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Kansas Department of Labor K-CNS 010 INSTRUCTIONS Page 5 of 5
Employer Status Report
K-CNS 010 (Rev. 10-21)
1. Place an X before the appropriate type of ownership of Enter your street number, the direction (N, S, NE, SW, etc.),
your business. If not listed, place an X in OTHER and the street name, any apartment or suite number, city, state
describe the ownership. and ZIP.
2a. Place an X before your type of governmental agency: 16. Enter your Kansas wages, by calendar quarter, for the
State, local (city, county, etc.) or Indian Tribe. current calendar year and the prior calendar year.
2b. Place an X in the selected finance (payment) option. 17. Enter a number from 1 through 52 which indicates the
3. Indicate if you are a 501(c)(3) organization. If YES, you number of the week during the current or prior calendar
must complete questions 3a and 3b. year in which you had sufficient employees for at least 20
a. Place an X in the finance option. weeks. For purposes of this report, each week counted
b. Place an X in the YES box if you have received must include the Saturday. The weeks do not have to be
your IRS exemption letter. If NO, explain. consecutive. For general employment, you must have one
4. Indicate if you are a Professional Employment or more employees each week; agriculture employment
Organization (Employee Lease Organization). If YES, must have 10 or more employees each week; and 501(c)
you must complete a K-CNS 015 for each client that you (3) employment is four or more employees in each week.
represent. 18. Are you operating a business that was once operated
5. Describe your major service or product in Kansas (that by someone else? Note: If you reorganized/restructured
portion producing the major income source). your business and are now reporting employees under
a. Indicate if your business is considered to be in the a different entity/FEIN, please answer YES to the above
construction industry. question.
6. Enter the first date you paid wages in Kansas. a. Enter the date when you purchased or acquired the
7. List your nine-digit Federal Employer Identification business and whether you purchased all the business or
Number (FEIN) issued by the IRS used on your 940 and what percent of the business. Enter termination date of
941 reports. prior owner.
8. Enter your legal business name (for example - ABC Inc., b. Is the prior owner operating any other business in
Kansas? If YES, explain how the previous owner
ABC, LLC, John Smith, Sole Proprietor, etc.).
continues in operation.
9. Enter your business or trade name (doing business as
c. Would you like to have the prior owner's
name, Dark Corner #1, ABC Inc. d/b/a House Restaurant,
unemployment tax rate and experience factors used
etc.).
to calculate your tax rate?
10. Enter your actual business phone number, including the
d. Enter the name of the prior owner and serial number, if known.
area code. List the main fax number and business email. e. Enter the prior business or trade name and phone.
11. Enter the business mailing address where f. Enter the prior owner's current address, if known.
correspondence from the agency is to be sent. List your 19. List each business location you have operated in
street number or PO Box, the direction (N, S, NE, SW, Kansas for the last three years. If you have more than
etc.), the street name, any apartment or suite number, city, one, list each location separately.
state and ZIP. 20. State Information Data Exchage System (SIDES) provides
12. Indicate if your Kansas location is a storefront/physical a nationally standardized format in which employers and
location, a job/construction site or an employee's Third Party Administrators (TPA) can receive and easily
residence. Tell us the Kansas location's street number, respond to Unemployment Insurance claims. Using
direction of street address (N, S, NE, SW, etc.), the street SIDES reduces phone calls, helps prevent payment to
name and apartment number or suite number, city, state those who do not meet eligiblilty requirements, eliminates
and ZIP. unnecessary appeals and streamlines UI response
13. Enter the Kansas location where your accounting processes, which reduces paperwork while saving time
records are maintained and can be examined by agency and money.
personnel. If the address information is the same 21. Indicate if you are subject to the Federal Unemployment
as entered in item #12, place an X in the checkbox. Tax Act (FUTA), for the current or prior year.
Otherwise, enter the street number, direction of street 22. Indicate if your business is continuing to pay wages in
address (N, S, NE, SW, etc.), the street name and Kansas.
apartment number or suite number, city, state and ZIP. 23. Indicate which workers you believe are not employees.
14. Indicate who is your company or in-house payroll contact Explain in detail why you consider them to be something
person. If the address information is the same as entered other than employees.
in item #12, place an X in the checkbox. Otherwise, enter 24. Indicate if you wish to elect to extend unemployment
the street number or PO Box, direction of street address insurance coverage to your workers if a determination
(N, S, NE, SW, etc.), the street name and apartment indicates that you are not required by statute to cover
number or suite number, city, state and ZIP. Also list the employees. You may also elect coverage for workers who
main company email address of the payroll contact person are not defined by the statute as employees. (Election of
and a direct phone number. coverage is for two calendar years). If YES, place an X before
15. Enter the legal names of officers, members, member/ your choice of coverage. If NO, place an X in the NO box.
managers, partners or owners of the business. Include 25. Indicate if you would like a further explanation from a KDOL
Social Security numbers for each listing and title of the staff member about any questions on this form.
person (Corp. Pres., Mem/Mgr, Mem. Gen Ptr, Owner, etc.). 26. Sign the report, providing your title and the date.
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