Free UCT-7A - Florida

Application for Annual Filing
(Forthosewhoonlyemploystafffordomesticservices.)

UCT-7A R. 01/09

Nameorlegalentityname Mailingaddress Unemployment Tax Account Number City,StateZIP Telephonenumber(includeareacode)

















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I am an employer liable for unemployment tax reporting and certify to the following:
· Ionlyemployemployee(s)whoperformdomesticservicesasdefinedinsection443.1216(6),FloridaStatutes(F.S.). · Iameligibleforanearnedtaxrate(tobeeligibleforanearnedtaxratemeanstheemployerhasreportedfortherequired numberofcalendarquartersandhasbeenassignedataxrateotherthantheinitialrate).

I hereby make application to change from quarterly reporting to annual reporting, effective January 1,_____. I understand that:
· IfIemployindividualswhoperformservicesotherthandomesticservices,Inolongerqualifyforannualreportingand agreetoimmediatelynotifytheDepartmentofRevenueandunderstandmyfilingperiodwillreverttoquarterlyfiling. (Example:Asoleproprietorhasabusinessemployeeandanemployeeintheowner'shomewhoperformsdomestic services.Sincethesoleproprietoremploysindividualswhoperformservicesotherthandomesticservices,all employmentmustbereportedquarterly). · FailuretotimelyprovidewageinformationrequestedbytheAgencyforWorkforceInnovationoritsdesigneeshallresultin thelossofprivilegetofileannually,effectivethecalendarquarterimmediatelyfollowingthecalendarquarterinwhichsuch failureoccurred. · IfIamassignedan.0540rateduetoindebtednessbilledformorethanoneyear,myfilingperiodwillreverttoquarterlyfiling. · IfIdonothaveanannualpayrollasdefinedins.443.131(3)(b)1,F.S.,andbecomeineligibleforanearnedrate,myfiling periodwillreverttoquarterlyfiling. · AlthoughIwillbereportingonanannualbasis,thewagesforeachemployeemustbeitemizedbyquarterontheannual reportingform.TheannualreportisdueJanuary1andisdelinquentifnotpostmarkedbyJanuary31. · Thisapplicationmustbepostmarkedno later thanDecember1tobeeligibleforannualfilingforthenextcalendaryear. (Note:forthetransitionyear,anEmployer's Quarterly Report(UCT-6)willbedueonJanuary1forthefourthquarterofthe precedingcalendaryear.ThefirstannualreportwillthenbeduethefollowingyearonJanuary1. · IwillremaininannualreportingstatusuntilIrequestachangetoquarterlyfilingorInolongerqualifyforannualreporting. · IfIceaseemploymentandmyaccountisinactivated,Iwillimmediatelyreverttoquarterlyfillingforthecompletedquarters ofthecurrentcalendaryear.

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Thisformmustbesignedbythesoleproprietororowner,ifasoleproprietorship;byapartner,ifapartnership;orbyanauthorizedagentwho hasaPower of Attorney (DR-835)onfilewiththeDepartmentofRevenue.

Submit the completed application to: Account Management Florida Department of Revenue PO Box 6510 Tallahassee FL 32314-6510

For assistance call: 800-482-8293 Select option #2, and then select #2 again.

Internet address: www.myflorida.com/dor