Fill Out a Valid Georgia Department Of Labor Template Edit Georgia Department Of Labor Here

Fill Out a Valid Georgia Department Of Labor Template

The Georgia Department of Labor form, specifically the Employer Status Report, is a mandatory document for all employers in Georgia. It collects detailed information about the business, including ownership details, type of organization, industry sector, and employment data. This comprehensive form plays a crucial role in ensuring compliance with state labor laws and in facilitating the accurate calculation of unemployment taxes.

Edit Georgia Department Of Labor Here

The Georgia Department of Labor form, integral for employers operating within the state, serves multiple purposes, from helping businesses comply with state employment laws to facilitating the smooth administration of unemployment insurance programs. Employers are instructed to provide comprehensive details, including the business name, address, organization type (such as individual, partnership, corporation, nonprofit, or LLC), and the principal location of operation within Georgia. Moreover, the form requests information on the initial employment date and payroll commencement within the state, alongside the business's liability under the Federal Unemployment Tax Act. Additional details on business transitions like acquisitions or mergers, along with specifics on diverse employment types such as agricultural, domestic, and private business employment, are crucial components. The form also caters to nonprofit organizations, demanding an attached copy of the IRS exemption letter if applicable. A meticulous accounting of the number of employees, the nature of the business, and certification by the owner or principal officer underscores the comprehensive nature of this report. This essential document not only ensures regulatory compliance but also aids in the accurate assessment of unemployment taxes and benefits, underscoring its pivotal role in Georgia's employment landscape.

Form Example

GEORGIA DEPARTM ENT OF LABOR

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

EM PLOYER STATUS REPORT

READ INSTRUCTIONS ON REVERSE SIDE

BEFORE COM PLETION OF FORM

1 . ENTER OR CORRECT BUSINESS NA M E A ND A DDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RETURN ORIGINAL W ITHIN 1 0 DAYS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GEORGIA DOL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A CCOUNT NUM BER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_

 

 

 

 

 

 

 

 

3 . T RA DE NA M E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(I f

al ready

assi gned)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. TYPE OF ORGA NI ZA TI ON

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I ndi vi dual

 

 

 

Part nershi p

 

 

Corporat i on

 

 

 

Nonprof i t org.

 

4 . PRI NCI PA L BUSI NESS,

 

St reet

A ddress

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Li mi t ed Li abi l i t y CO. (LLC)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FA RM O R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HO USEHO LD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ot her (speci f y)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO CA T I O N I N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GEO RGI A

 

Ci t y

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Zi p Code

 

 

 

Count y

 

 

 

 

Tel ephone Number

 

(Do not use a

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P. O. Box number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5 . DA T E FI RST BEGA N

 

 

 

 

DA T E O F

 

6 . A RE Y O U LI A BLE

 

 

 

 

 

FEDERA L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EM PLO Y I NG W O RKERS

 

 

 

 

FI RST GA .

 

 

FO R FEDERA L Y ES

 

NO

 

 

I . D.

 

 

 

 

_

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

W I T HI N ST A T E O F GA .

 

 

 

 

PA Y RO LL

 

 

UNEM PLO Y M ENT T A X ?

 

 

NUM BER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. HA VE YOU

 

 

 

 

 

 

 

DA T E A CQ UI RED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DI D Y O U A CQ UI RE

 

 

 

 

 

 

 

 

 

 

 

 

A cqui red anot her busi ness?

Yes

 

No

 

 

 

O R CHA NGED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A l l of Georgi a operat i ons?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PREDECESSO R' S

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M erged wi t h anot her busi ness? Yes

 

No

 

 

 

GEO RGI A DO L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Subst ant i al l y

 

al l of Georgi a operat i ons

 

 

 

 

 

 

 

 

 

 

A CCO UNT NUM BER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(90% or more)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Formed a corporat i on or

 

 

 

 

 

 

 

DOES THE FORM ER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OWNER CONTI NUE TO

 

 

 

Yes

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part of Georgi a operat i ons (l ess t han 90%)

 

part nershi p?

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HA VE EM PLOYEES?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M ade any ot her change i n t he

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ownershi p of your busi ness?

Yes

 

No

 

 

I f yes, ex pl ai n

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FROM WHOM ? (Organi zat i on name, i ncl udi ng t rade name)

A DDRESS

8. I F YOU HA D PRI VA TE BUSI NESS EM PLOYM ENT:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. I F YOU HA D DOM ESTI C EM PLOYM ENT:

 

 

 

 

 

 

 

 

 

 

Di d you, or do you ex pect t o empl oy at

l east one worker Yes*

 

 

 

No

 

 

Di d you, or do you ex pect t o pay cash wages

 

 

Yes*

 

No

 

 

 

 

 

 

 

 

of

$ 1,000 or more

i n any cal endar quart er?

 

 

 

 

 

 

i n 20

di f f erent cal endar weeks duri ng a cal endar year?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* I f

yes, show

dat e

t he 20t h week f i rst

occurred:

 

 

 

 

 

 

 

 

 

 

 

 

 

*

I f

yes, show dat e t hi s f i rst

occurred:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes*

 

 

 

 

No

 

 

 

10. I F YOU HA D A GRI CULTURA L EM PLOYM ENT:

 

 

Yes*

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Di d you, or do you ex pect t o have a

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Di d you, or do you ex pect t o empl oy 10 or more agri cul t ural

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

quart erl y payrol l

of $ 1,500 or more?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

workers i n 20 di f f erent cal endar weeks duri ng a cal endar year?

 

 

 

 

 

 

* I f

yes, show

dat e

t hi s f i rst occurred:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*

I f

yes, show dat e t he 20t h week f i rst occurred:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. I F YOU A RE A NONPROFI T ORGA NI ZA TI ON EX EM PT

 

 

 

 

 

 

 

 

 

 

 

 

 

Di d you, or do you ex pect t o have a gross cash agri cul t ural Yes*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

FROM I NCOM E TA X

UNDER I RS CODE 501(c)(3):

Yes*

 

 

 

 

No

 

 

 

 

payrol l of $ 20,000 or more i n any cal endar quart er?

 

 

 

 

 

 

Di d you, or do you ex pect t o empl oy f our or more

 

 

 

 

 

 

 

*

I f

yes, show dat e t hi s f i rst

occurred:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

workers i n 20 di f f erent cal endar weeks duri ng a

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

cal endar year?

( ATTACH COP Y OF 5 0 1 ( C) ( 3 )

 

EXEMP TI ON LETTER)

 

 

12. HOW M A NY EM PLOYEES do you have, (or ant i ci pat e

 

 

 

 

 

 

 

 

* I f

yes, show

dat e

t he 20t h week f i rst

occurred:

 

 

 

 

 

 

 

 

 

 

 

 

 

when i n f ul l

operat i on)?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I NF ORMATI ON

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I NFO RM A T I O N

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A BO UT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ABOUT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PERSO N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OWNER,

 

Soci al Securi t y

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

O R FI RM

 

A ddress

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ALL

 

Number

 

 

 

 

 

 

 

_

 

 

 

 

_

 

 

 

 

 

 

 

 

 

 

 

 

 

W HO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P ARTNERS ,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M A I NT A I NS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OR P RI NCI P AL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FI NA NCI A L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Resi dence A ddress

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ci t y

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RECO RDS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OF F I CER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

O F BUSI NESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

( ATTACH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDI TI ONAL

Ci t y

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

St at e

 

Zi p Code

 

Tel ephone

 

 

 

 

 

S HEET, OR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S HEETS ,

I F

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

NECES S ARY)

St at e

 

Zi p Code

 

 

CERTI FI CA TI ON: I

hereby cert i f y under penal t i es of perj ury, t hat t he f oregoi ng st at ement and t hose cont ai ned

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

i n any at t ached sheet s si gned by me are t rue and correct , and t hat I am aut hori zed t o ex ecut e t hi s report on

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

behal f of t he empl oyi ng uni t . Thi s report must be si gned by owner, part ner or pri nci pal of f i cer.

 

 

 

 

 

 

 

 

Tel ephone

 

 

Si gnat ure

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ti t l e

 

 

 

 

Dat e

 

 

 

 

 

 

 

 

(

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLEASE COM PLETE INDUSTRY INFORM ATION ON REVERSE SIDE.

DO L- 1 A (R- 5 / 0 1 )

T A 4 8 9 A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(CONTINUED)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NATURE OF BUSINESS: Inf ormation

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

f ollow ing

inf ormation

f or

each location,

attaching

additional

 

 

 

approximate % of total annual income derived

 

sheets

if

necessary.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

f rom each:

 

 

 

 

 

 

 

 

 

 

 

 

 

B. Check the box that best

describes

the industry

that

relates

to

your

 

 

 

Principal

Service(s)

OR

 

Principal Product(s)

 

business

activities:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rendered*

 

 

 

Mf g.

Grow n

Sold

 

 

 

 

 

 

 

 

 

Manuf acturing

 

 

 

 

 

 

 

 

 

Agriculture

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

Forestry

 

 

 

 

 

 

 

 

 

 

Transportation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

 

 

 

 

 

 

 

 

 

Communication

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fishing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%

 

 

 

 

 

 

 

 

 

 

 

 

Public

Utilities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mining

 

 

 

 

 

 

 

 

 

 

 

 

 

*

I f

Transport at i on- Trucki ng,

i ndi cat e

i f i nt erst at e carri er

 

 

 

 

 

 

 

 

 

 

 

 

 

W holesale Trade

 

 

Construction (specif y):

 

 

 

 

 

 

 

 

D. If

this report includes

establishment(s)

that

only

 

 

 

 

 

 

 

 

Retail

Trade

 

 

General

Contractors

Industrial_

_

_

%

 

 

 

 

 

perf orm

services

f or other units of

the

company,

 

 

 

Finance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

indicate

the primary type of

 

service or support

 

Residential_

_

_ % Commercial_

_

_

%

 

 

 

 

 

 

 

 

 

 

Insurance

 

 

 

 

 

 

Speculative

Building

 

 

 

 

 

 

 

 

 

 

 

 

provided.

Check

as many as apply:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Real Estate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Special

Trade

Contractor

(specif y plumbing,

 

 

 

1 .

 

Central

Administration

3 .

Storage (w arehouse)

 

 

 

Services

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

etc.,)_

_ _

_

_ _ _ _

_

_ _ _

_

_

_

_ _

 

 

 

 

2 .

 

Research,development,

4 .

Other: (specif y),

 

 

 

Public

Administration

 

 

 

Heavy Construction (specif y cable,

highw ay,

 

 

 

 

 

 

 

Private

Household

 

 

 

 

and

testing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

etc.,)_

_

_ _

_ _ _ _

_

_ _ _ _ _

_

_ _

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOR ASSISTANCE,

call

the Industry Classif ication

Unit,

(4 0 4 ) 6 5 6 - 3 1 7 7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IMPORTANT - This report must be f iled! The law provides that all employing units shall f ile a report of its employment during a calendar year. For the purpose of aiding you in complying w ith OCGA Section 3 4 - 8 - 1 2 1 of the Employment Security Law , this f orm has been prepared to assist you in f urnishing the required inf ormation. Answ er all questions f ully and if additional space is necessary under any item, attach signed and dated sheets w hich bear the w ords "Supplement to Form DOL- 1 ."

Each f alse statement or w illf ul f ailure to f urnish this report is punishable as a crime. Each day of such f ailure or ef usal constitutes a separate of f ense.

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

The f iling of this f orm is required at the time your business f irst had individuals perf orming service in Georgia, or w hen 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 f or the purpose of identif ication and it is required under the authority of 42 U.S.C. Section405(2)(c)andOCGASection 34- 8- 121(a).

IN S TRUCTIO N S

(NUMBERS CORRESPOND TO ITEMS ON FORM)

1 . Enter or correct name and address of individual ow ner, partners, corporation or organization. This is the address to w hich 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 nonprof it organization, attach copy of I.R.S. letter ex empting the organization f rom Federal Income Tax under Section 5 0 1 (c)(3 ) of Internal Revenue Code.

3 . Trade name by w hich business is know n if dif f erent than 1 .

4 . Physical location of business, f arm or household in Georgia if dif f erent than 1 . Please include telephone number w ith area code.

5 . Enter the f irst date of employment in Georgia and the f irst date of Georgia payroll.

6 . If you are subj ect to the Federal Unemployment Tax Act, and are required to f ile Federal Form 9 4 0 , answ er this question "yes". Be sure to enter your Federal Employer Identif ication Number w hether answ ered "yes" or "no".

7 . Answ er this question if you acquired this business f rom another employer or if af ter you began employing w orkers you have acquired other businesses; merged w ith other businesses; f ormed or dissolved partnerships, corporations, prof essional associations; or if any other change in the ow nership of the business has occurred. Indicate the date of acquisition or change and provide all inf ormation concerning the previous ow ner's name, trade name, address and DOL Account Number. Indicate by checking the appropriate block the portion of the previous ow ner's business involved in the acquisition or change. No transf er of ex perience rating history can be made unless inf ormation concerning the previous ow ner is provided.

8 . Private Business Employment - Most employment is considered private business employment. This includes all types of w ork ex cept domestic service such as maids, gardeners, cooks, etc., agricultural service and service perf ormed f or governmental or nonprof it organizations.

9 . Domestic employment includes all service f or a person in the operation and maintenance of a private household, local college club or local chapter of a college f raternity or sorority such as chauf f eurs, cooks, babysitters, gardeners, maids, butlers, private and/ or social secretaries, etc. If you had such employment, consider only cash payments made to all individuals perf orming domestic services to determine if $1 ,0 0 0 or more cash w ages w ere paid in any calendar quarter during 1 9 7 7 and subsequent quarters.

1 0

. Consider only cash payments made to all individuals perf orming agricultural services to determine if $2 0 ,0 0 0 or more cash w ages w ere paid in

 

any calendar quarter during 1 9 7 7 and subsequent quarters.

 

1 1

. Answ er this question only if this business is a nonprof it organization ex empt f rom Federal Income Tax under Section 5 0 1 (c)(3 ) of the Internal

 

Revenue Code. Attach a copy of the I.R.S. letter granting this ex emption. Nonprof it organizations w ith tax ex emptions other than under Section

 

5 0 1 (c)(3 ) should answ er question 8 , Private Business Employment.

 

1 2

. Self - ex planatory.

 

 

 

 

 

 

 

 

 

FOR ASSISTANCE, call the Adj udication Section, (4 0 4 ) 6 5 6 - 3 0 6 9

 

Please RETAIN a copy f or your

f iles.

RETURN ORIGINAL WITHIN TEN (10) DAYS TO:

Georgia Department of Labor

 

 

 

 

P O Box 7 4 0 2 3 4

The

enclosed envelope requires

postage.

 

Atlanta, GA 3 0 3 7 4 - 0 2 3 4

 

 

Document Details

Fact Name Detail
Form Title Employer Status Report
Form Number DOL-1A (R-5/05) TA489A
Issuing Department Georgia Department of Labor
Form Purpose To report employment status, including type of organization, trade name, business location, and employer liability for federal unemployment tax
Location 148 Andrew Young International Blvd NE, Suite 850, Atlanta, GA 30303-1751
Governing Law(s) OCGA Section 34-8-121 of the Employment Security Law, 42 U.S.C. Section 405(c)(2)(C)
Submission Requirement Required of all employers having individuals performing services in Georgia; must be returned within 10 days of receipt
Mandatory Disclosure Social Security Number required for identification purposes

Detailed Guide for Using Georgia Department Of Labor

Filling out the Georgia Department of Labor Employer Status Report requires careful attention to detail. This document is pivotal for businesses employing individuals in Georgia, as it records essential information about the employment status within the state. It's also a legal requirement for adjusting or setting up your business's account with the Georgia Department of Labor. To ensure compliance and accuracy, follow the listed steps meticulously. Starting with information about your business and moving through various employment types your business may engage with, including specific operational changes your business has undergone, this guide will help you navigate the process seamlessly.

  1. Enter or correct your business name and address at the top of the form. If you have a Georgia Department of Labor Account Number, insert it in the space provided.
  2. Select the type of organization from the options provided by checking the appropriate box. If your organization is a nonprofit, attach the I.R.S. exemption letter.
  3. Specify any trade name your business operates under if it differs from the one listed in step 1.
  4. Provide the physical location of your business in Georgia, including the telephone number with the area code, ensuring it's not a P.O. Box number.
  5. Indicate the first date you began employing workers in Georgia and the date of your first Georgia payroll.
  6. Answer whether you are liable for Federal Unemployment Tax, including your Federal Employer Identification Number regardless of your answer.
  7. If applicable, detail any business acquisitions or ownership changes, including the date of change and the previous owner's information. Specify the portion of the business affected by checking the appropriate box.
  8. For private business employment, indicate if you expect to or have employed at least one worker in 20 different weeks within a calendar year or paid $1,000 or more in any calendar quarter.
  9. If you have engaged in domestic employment, specify whether you paid cash wages of $1,000 or more in any calendar quarter.
  10. Regarding agricultural employment, state whether you expect to or have had a payroll of $1,500 or more in a quarter or employed ten or more agricultural workers in 20 different weeks within a year.
  11. If the business is a nonprofit organization exempt under IRS Code 501(c)(3), indicate whether you expect to employ four or more workers in 20 weeks within a calendar year. Attach the exemption letter from the IRS.
  12. List the number of employees currently employed or anticipated at full operation.
  13. Provide information about the owner, partners, or principal officer including their names, social security numbers, addresses, and contact details.
  14. Sign and date the form certifying the accuracy of the information provided, stating your title next to your signature.
  15. Lastly, ensure to fill out the industry information on the reverse side of the form, including details about your principal services or products.

After completing the form, retain a copy for your records and send the original to the Georgia Department of Labor using the provided address. Timely submission within the specified ten-day period is important for ensuring compliance with state labor regulations. Should you require assistance or have questions about specific items on the form, contact information for the Georgia Department of Labor is available for support.

More About Georgia Department Of Labor

  1. What is the purpose of the Georgia Department of Labor Form?

    The form, known as the Employer Status Report, gathers essential information about businesses operating within Georgia. Its purpose is to identify employers who are subject to the state's unemployment insurance laws, ensuring that these businesses contribute to the state's unemployment insurance fund. This fund provides temporary financial assistance to workers who have lost their jobs through no fault of their own.

  2. Who is required to fill out this form?

    Any business that has individuals performing services in Georgia, including corporations, partnerships, and sole proprietors, must complete this form. This requirement applies regardless of the number of workers employed or the duration of employment. Employers who have recently started a business in Georgia, acquired another entity, or undergone significant changes in ownership also need to submit this form.

  3. When should the Georgia Department of Labor Form be returned?

    The completed form must be returned to the Georgia Department of Labor within 10 days of the business starting operations in Georgia or after any significant change in ownership or structure. Timely submission of the form ensures that businesses comply with state regulations and are properly registered for unemployment insurance purposes.

  4. How do I determine if my business is liable for Federal Unemployment Tax?

    Section 6 of the form asks whether your business is subject to the Federal Unemployment Tax Act (FUTA) and requires your Federal Employer Identification Number (FEIN). You are generally liable for FUTA if you paid wages of $1,500 or more in any quarter or had one or more employees for at least part of a day in 20 different weeks in a calendar year. It’s important to accurately assess and answer this question to ensure compliance with federal and state unemployment tax laws.

  5. What information is needed from nonprofit organizations?

    Nonprofit organizations exempt under IRS Code 501(c)(3) must attach a copy of the exemption letter received from the IRS. These organizations are held to different standards regarding unemployment tax liabilities and must indicate if they expect to employ four or more workers in 20 different calendar weeks during a calendar year.

  6. Is it necessary to report the acquisition of another business?

    Yes, if you acquired another business or merged with another business, you need to provide details about the transaction in Section 7 of the form. This includes the date of acquisition or merger, any change in the business ownership, and the Georgia Department of Labor Account Number of the predecessor, if available. Accurate reporting of these transactions ensures the correct assessment of your unemployment insurance obligations.

  7. What should I do if I need help filling out the form?

    If you need assistance, the Georgia Department of Labor provides resources and support. You can call the Adjudication Section at (404) 232-3301 for help with specific questions about completing the form. Additionally, the instructions on the reverse side of the form offer guidance for each section, making it easier to understand the requirements and provide the necessary information.

Common mistakes

When filling out the Georgia Department of Labor form, people often make a range of mistakes. Below are seven common errors to watch out for:

  1. Not entering or correcting the business name and address accurately. This is critical as it is the primary method of contact and identification for your business.
  2. Failing to indicate the type of organization correctly (Individual, Partnership, Corporation, Nonprofit Organization, LLC, etc.). This affects how your business is classified and the regulations that apply.
  3. Omitting the trade name if it differs from the business name. The trade name is how your business is known to the public, and it's important for the Department of Labor's records.
  4. Using a P.O. Box number instead of the physical location of the business in Georgia. The form specifically requests a street address, city, zip code, and county.
  5. Incorrectly answering federal unemployment tax liability questions. Understanding whether you are liable for federal unemployment tax is crucial for compliance.
  6. Not providing complete information about any business acquisition, merger, or ownership change. This information is necessary for the accurate transfer of experience rating histories and other purposes.
  7. Forgetting to sign the form or include the date and title. This certification is necessary under penalties of perjury and validates the authenticity and accuracy of the information provided.

In addition to these specific mistakes, people often overlook the importance of:

  • Attaching necessary documentation, such as the IRS exemption letter for nonprofit organizations under Section 501(c)(3).
  • Accurately counting the number of employees to ensure correct reporting. This impacts the determination of liability and compliance with employment laws.
  • Completing the industry information on the reverse side in detail, which helps in the proper classification of your business activities.

Making sure to avoid these mistakes can streamline the process of dealing with the Georgia Department of Labor and ensure compliance with state employment regulations.

Documents used along the form

Completing the Georgia Department of Labor form is a significant step for employers, but it's often just one part of the documentation and compliance requirements for operating a business in Georgia. The following list encapsulates additional forms and documents commonly used alongside the Georgia Department of Labor form, aiming to provide a comprehensive overview for employers to ensure full compliance and smooth operations.

  • IRS Form W-4: Used to determine the amount of federal income tax to withhold from an employee's paycheck. It is completed by the employee and provided to their employer.
  • IRS Form W-9: Request for Taxpayer Identification Number and Certification, often used when hiring independent contractors, to collect their tax information for reporting purposes.
  • IRS Form 940: Employers use this form to report annual Federal Unemployment Tax Act (FUT and typically accompanies state-level unemployment documents like the Georgia Department of Labor form.
  • IRS Form 941: Used by employers to report quarterly federal tax returns, including withheld income tax, social security, and Medicare taxes.
  • Employee's Withholding Certificate for Local Taxes: Similar to the IRS Form W-4, but for local (city or county) tax withholdings, if applicable in certain areas of Georgia.
  • Georgia New Hire Reporting Form: Mandated by federal and state law, employers must report new hires to a state directory, aiding in the enforcement of child support orders.
  • Notice to Employer of Injury: Used by employees to formally notify their employer of a work-related injury, initiating a claim for workers' compensation.
  • Employee Handbook Acknowledgment Form: A document where employees acknowledge receiving and understanding the company’s employee handbook.
  • Job Application Forms: Used to collect information from applicants. It's crucial for compliance to ensure these forms do not ask discriminatory questions.
  • Employee Eligibility Verification (I-9 Form): Required by the Department of Homeland Security to verify the identity and employment authorization of individuals hired for employment in the United States.

Each document plays a pivotal role in the myriad processes of hiring, payroll, tax compliance, and regulatory adherence for Georgia employers. It's essential for employers to familiarize themselves with these forms and documents to guarantee they meet all legal obligations and provide a structured, compliant workplace for their employees. While managing these documents can seem daunting, maintaining organized records and staying informed about changing regulations will significantly streamline the administrative side of managing a workforce.

Similar forms

The Georgia Department of Labor form is similar to the IRS Form SS-4, Application for Employer Identification Number (EIN). Both documents require detailed information about the business, including the legal name, address, and type of entity (such as an individual, partnership, corporation, or nonprofit organization). They also inquire about the principal activity of the business, whether agricultural, manufacturing, service-oriented, etc. Each form is designed to register the business with the respective federal or state agency for identification and tax purposes. Additionally, both forms ask for the taxpayer identification number or EIN if previously assigned, emphasizing their role in the broader financial and regulatory ecosystems businesses must navigate.

Another document similar to the Georgia Department of Labor form is the U.S. Department of Labor's Form 940, Employer's Annual Federal Unemployment (FUTA) Tax Return. This similarity lies in the requirement for businesses to report their employment practices. While the Georgia form is focused on establishing an employer's account for state unemployment insurance purposes, including determining liability and reporting employees and payroll within the state, Form 940 is concerned with the employer's federal unemployment tax obligations. Both forms are integral to ensuring compliance with respective unemployment insurance systems and require employers to provide detailed employment information, such as the number of employees, payroll expenses, and any significant changes to the business structure that would affect their tax and insurance responsibilities.

Dos and Don'ts

Filling out the Georgia Department of Labor form is crucial for employers, ensuring compliance with state laws and regulations regarding employment. Here are key dos and don'ts to keep in mind while completing this paperwork.

  • Do read the instructions on the reverse side of the form carefully before starting to fill out the form. Understanding each section thoroughly will prevent mistakes and ensure that the form is completed correctly.
  • Don't leave any required fields blank. If a section does not apply to your situation, indicate this with a "N/A" for "Not Applicable" instead of leaving the space empty.
  • Do use the official business name and address when entering or correcting this information. The address you provide will be used for all communications, so it should be accurate and up to date.
  • Don't use a P.O. Box number for the principal business location in Georgia. A physical street address is required to validate the location of your business operations within the state.
  • Do attach a copy of the IRS letter exempting your organization from Federal Income Tax under Section 501(c)(3), if applicable. This document is essential for nonprofit organizations to confirm their tax-exempt status.
  • Don't forget to provide detailed information about the nature of your business, including the principal services or products rendered. This information helps classify your business correctly for industry purposes.
  • Do accurately report the number of employees and anticipate employment numbers when in full operation. This information is critical for assessing your obligations under various employment and labor laws.
  • Don't hesitate to call for assistance if you have questions or need clarification while filling out the form. Utilizing the provided contact information can prevent errors and ensure compliance.
  • Do retain a copy of the completed form for your records. Having a copy on file can be helpful for future reference and in case of any disputes or inquiries from the Department of Labor.

Following these guidelines will help ensure that the Georgia Department of Labor form is filled out correctly and efficiently, thus fulfilling your obligations as an employer within the state.

Misconceptions

Many people have misconceptions about the Georgia Department of Labor (GDOL) form, often leading to confusion or errors when completing it. Here are four common misconceptions explained to help clarify the process.

  • Only businesses with employees need to file. This is a misconception because every business that begins performing services in Georgia, whether it has employees or not at the start, must file the Georgia Employer Status Report. This includes individual proprietors, partnerships, corporations, and non-profit organizations.
  • Non-profit organizations do not need to file if they don’t pay taxes. Even if a non-profit organization is exempt from federal income tax under IRS code 501(c)(3), it is still required to file the report with the GDOL. Exemption from income tax does not exempt an organization from reporting employment within Georgia.
  • The form is only for reporting employment of permanent workers. This misconception could lead to non-compliance with state labor laws. The form is actually designed to report any individual performing services in Georgia, encompassing a range of employment types, including agricultural, domestic, and part-time employment.
  • Filing the form once is enough. While many businesses may only need to file the form once, certain changes in business structure, such as merging with another business, acquiring another company, or significant changes in the ownership structure, require the form to be updated and re-filed. It’s important to understand that compliance is an ongoing process, not a one-time event.

Understanding these nuances can greatly assist employers in maintaining compliance with Georgia's employment laws. It’s always advisable to seek guidance directly from the Georgia Department of Labor or a legal professional with expertise in employment law to ensure accuracy and compliance.

Key takeaways

When dealing with the Georgia Department of Labor Employer Status Report, understanding the detailed instructions and providing accurate information is critical. Here are key takeaways to guide you through the process:

  • Accurate business information is essential. Ensure the business name, address, and, if applicable, the Georgia Department of Labor Account Number are correctly entered. This data helps identify your organization within the state labor system.
  • Define your organization type clearly. Mark the appropriate box that describes your organization (e.g., Individual, Partnership, Corporation, Nonprofit Organization, LLC, etc.). If your organization is a nonprofit, remember to attach a copy of the IRS exemption letter.
  • Employment specifics are crucial. Specify the nature of your employment activities, such as private business, agricultural, domestic, or nonprofit organization employment, to determine your liabilities and obligations under the state labor laws.
  • Reporting changes in business ownership or structure. If your business undergoes any changes in ownership, acquisitions, mergers, or any significant restructuring, disclose these details. This includes the date of change and information about the previous owner.
  • Compliance with deadlines is necessary. The completed form and any necessary attachments should be returned within ten days to ensure compliance and avoid penalties. This timely submission helps maintain accurate employment records and ensures your business meets state regulations.

By paying close attention to these areas, employers can navigate the completion and submission of the Georgia Department of Labor Employer Status Report more effectively. This ensures not only compliance with state laws but also the accurate administration of employment records.

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