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SECTIONTWO–QUALIFICATIONOFTHEENTITY
Youcanonlyqualify–answeryes–toonequalificationtype(questions1–6).
1. AreyouregisteringasaFUTAexemptorganizationunder26USC3306(c)(7)
(governmentormunicipality)?
Yes No
IfNo,goto
questions2.
IfYes,selectthe IndianaStateAgency FederalGovernment LocalGovernment
typeofentity: Foreign/International OtherStateAgency INQuasi‐StateAgency
(a) Onwhatdatewasthefirstpayrollcheckissuedtoanindividualnotexcludedunder
IC22‐4‐8‐2(i)(2):
/ /
IfyouansweredYestoQuestion1,haveselectedthetypeofentity,andanswered1(a),gotosection3tocompletethe
registration.Ifyouareelectingtomakepaymentsinlieuofcontributions,youmustsubmitthisformandSF24321within
thirty‐one(31)daysofthedateindicate
don1(a
).
2. Areyo
uregisteringasaFUTAexemptorganizationunder26USC3306(c)(8)also
knownas501(c)(3)?
Yes No IfNo,goto
question3.
IfYes,areyouan: IndianaNotforProfit OtherStateNotforProfit
(a) Areyouachurchorothernon‐qualifyingexemptorganizationrequestingto
voluntarilyextendtheAct?
Yes No
IMPORTANT:Voluntaryelectionmeansthatyouarenotrequiredtopayintotheunemploymentsystem,butthatyouwould
liketopaycontributionssothatyourworkersareinsuredforunemployment.VoluntaryelectionmustbemadebyJanuary
31
st
oftheyearforwhichisiteffectiveandisbindingforaminimumoftwo(2)calendaryears.Theelectionremainsineffect
unlessterminatedinwritingaftertwo(2)calendaryearsandbyJanuary31
st
oftheyearofrevocation.CheckingYesand
signingthisformisanelectiontoextendtheActperIC22‐4‐7andIC22‐4‐9.Ifyouaremakingavoluntaryelection,please
gotosection3tocompletetheregistration.Anentityvoluntarilyelectingtoextendtheactun
derIC22
‐4‐7‐2(d)isnot
eligibletomakepaymentsinlieuofcontributionsperIC22‐4‐10‐1.
(b) Hasyour50
1(c)(3)hadfour(4)ormoreworkersintwenty(20) different
calendarweeksinthesamecalendaryear?
Yes No
IMPORTANT:Ifyouanswerednototheabove,andyouarenotvoluntarilyextendingtheAct,andyouarenotreportinga
reorganization,spin‐off,orrestructuring;youarenotcurrentlyliableunderIC22‐4‐7‐2.Pleasesubmitthisformonlyonceyou
areliable.Ifyoubecomeliableatan
ytimedu
ringacalendaryear,youareliableforallpayrollfortheentirecalendaryear.A
qualifying501(c)(3)willalwayshaveaminimumoftwo(2)quarterstoreportatthetimetheybecomeliable.Ifyouare
registeringduetoareorganization,spin‐off,orrestructuringofth
eorga
nization,pleasegotoquestion5.
(c) Pleaseprov
idethedateonwhichyoumadeyourfirstpaymenttoanyworker: / /
(d) Pleaseprovidethedateofthe20
th
calendarweekwhenyouhadfour(4) ormore
workersinthesameyear:
/ /
IfyouansweredYestoQuestion2(b),haveselectedthetypeofentity,andhaveansweredquestions2(c)and2(d)pleasegoto
section3tocompletetheregistration.Ifyouareelectingtomakepaymentsinlieuofcontribution,youmustsubmitthisform
andSF24321withinthirty‐one(3
1)daysofthedat
eindicatedon2(d).
3. Areyo
uregisteringtoreportdomesticemploymentinaprivatehome,local
collegecluborlocalchapterofacollegefraternityorsororitywithwagesof$1000
ormoreinasinglecalendarquarter?
Yes No IfNo,goto
question4.
IfYes,selecttypeofentity:HomeLLC Corporation Association
(a) Onwhatdatewasthefirstpaymentmadetoadomesticworker: / /
(b) Onwhatdatedidtotalpaymentstodomesticworkersforaquartermeet
orexceed$1000:
/ /
IfyouansweredYestoQuestion3,haveselectedthetypeofentity,andhaveansweredquestions3(a)and3(b)pleasegoto
section3tocompletetheregistration.