The New York LS 665 form serves as a request for registration for Professional Employer Organizations (PEOs) in New York State. This essential document ensures that PEOs comply with state regulations, providing vital information about their ownership, business structure, and operational details. If you're ready to navigate the registration process, fill out the form by clicking the button below.
The New York LS 665 form is a critical document for Professional Employer Organizations (PEOs) seeking to register or renew their registration in the state. This form serves as a request for registration and is divided into several sections that gather essential information about the PEO and its ownership structure. Applicants must indicate whether they are applying for an initial registration or a renewal, either as an individual PEO or as part of a PEO group. The form requires general information such as the name and address of the PEO, the type of business organization, and the Federal Employer Identification Number (FEIN). Ownership details are also necessary, including the names and addresses of individuals or entities holding significant interests in the organization. For group applicants, additional information about each member of the group is required, including their respective FEINs and addresses. Submission instructions outline the necessary attachments, including proof of insurance, financial statements, and client lists. The LS 665 form also emphasizes the responsibilities of PEOs regarding tax compliance and client notifications upon contract termination. By completing this form, applicants affirm their commitment to adhere to New York's labor laws and regulations, ensuring transparency and accountability in their operations.
Division of Labor Standards
Permit and Certificate Unit
Harriman State Office Campus
Building 12, Room 185B
Albany, NY 12240
Professional Employer Organization
Request for Registration
A. Type of Request (check one)
Initial
Renewal for an individual Professional Employer Organization (PEO)
Renewal for a PEO Group (two or more PEOs that are majority owned by the same entity).
B. General Information (to be completed by individual and group applicants)
1a. Name of individual PEO or of parent organization (applicant) that has majority ownership of all members of the Group:
1b. Additional names, if any, under which the PEO currently conducts business:
2.Type of business organization (check one)
Corporation
Sole Proprietorship
Limited Liability Partnership
Partnership
Limited Liability Company
3.Federal Employer Identification Number (FEIN): __ __ - __ __ __ __ __ __ __
4a. Complete physical address of Principal Administrative Office:
4b. Mailing address, if different:
4c. Telephone, fax, and e-mail address of Principal Administrative Office: Telephone:
Fax: E-mail:
5a. List the current address of each additional office the individual PEO or parent organization maintains in New York. Use separate sheet of paper if necessary.
5b. Other than those in 5a., list the addresses of each office you maintained in New York during the past five years. Include any other names used and names of any predecessors and successors, if known. Use additional paper if necessary.
6. Fiscal year starts
and ends
LS 665 (06/20)
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C. Ownership Information (to be completed by individual and group applicants)
1a. If the applicant PEO is privately or closely held, list all persons or entities that own a five percent (5%) or greater interest in the individual PEO or the parent organization of the PEO group at the time of this application. Use additional paper if necessary.
Person or Entity
% Ownership
Address
1b. List all persons not listed above that have owned a five percent (5%) or greater interest in the individual PEO or the parent organization of the PEO group in the five years preceding the date of this application. Use additional paper if necessary.
2.If the applicant PEO or its parent company is a publicly traded company, list all persons or entities that own fifty percent (50%) or greater interest in the PEO or the parent company of the PEO.
D. Group Information (to be completed only by group applicants)
1a. List all the Professional Employer Organizations in the group. Include the FEIN and address for each PEO. Use additional paper if necessary.
PEO
FEIN
1b. Additional names, if any, under which the PEOs conduct business.
2a. List the addresses of each additional office each member of the group maintains in New York. Use separate sheet of paper if necessary.
2b. Other than those in 2a., list the addresses of each office maintained by each member of the group in New York during the past five years. Include any other names used and names of predecessors and successors, if known. Use additional paper if necessary.
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E. Submission Instructions (applicable to individual and group applicants)
•For any questions, email [email protected] or call (518) 457-1942.
•The initial PEO registration application must be submitted prior to operating in New York State. Renewal registration application(s) must be submitted no later than 180 days after the end of the PEO’s fiscal year.
•Make sure you have marked on the first page whether this is an initial or renewal request by an individual PEO or a PEO Group, and the Declaration and Group Guaranty, if applicable, on the next page are completed.
•With an initial request, submit a copy of the corporate filing receipt and/or authorization to do business in New York State from the New York State Secretary of State for each incorporated individual PEO, parent organization and PEO group member.
•Attach a blank client contract incorporating the requirements of Article 31 of the New York Labor Law and a sample written notice to worksite employees.
•Attach a list of all New York clients including the name, address, FEIN, type of business, name of the New York State Workers’ Compensation and Disability Insurance policyholders, and number of employees for each client. This list will be kept confidential. Attach a reviewed or audited financial statement of the PEO’s most recent fiscal year;
o The statement must have been prepared within 180 days prior to the submission by an independent certified public accountant (CPA) using generally accepted accounting principles (GAAP) and must show a minimum net worth of $75,000.
o The statement must be accompanied by a cover letter, signed by the independent CPA, certifying that (1) the statement fairly represents the financial position of the firm in accordance with GAAP and (2) there is reasonable assurance that the firm has timely paid all applicable federal and state payroll taxes on all New York employees (for example: office, worksite, etc.) for that fiscal year and explaining the basis for these certifications.
o A PEO Group may submit combined or consolidated audited or reviewed financial statements.
o Where the Group or the Group’s parent submit a combined or consolidated statement, supplemental consolidated or combined schedules covering each professional employer organization registered under the group must be included.
o If a bond or security is to be submitted in place of financial statements, email or call us for submission information.
•Attach proof of New York Workers’ Compensation and Disability Insurance:
oIf you have office and internal employees in New York, provide evidence of coverage for New York State Workers’ Compensation and
Disability Insurance by attaching copies of Form C-105.2 and DB-120.1 (Certificate of Insurance) that are available from your carrier(s).
oIf you have no office or internal employees in New York, attach Form CE-200. Information on and copies of this form are available from any District Office of the New York State Workers’ Compensation Board or from their website at www.wcb.ny.gov. Click on “WC/DB Exemptions”. Then click “Request for WC/DB Exemptions.”
•If a corporation, the request must be signed by an officer of the corporation authorized to bind the entity.
•If a partnership, proprietorship or LLC, the request must be signed by a partner, owner or member authorized to bind the entity.
•Mail the completed request with all attachments to:
New York State Department of Labor
State Office Campus
F. Responsibilities (applicable to individual and group applicants)
•Within 60 days of the end of each calendar quarter, the PEO must submit a statement, signed by an independent CPA, certifying that there
is reasonable assurance that the firm has timely paid all applicable federal and state payroll taxes on all New York employees (for example: office, worksite, etc.) for that quarter and explaining the basis for this certification.
•Within 60 days of the end of each calendar quarter, a client list must be submitted, showing all changes since the last list submitted. Include the name and address, FEIN, type of business, and name of New York State Workers’ Compensation and Disability Insurance policyholders for each new client. The list should be signed by an officer, partner, owner or member, certifying the list is complete, current and accurate.
•Upon ending a contract, the client must be advised to contact the Unemployment Insurance (UI) Division concerning its UI liability. Inquiries can be directed to Liability and Determination Section, Unemployment Insurance Division, Department of Labor, State Campus, Albany, NY 12240. The telephone number is (518) 457-2635.
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G. Declaration (to be completed by individual and group applicants)
By filing this request, the applicant authorizes the Unemployment Insurance Division to release the Unemployment Insurance records of the individual PEO, or PEO parent and each member of the group to the Division of Labor Standards.
I, the undersigned, affirm that I am an officer, partner, proprietor or member of the PEO, or the Applicant and Applicant Group, and am authorized to file this Request for Registration to operate as a PEO, or as a PEO Group, in the State of New York on its behalf or on behalf of the applicant PEO Group. I further affirm that the individual PEO, or PEO parent and each member of the group reviewed and will comply with all legal requirements of statues, in particular Article 31, the New York Professional Employer Act, and regulations of the Department of Labor. I affirm that the information in this request and all attachments is complete and accurate to the best of my knowledge.
Date
Signature of Chief Executive Officer, Partner,
Sole Proprietor or Member
Print name of above signatory
H. Group Guaranty (to be completed by each member of a PEO Group)
Each PEO that is a member of the PEO Group and is listed on this request must provide the following guaranty.
Guaranty
I, the undersigned, affirm that I am authorized to file this guaranty with the Department of Labor of the State of New York on
behalf of
[insert PEO name] (hereinafter Member Company).
Member Company is a PEO member of the
[insert name of applicant]
PEO Group and joins in the application for registration as a PEO group.
As part of this request, Member Company guarantees payment of all legal financial obligations of all other PEOs listed as members of the PEO Group in the request so long as they continue as members of the Group and under the common ownership and control of the applicant.
Date Signed
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Completing the New York LS 665 form is a crucial step for Professional Employer Organizations (PEOs) seeking registration in New York State. This process ensures that your application is thorough and meets all necessary requirements. Below are the steps to guide you through filling out the form accurately.
After submitting your application, the review process will begin. It’s essential to ensure all information is accurate and complete to avoid delays in registration. Keep an eye on any correspondence from the Department of Labor, as they may require additional information or clarification during their review.
The New York LS 665 form is a request for registration for Professional Employer Organizations (PEOs) in the state of New York. This form is essential for both individual PEOs and PEO groups seeking to operate legally within the state. It gathers crucial information about the organization, including ownership details, business structure, and compliance with state regulations. Submitting this form is a necessary step before commencing operations in New York.
Any individual Professional Employer Organization or a group of PEOs that are majority-owned by the same entity must complete the LS 665 form. This includes both initial registrations and renewals. If you plan to operate as a PEO in New York, it is vital to ensure that this form is filled out accurately and submitted on time to avoid any legal complications.
The LS 665 form requires various types of information, including:
Gathering this information beforehand can streamline the application process and help ensure compliance with state regulations.
When submitting the LS 665 form, it is important to follow specific guidelines:
Make sure to review all documents for accuracy and completeness before submission to avoid delays in processing your application.
Inaccurate Ownership Information: Many applicants fail to provide complete and accurate details regarding ownership. This includes not listing all individuals or entities that own a five percent (5%) or greater interest in the Professional Employer Organization (PEO) or its parent organization. Omitting this information can lead to delays or denials.
Incorrect Business Type Selection: Applicants often check the wrong box when indicating the type of business organization. It is crucial to select the appropriate category—be it Corporation, Sole Proprietorship, Limited Liability Company, or others. A mistake here can complicate the registration process.
Missing Required Attachments: Failing to include necessary documents is a common error. This includes not attaching proof of insurance, financial statements, or the corporate filing receipt. Each of these documents is essential for a complete application.
Improper Signatures: Applications must be signed by an authorized individual. If a corporation is applying, the signature should come from an officer. For partnerships or LLCs, it should be from a partner or member. A missing or incorrect signature can result in immediate rejection of the application.
The New York Ls 665 form is essential for Professional Employer Organizations (PEOs) seeking registration in New York. Along with this form, several other documents are commonly required to ensure compliance with state regulations. Below is a list of these documents, each with a brief description.
These documents collectively support the registration process and ensure that PEOs operate within the legal framework established by New York State. Proper preparation and submission of these materials can facilitate a smoother registration experience.
The New York LS 665 form shares similarities with the IRS Form SS-4, which is used to apply for an Employer Identification Number (EIN). Both forms require detailed information about the business structure, ownership, and contact information. Just as the LS 665 form collects data about the Professional Employer Organization (PEO) and its operations, the SS-4 form gathers information necessary for the IRS to assign a unique identifier to the business for tax purposes. Each form plays a critical role in ensuring compliance with federal and state regulations.
Another document comparable to the LS 665 is the New York State Department of State’s Application for Authority. This application is required for foreign corporations wishing to conduct business in New York. Similar to the LS 665, it necessitates disclosure of the corporation's name, address, and ownership structure. Both documents aim to ensure that businesses operating within New York are properly registered and accountable to state authorities.
The New York Workers' Compensation Board’s Form C-105.2 is also similar to the LS 665 form. This form provides proof of workers' compensation insurance coverage for employees. Like the LS 665, it requires detailed information about the business and its operations. Both forms are essential for compliance with state labor laws and protecting employees' rights in the workplace.
The Certificate of Incorporation is another document that aligns with the LS 665 form. This certificate is filed with the New York Secretary of State to officially create a corporation. Both documents require similar ownership and operational details. They serve to establish a legal entity that can operate within the state, ensuring adherence to state regulations and laws.
Lastly, the New York State Department of Labor’s Client List Submission form is akin to the LS 665 form. This form is used by PEOs to report their client relationships and must be updated regularly. Both forms emphasize transparency and accountability in business operations, ensuring that the PEO maintains accurate records of its clients and complies with state labor regulations.
When filling out the New York LS 665 form, there are several important do's and don'ts to keep in mind. Following these guidelines can help ensure that your application is processed smoothly and efficiently.
Understanding the New York LS 665 form is crucial for those looking to register as a Professional Employer Organization (PEO) in the state. However, several misconceptions can lead to confusion. Here are six common misunderstandings:
Awareness of these misconceptions can help streamline the registration process and ensure compliance with New York's labor laws. It is essential to approach the LS 665 form with a clear understanding of its requirements and implications.
When filling out the New York LS 665 form, consider the following key takeaways:
Each of these steps is crucial for a successful registration process. Make sure to double-check all information for accuracy before submission.