basic Information—Provide the requested employer, address, and contact information.

Legal Business Name (Enter the actual name of the business registered with the Secretary of State, including suffixes such as Inc or LLC, if applicable)

Street Address of Principal Place of Business in Colorado (provide a residence address only if it is the only Colorado address; include city, state, and ZIP code)

Attach additional sheets of paper if there are additional owners, partners, or corporate officers.

Bank Name and Address (provide complete address; include city, state, and ZIP code)

UITL-100 (R 05/2011)

5.Has this business paid wages or paid other remuneration in lieu of wages such as dividends (“S” corporation only), bonuses, draws, or disbursements?

Yes No

NOTE: Wages include payments made to corporate officers performing any services in Colorado.

If Yes, provide the federal employer identification number (FEIN) if different than the FEIN provided in Item 4 or the UI account number if different than the account number provided in Item 2 if applicable.

12.Select the item that best describes the business’s activity in Colorado (check only one box) and provide specific detail below. For additional information regarding these industry descriptions, call Labor Market Information (LMI) at 303-318-8850 or contact LMI in writing at 633 17th Street, Suite 600, Denver, CO 80202. Additional information is available online at lmigateway.coworkforce.com/lmigateway.

Provide specific detail regarding the business’s activity in Colorado. If more than one service is provided, indicate which is predominant.

NOTE: If the business’s entire activity is seasonal or if it has seasonal occupations, a request for seasonal designation can be made by completing and returning Form UITL-5, Request for Seasonal Determination. To obtain this form, go to www.colorado.gov/cdle/ui, click on Forms and Publications, and then click on Employer Forms. If you have any questions regarding seasonal status, call us at one of the telephone numbers at the top of the initial page of this application.

13.Worksite Information—Provide the following information for each physical location in Colorado. Do not provide P.O. boxes, payroll, or accountant addresses. If an employee works from his or her home, you must provide the employee’s residence address. Attach additional sheets of paper for more than one physical location in Colorado.

Complete Physical Street Address of Worksite (include city, state, and ZIP code)

14.Business Acquisition—For purposes of this application, an acquisition is defined as the purchase or transfer of any or all of the assets and/or employees of a previously established business. If this business entity was acquired, in accordance with CESA 8-76-104, we must make a determination regarding the purpose of the business acquisition. If you have any questions regarding the acquisition of a business, call us at one of the telephone numbers at the top of the initial page of this application. Enclose a copy of the sales agreement and a list of the board of directors for the new business and all acquired businesses.

If Yes: Provide the date of acquisition

Check one of the boxes below to indicate the type of acquisition and complete Items 15 and 16.

Total Business Acquisition or Employee Transfer—This business acquired all of the organization, trade, or business or substantially all of the assets of at least one employer or utilizes the services of 90 percent or more of the total number of employees from another employer.

NOTE: This can include a reorganization of a current business.

Partial Business Acquisition or Employee Transfer—This business acquired some of the organization, trade, or business or assets of at least one employer or utilizes the services of less than 90 percent of the total number of employees from another employer. NOTE: This can include a reorganization of a current business.

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17.In accordance with the Colorado Employment Security Act (CESA), employers are required to provide UI coverage if one of the following conditions are met. Employers can meet these conditions through the employment of full-time, part-time, and temporary workers (including temporary agricultural workers with an H-2A visa).

NOTE: Calendar quarters are defined as January–March, April–June, July–September, and October–December.

Check the appropriate box and provide the corresponding information that is requested.

Commercial, Industrial, or Professional Organization (as defined in CESA 8-70-113)

Paid one or more workers a total of $1,500 in gross wages during any calendar quarter in the current or preceding calendar year Date on which you paid $1,500 in gross wages during a calendar quarter to meet this requirement

Employed one or more workers for some portion of a day in 20 different calendar weeks during the current or preceding calendar year (all 20 calendar weeks must occur within the same calendar year)

NOTE: The services do not have to be performed in consecutive weeks or by the same employee. Date on which you first employed a worker for some portion of a day to meet this requirement

Date on which you employed a worker for some portion of a day in the 20th calendar week to meet this requirement Agricultural Employer (as defined in CESA 8-70-120)

Paid one or more agricultural workers a total of $20,000 in gross wages during any calendar quarter in the current or preceding calendar year Date on which you paid $20,000 in gross wages during a calendar quarter to meet this requirement

Employed ten or more workers for some portion of a day in 20 different calendar weeks during the current or preceding calendar year (all 20 calendar weeks must occur within the same calendar year)

NOTE: The services do not have to be performed in consecutive weeks or by the same ten employees. Date on which you first employed ten workers for some portion of a day to meet this requirement

Date on which you employed ten workers for some portion of a day in the 20th calendar week to meet this requirement

Household/Domestic-Services Employer (as defined in CESA 8-70-121)

Paid one or more workers performing domestic services in a private home, local college club, or local chapter of a fraternity or sorority a total of $1,000 in gross wages during any calendar quarter in the current or preceding calendar year

Date on which you paid one or more workers $1,000 in gross wages during a calendar quarter to meet this requirement

Nonprofit Organization, Including Political Subdivision (exempt under section 501[c][3] of the Internal Revenue Code and as defined in CESA 8-70-118)

Political Subdivision/Government

Had four or more workers employed anywhere in the U.S. in any calendar quarter in the current calendar year or preceding calendar year NOTE: The services do not have to be performed in consecutive weeks or by the same four employees.

Date on which you first employed at least one worker in Colorado

Date on which you first employed four workers anywhere in the U.S. to meet this requirement

Date on which you employed four workers anywhere in the U.S. in the 20th calendar week to meet this requirement

Type of services provided

18. Has the owner, partner, or corporate officer of this business entity owned or operated any business in Colorado or does the owner, partner, or corporate

If Yes, provide the information requested below for each business regardless of whether it is still in operation or related to this business entity. In addition, provide the requested information for all affiliated businesses. Attach additional sheets of paper if necessary.

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19.Will the business entity file a consolidated federal tax return, including Internal Revenue Service Form 851, with any other business or entity?

Yes No

If Yes, provide the information requested below for each business or entity included in the consolidated tax return. Attach additional sheets of paper if necessary.

If Yes, provide the information requested below for all business entities. Attach additional sheets of paper if necessary.

NOTE: Attach a copy of your reorganization plan. Provide the names of all corporate officers for all entities, a statement explaining the reason for the reorganization, and any cost-benefit analysis that was completed in relation to the reorganization.

22.Please provide additional information or comments in the space provided below. If you are providing information relative to a question above, please note the question number.

Information/Comments

I certify under penalty of perjury that the above information is true, accurate, and complete to the best of my knowledge. I understand that there are severe penalties for providing false statements and willfully misrepresenting information in order to reduce UI rates.

The completion of this application is for UI purposes only. If you need to register your business in Colorado for other purposes such as establishing wage withholding, applying for a state sales tax license, or registering a trade name, complete Form CR 0100, Colorado Business Registration. The Colorado Business Registration is available at www.colorado.gov/revenue.

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