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SECTION TWO – QUALIFICATION OF THE ENTITY
You can only qualify – answer yes – to one qualification type (questions 1 – 6).
1. Are you registering as a FUTA exempt organization under 26 USC 3306(c)(7) Yes No If No, go to
(government or municipality)? questions 2.
If Yes, select the Indiana State Agency Federal Government Local Government
type of entity: Foreign/ International Other State Agency IN Quasi State‐ Agency
(a) On what date was the first payroll check issued to an individual not excluded under / /
IC 22 4‐ ‐ ‐ 8 2(i)(2):
If you answered Yes to Question 1, have selected the type of entity, and answered 1(a), go to section 3 to complete the
registration. If you are electing to make payments in lieu of contributions, you must submit this form and SF 24321 within
thirty one‐ (31) days of the date indicated on 1(a).
2. Are you registering as a FUTA exempt organization under 26 USC 3306(c)(8) also Yes No If No, go to
known as 501(c)(3)? question 3.
If Yes, are you an: Indiana Not for Profit Other State Not for Profit
(a) Are you a church or other non qualifying‐ exempt organization requesting to Yes No
voluntarily extend the Act?
IMPORTANT: Voluntary election means that you are not required to pay into the unemployment system, but that you would
like to pay contributions so that your workers are insured for unemployment. Voluntary election must be made by January
st
31 of the year for which is it effective and is binding for a minimum of two (2) calendar years. The election remains in effect
st
unless terminated in writing after two (2) calendar years and by January 31 of the year of revocation. Checking Yes and
signing this form is an election to extend the Act per IC 22 4 7 and IC‐ ‐ 22 4 9. If you are‐ ‐ making a voluntary election, please
go to section 3 to complete the registration. An entity voluntarily electing to extend the act under IC 22 4 7 2(d) is‐ ‐ ‐ not
eligible to make payments in lieu of contributions per IC 22 4 10 1.‐ ‐ ‐
(b) Has your 501(c)(3) had four (4) or more workers in twenty (20) different Yes No
calendar weeks in the same calendar year?
IMPORTANT: If you answered no to the above, and you are not voluntarily extending the Act, and you are not reporting a
reorganization, spin off,‐ or restructuring; you are not currently liable under IC 22 4 7 2. Please‐ ‐ ‐ submit this form only once you
are liable. If you become liable at any time during a calendar year, you are liable for all payroll for the entire calendar year. A
qualifying 501(c)(3) will always have a minimum of two (2) quarters to report at the time they become liable. If you are
registering due to a reorganization, spin off,‐ or restructuring of the organization, please go to question 5.
(c) Please provide the date on which you made your first payment to any worker: / /
th
(d) Please provide the date of the 20 calendar week when you had four (4) or more / /
workers in the same year:
If you answered Yes to Question 2(b), have selected the type of entity, and have answered questions 2(c) and 2(d) please go to
section 3 to complete the registration. If you are electing to make payments in lieu of contribution, you must submit this form
and SF 24321 within thirty one‐ (31) days of the date indicated on 2(d).
3. Are you registering to report domestic employment in a private home, local Yes No If No, go to
college club or local chapter of a college fraternity or sorority with wages of $1000 question 4.
or more in a single calendar quarter?
If Yes, select type of entity: Home LLC Corporation Association
(a) On what date was the first payment made to a domestic worker: / /
(b) On what date did total payments to domestic workers for a quarter meet / /
or exceed $1000:
If you answered Yes to Question 3, have selected the type of entity, and have answered questions 3(a) and 3(b) please go to
section 3 to complete the registration.
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