Employer Status Report for Unemployment Compensation (UC-1A) 

You may complete this application on-line.  After completing the application, print it, sign it and mail it.

If you do not wish to complete the application on-line, you can print it, fill it out in ink and then mail it.  If you do so, please make sure that it is legible.

Return completed form to:

State of Connecticut

Department of Labor

Employment Security Division

200 Folly Brook Blvd.

Wethersfield, CT 06109-1114

Attn: Employer Status Unit

Form UC-1A (PDF)

*Please read instructions below for assistance with completing this form.

State of Connecticut Department of Labor, Employer Status Report

Employment Security Division, Wethersfield, CT 06109-1114 Form CONN UC-1AI (Rev. 6/08)

PLEASE READ INSTRUCTIONS BEFORE COMPLETING FORM

INSTRUCTIONS

The Connecticut Unemployment Compensation law provides that the Administrator may require from  any employer, whether or not otherwise subject to the law, such reports as are necessary for the administration of the law.  All employers are required to file an Employer Status Report, Form Conn UC-1A.  Failure to receive a copy of the form does not relieve an employer of the obligation to file.  If space provided under any item is insufficient for a complete answer, attach an additional sheet of plain paper and indicate item number.

• Item 1. Enter your Federal Identification Number, found on Federal Form 941.  Enter your telephone number, include area code, and email address.

• Item 2. Enter the trade or business name under which you operate.

• Item 3. Enter the legal name of the proprietor, partners, corporate name, or LLC name if different from trade name.

• Item 4. Enter on this line the exact address to which communications are to be directed, whether the location is in Connecticut or elsewhere.

• Item 5. List the trade name and Connecticut address for each establishment located in Connecticut if different than item number 4.  Do not enter a Post Office Box number.  If you are an out-of-state employer with no permanent establishment in Connecticut, give location of present job in Connecticut or a salesperson’s home address.  Attach a separate sheet if necessary.

• Item 6a. Describe the exact nature of business in the space provided.  If business is construction, list type, for example: carpenter, road, general building, bridge, etc.  If manufacturing, list principal products and percent of total, for example: textile machinery 70%, nuts and bolts 20%, hardware 10%.  If trade, state whether wholesale or retail and products sold, for example: bakery, retail.

• Item 6b. Describe function of Connecticut facility: manufacturing, research facility, sales representative, etc.

• Item 7a. Check only one type of business organization.  If a Limited Liability Company, please indicate your filing status for Federal Income Tax purposes.

• Item 7b. If a Corporation or LLC; enter name of the State in which the entity was incorporated or organized (for LLC's), and the date of incorporation or organization (for LLC's).

• Item 8. List the name, social security number, title and home address of the owner, or all of the partners if a partnership, or the officers if a corporation.

• Item 9. Enter the date on which employer hired first employee (not pay date) in Connecticut under type of business organization checked in Item 7.  If employer is a corporation, enter the date when corporation commenced business or date when corporate officer(s) began performing services, whichever is earlier. NOTE: Officers who receive compensation are considered employees under Connecticut Unemployment Compensation Law.

• Item 10. If you acquired captioned business by purchase, merger assignment, transfer, receivership, etc. (Example: proprietor incorporating prior business), state whether you acquired all of the business or only a part of the business.  If you acquired only part, describe fully what part was acquired and which part was not and if business is owned by the same interest as the predecessor, common ownership.  Acquisition can be facilitated by a third party such as a bank or a court.  Please note that when determining whether all or part of a business has been acquired, refer only to the previous employer’s business in Connecticut.

• Item 11. If you acquired the business in whole or part show under (1) name under which previous employer did business, (2) name(s) of previous owner or partners, (3) if previous employer was subject to Connecticut Unemployment Law, answer “yes” and show employer registration number, if known, and (4) indicate if previous employer will remain in business in Connecticut.

• Item 12. Please indicate current or prior Connecticut Registration Number.

• Item 13. Were you required to file Employer’s Annual Federal Unemployment Tax Return (Treasury Form 940) for the business indicated on Item 2?  If “yes,” indicate the years.

• Item 14. You have met the liability requirements if (a) you have paid $1,500 or more in any quarter of this calendar year or (b) you had one or more employees for any part of 20 weeks in this calendar year.  If NO, you must answer questions 15 and 16.

• Item 15. If you have engaged employees and will (a) pay $1,500 or more in any quarter of this calendar year, or (b) have one or more employees for any part of 20 weeks in this calendar year, you will be subject from the first day you engaged employees.  Therefore, you will be issued a registration number later this year when the liability requirement is met, retroactive to the first date employees were engaged.  By voluntarily accepting coverage now, a registration number can be issued immediately, rather than later this year.

• Item 16. If you have engaged employees and will not (a) pay $1,500 or more in any quarter of this calendar year or (b) have one or more employees for any part of 20 weeks in this calendar year, but will next calendar year, you will be subject commencing January 1 of next year.  Therefore, you will be issued a registration number next year when the liability requirement is met, retroactive to January 1.  By voluntarily accepting coverage now, a registration number can be issued in January of next year immediately, rather than later that year.

• Item 17. Please list gross wages paid by calendar quarter.  Gross wages include but are not limited to:

  • Salaries;

  • Vacation Pay;

  • Cafeteria Plans;

  • Commissions;

  • Cash Wages;

  • Severance Pay;

  • S Corp. Profit/Dividend  Distribution;

  • Tips and Gratuities;

  • Bonuses/Prizes/Awards;

  • 401(K) Plans;

  • Drawing Accounts not required to be repaid.

• Item 18. Applies to Agricultural employers only.  For clarification contact the Employer Status Unit at (860) 263-6550.

• Item 19. Applies to Domestic employers only.

• Item 20. If at any time you have engaged any subcontractors or concessionaires to perform work in the usual course of your business, answer “yes” and explain.

• Item 21. Enter bank name, address and account number of your main checking account.

• Item 22. Enter the name, address, and phone number of outside accountant, or payroll service, if applicable.

• Item 23. Enter the total number of employees paid wages in Connecticut during the payroll period which includes the 12th day of each month of the first quarter of liability.

This report must be signed by the owner, a partner, corporate officer, or an authorized employee. All others must provide documentation of authorization (i.e., Power of Attorney).

If there are any questions regarding the status of any individuals compensated by you, or if any additional information is needed to complete the Employer Status Report (Form UC-1A), call or write the Employer Status Unit, Employment Security Division, 200 Folly Brook Boulevard, Wethersfield, CT 06109-1114 for clarification.  Telephone (860) 263-6550.  You may also contact one of our field representatives at a Field Audit Unit.  They are listed in the Blue Pages of your telephone book under the State of Connecticut, Labor Department, Unemployment Compensation.

• FORM UC-1A (PDF)