The New York LS 665 form is a crucial document used for registering Professional Employer Organizations (PEOs) in New York State. This form is essential for both initial registrations and renewals, ensuring compliance with state labor laws. By providing detailed information about ownership, business structure, and operational compliance, the LS 665 form helps maintain a transparent and accountable workforce environment.
The New York LS 665 form is an essential document for Professional Employer Organizations (PEOs) seeking registration in the state. This form facilitates both initial and renewal requests, ensuring that PEOs comply with state regulations. Applicants must provide detailed information about their business structure, ownership, and operational history. Key sections include general information about the PEO, ownership details, and specific requirements for groups of PEOs. Additionally, the form outlines submission instructions, responsibilities, and necessary attachments, such as proof of insurance and financial statements. Accurate completion of the LS 665 is crucial for legal compliance and operational legitimacy in New York.
Misconception 1: The LS 665 form is only for new Professional Employer Organizations (PEOs).
Many people believe that the LS 665 form is only necessary for new PEOs. In reality, it’s also required for existing PEOs that are renewing their registration. Whether you're starting fresh or continuing your operations, this form is essential.
Misconception 2: Only large businesses need to register as a PEO.
This is a common misunderstanding. Both small and large businesses can operate as PEOs. If a company meets the criteria set by the New York State Department of Labor, it must register, regardless of its size.
Misconception 3: The LS 665 form is a one-time requirement.
Some assume that once they submit the LS 665 form, they’re done. However, PEOs must renew their registration every year. Staying compliant means keeping track of deadlines and ensuring all documentation is up to date.
Misconception 4: The information submitted is public and easily accessible.
While some information may be public, many details, such as client lists, are kept confidential. This helps protect sensitive business information while still allowing for necessary oversight.
Misconception 5: Submitting the LS 665 form guarantees approval.
Filing the form does not automatically mean approval. The Department of Labor reviews all applications carefully, ensuring that all requirements are met before granting registration.
Misconception 6: You can submit the LS 665 form without supporting documents.
It’s crucial to include all required documents when submitting the LS 665 form. Missing paperwork can lead to delays or even denial of your application. Ensure you have everything ready before you hit send.
Misconception 7: The LS 665 form is the same for individual PEOs and PEO groups.
While both types of applicants use the LS 665 form, the information required can differ. Group applicants must provide additional details about each PEO in the group, which is not necessary for individual applicants.
Misconception 8: Once registered, PEOs have no further obligations.
Registration is just the beginning. PEOs have ongoing responsibilities, such as submitting quarterly statements and maintaining compliance with labor laws. Staying proactive is key to successful operation.
When filling out the New York LS 665 form, there are several important steps to consider. Here’s a helpful list of things you should and shouldn’t do:
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)
Page 1 of 4
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 PEOinfo.LS@labor.ny.gov 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.
Page 3 of 4
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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The New York LS 665 form is a registration request for Professional Employer Organizations (PEOs) in New York State. It is used for both initial registrations and renewals for individual PEOs and PEO groups. This form collects essential information about the organization, its ownership, and its operations in New York.
Any Professional Employer Organization that wishes to operate in New York State must complete the LS 665 form. This includes both individual PEOs and groups of PEOs that are majority owned by the same entity. Renewal applications are also required for organizations that have previously registered.
The LS 665 form requires various types of information, including:
Complete the LS 665 form and mail it to the New York State Department of Labor at the specified address: Division of Labor Standards, Permit and Certificate Unit, State Office Campus, Building 12, Room 185B, Albany, NY 12240. Ensure all required attachments are included with your submission.
For initial registrations, the LS 665 form must be submitted before operating in New York State. For renewals, the application must be submitted no later than 180 days after the end of the PEO’s fiscal year. Adhering to these deadlines is crucial to maintain compliance.
When submitting the LS 665 form, include the following attachments:
PEOs must submit a financial statement prepared by an independent CPA, demonstrating a minimum net worth of $75,000. This statement must comply with generally accepted accounting principles (GAAP) and confirm timely payment of applicable payroll taxes for New York employees.
Registered PEOs must submit quarterly statements certifying timely payment of payroll taxes and provide an updated client list. Additionally, they must inform clients about their unemployment insurance liabilities upon contract termination.
If you have questions regarding the LS 665 form, you can email PEOinfo.LS@labor.ny.gov or call (518) 457-1942 for assistance. It is advisable to seek clarification before submitting the form to ensure all requirements are met.
After gathering the necessary information, you are ready to fill out the New York LS 665 form. This process requires careful attention to detail, as accurate completion is essential for your registration as a Professional Employer Organization (PEO) in New York. Follow these steps to ensure you fill out the form correctly.
Once you submit the form and all necessary documents, the Department of Labor will review your application. Be prepared to respond to any follow-up requests or inquiries they may have. Ensure you keep copies of everything submitted for your records.
Filling out the New York LS 665 form can be a straightforward process, but many applicants make common mistakes that can lead to delays or complications. One frequent error is failing to specify the type of request correctly. Whether it’s an initial registration or a renewal, marking the right option on the first page is crucial. If this step is overlooked, it could result in the application being rejected or returned, wasting valuable time.
Another common mistake involves providing incomplete or inaccurate information in the General Information section. Applicants sometimes forget to include all additional names under which the Professional Employer Organization (PEO) conducts business. This section is essential for the Department of Labor to understand the full scope of the PEO’s operations. Omitting details here can lead to confusion and may require resubmission of the application.
Ownership information is another area where applicants trip up. Many fail to list all individuals or entities that own a five percent or greater interest in the PEO. Incomplete ownership disclosures can raise red flags during the review process. It’s important to provide thorough and accurate ownership details to avoid any potential issues down the line.
Lastly, applicants often neglect to attach necessary documentation, such as the corporate filing receipt or proof of insurance. These attachments are not optional; they are required for the application to be considered complete. Missing documents can lead to significant delays or even denial of the application. Being diligent about gathering and submitting all required paperwork can make the process smoother and more efficient.
Here are some key takeaways regarding the New York LS 665 form, which is essential for Professional Employer Organizations (PEOs) seeking registration:
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