Free 45982.pdf - Indiana

STATUS REPORT FOR DOMESTIC (HOUSEHOLD) EMPLOYMENT
State Form 45982 (R5 / 7-05) INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT 10 N SENATE AVE., RM SE106, INDIANAPOLIS, IN 46204-2277 local: 317-232-7436 Toll Free: 1-800-891-6499 Fax: 317-233-2706

Original Report Amended Preassigned

CONFIDENTIAL RECORD Pursuant to IC 22-4-19-6, IC 4-1-6

OFFICE USE ONLY
Account Number Effective Date

Please type or print in ink.

1. Legal Name of Employing Unit
Qualified On Under Section

2. Street Address

Pymt. Method

Merit Rate Start Date

Business Code

Merit Year Rate % % % % % %

City

State
Country Code

ZIP Code

Indiana County

County Code

__ __ __ __ __ - __ __ __ __ - __ __ - __
Reviewed By

3. Federal ID Number: __ Individual Estate

__ - __ __ __ __ __ __ __
Corporation Trust Partnership Guardian Administrator Other Fiduciary (Type)

Domestic includes those services which are of a household nature in or about a private home or college fraternity. 4. On what date did you first employ individual(s) in the State of Indiana? 5. Did you pay $1,000 or more in wages to individuals employed in domestic services(s) during any calender quarter in either the current or a preceding calendar year? Yes (Quarter/Year) / No 6. Name Title Social Security Number Residence Telephone Number Name Title Social Security Number Residence Telephone Number Yes No

7. Are you an employer under Indiana Law for employees other than domestic? (if yes, enter Indiana Unemployment account number) ___ ___ ___ ___ ___ ___

I hereby certify that I have carefully examined the foregoing questions and that my answers thereto and all information contained herein are true and complete to the best of my knowledge and belief.

Prepared By

Title

Date

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Preparer / Accountant Phone Number

Employer Signature

Title

(See back of page for additional information)

Common Types of Domestic Employment

Applicable to Domestic Service in a Private Home
Service of a household nature performed by an individual in or about the private home of the person whom she/he is employed is Domestic Employment. Services most commonly performed are in-house care. However, any other household employees would also be included as domestic employment. If you pay cash wages of $1,000 or more in a calender quarter, you must establish an unemployment tax account.

NOTE: Service performed in or about a rooming house, boarding house, clubs (except local college clubs), hotels or commercial offices of establishment, are not to be considered domestic employment. Service performed as a private secretary, even though in the employer's home, is not considered Domestic Employment.

Service performed for and about club rooms, house of a local college club or local chapter of a college fraternity or sorority which she/he is employed is Domestic Employment, and an unemployment tax account must be established if $1,000 are paid in a calendar quarter. This does not include an alumni club or chapter. Service performed in administration of a trust fund or an estate for an individual is Domestic Employment, and an unemployment tax account must be established if wages paid are over $1,000 per calendar quarter. If you qualify for one quarter in a calendar year, you must report and pay taxes on ALL cash wages paid during the year. The tax rate for all new employers is 2.7% of the first $7,000 of each employees wages, per calendar year. A separate quarterly report (UC-1 & UC-5) must be filed for each quarters wages.

For further details, see IC 22-4-8-2 (m), and IC 22-4-8-3 (d).