Unemployment Insurance Form - New York
* Refer to NYS – 100 I for instructions.
Department of Taxation and Finance and
Department of Labor-Unemployment Insurance Div. Reg Sec
W A Harriman State Campus, Bldg. 12
Albany, N.Y. 12240-0339
NYS-100
(02/13)
New York State Employer Registration
for Unemployment Insurance,
Withholding, and Wage Reporting
For office use only:
U.I. Employer Registration No.
Return completed form (type or print in ink) to the
address above, or fax to (518) 485-8010, or complete
the online registration at www.labor.ny.gov
Need Help? Call 1-888-899-8810
Do Not use this form to register a Nonprofit IRC 501 (c) (3), Agricultural, Governmental Employer, or Indian Tribe.
Part A – Employer Information
1. Type (check one):
Business (complete parts A, B, D, and E)
Household Employer of Domestic Services (complete A, C, D, and E-1)
2. Legal entity (check one – do not complete if household employer):
Corporation (includes Sub-Chapter S) Limited Liability Company (LLC) Limited Liability Partnership (LLP)
Sole Proprietorship
Partnership
Other (please describe):_______________________________________
3. FEIN (Federal Employer Identification Number): -
4. Phone no.: ( ) -
5. Fax no.: ( ) -
6. Legal name of business: ____________________________________________________________________________
7. Trade name (doing business as), if any: ________________________________________________________________
8. Business e-mail: _______________________________________ 9. Website: ________________________________
Part B – Business Employer
1. Enter date of first operations in New York State:
/ /
(
mm/dd/yyyy)
2. Enter the date of the first payroll from which you withheld or will withhold NYS Income Tax from your employees’
pay:
/ /
(mm/dd/yyyy)
3. a. Indicate the first calendar quarter and enter the year you paid (or expect to pay) total remuneration of $300 or more.
(Remuneration is every form of compensation, including payments to employees or to corporate and Sub-Chapter S
officers for services.)
Jan 1 – Mar 31 (1st)
Apr 1 – Jun 30 (2nd)
Jul 1 – Sep 30 (3rd)
Oct 1 – Dec 31 (4th)
Year
b. Are you registering to remit withholding tax only?
Yes
No
4. Total number of employees:_____________________
5. Do persons work for you, whom you do not consider employees?
Yes* No
* If Yes, explain the services performed and the reason you do not consider these persons employees.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
You may apply online at www.labor.ny.gov.
Call 1-888-899-8810 to request applicable form or visit www.labor.ny.gov.
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