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Fill a Valid Georgia Department Of Labor Template

Name: Free Georgia Department Of Labor Form ⋆ PDF Template
Brand: Forms Georgia
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The Georgia Department of Labor Employer Status Report is a crucial document that employers must complete to provide essential information about their business operations in Georgia. This form ensures compliance with state employment laws and helps maintain accurate records for tax and unemployment insurance purposes. Timely submission of this report is vital, as it must be returned within ten days of completion.

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Fill a Valid Georgia Department Of Labor Template

Contents

The Georgia Department of Labor form, known as the Employer Status Report, plays a crucial role for businesses operating within the state. This form must be completed accurately and returned within ten days of receipt. It requires employers to provide essential information, including their business name, address, and type of organization, whether it be a corporation, partnership, or nonprofit. Employers must also disclose their Georgia Department of Labor account number, if assigned, and the physical location of their business. The form prompts employers to answer questions about their workforce, including the date they began employing workers in Georgia and whether they are liable for federal unemployment tax. Additionally, it addresses any changes in business ownership, such as mergers or acquisitions, and requires details about the previous owner if applicable. Specific sections focus on various types of employment, including private, domestic, and agricultural, ensuring that all employers report their employment status accurately. Finally, the form includes a certification statement that must be signed by an authorized individual, emphasizing the importance of truthful reporting. Completing this form is not just a regulatory requirement; it is essential for compliance with Georgia's employment security laws.

Georgia Department Of Labor 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

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

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

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

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

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

part nershi p?

Yes

HA VE EM PLOYEES?

M ade any ot her change i n t he

ownershi p of your busi ness?

Yes

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*

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

Yes*

$ 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*

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

Yes*

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*

FROM I NCOM E TA X

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

Yes*

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

required on all items. Attach additional sheets,

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

necessary.

f rom each:

B. Check the box that best

describes

the industry

that

relates

your

Principal

Service(s)

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
The	enclosed envelope requires	postage.

Download Georgia Department Of Labor

Document Breakdown

Fact Name	Details
Purpose of the Form	The Georgia Department of Labor Form is used to report employer status and employment information for businesses operating in Georgia.
Submission Deadline	Employers must return the original form within 10 days of completion to comply with state regulations.
Governing Law	This form is governed by the Georgia Employment Security Law, specifically OCGA Section 34-8-121.
Required Information	Employers must provide their business name, address, type of organization, and Georgia DOL account number if applicable.
Liability for Taxes	The form asks if the employer is liable for federal unemployment tax, which is crucial for tax compliance.
Nonprofit Organizations	Nonprofits must attach a copy of their IRS exemption letter under Section 501(c)(3) to the form.
Employment Types	Employers must indicate whether they have private, domestic, or agricultural employment, as these categories have different reporting requirements.
Penalties for Noncompliance	Failure to file this report accurately or timely may result in penalties, including fines for false statements.

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