Fillable Unemployment Insurance Program Change Of Business Information For (New York)

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Unemployment Insurance Program Change Of Business Information For (New York)

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NYS Department of Labor
Unemployment Insurance Division
Registration Section
State Office Campus
Albany, NY 12240-0339
IA 15 (01/18)
┌ Employer Registration Number ┐
________________________________________
Employer legal name
________________________________________
Street or P.O. Box
________________________________________
City State ZIP code
________________________________________
└ ┘
New York State Department of Labor
Change of Business Information for the
Unemployment Insurance Program
To provide corrected or new information, fill out this form and
send it to the address above or fax it to (518) 485-8010.
F
or help, contact (888) 899-8810 or
www.labor.ny.gov
Your signature is required on the back of this form.
Part A – Federal Employer Identification Number
1. Enter your Federal Employer Identification Number (FEIN) if your FEIN --
• Was not previously reported
• Is incorrect
• You reported under an ID other than your FEIN
• Changed because of a change in business entity
Also complete Part B
Part B – Discontinuance of Business/ Change in Ownership/Name Changes
1. If your business or employment in NYS was permanently discontinued, provide the date this occurred:
(mmddyy)
2. Indicate if your business in NYS was sold or transferred: All Part Enter date of change:
(mmddyy)
Name of new owner:
Address of new owner:
3. If ownership*/business entity (i.e. partnership, sole proprietor, corporation, limited liability company (LLC),
limited liability partnership (LLP) has changed, give the date: (mmddyy)
* A corporate stock transfer or sale is not a change in ownership for Unemployment Insurance purposes.
Explain:
4. Name changes:
A. If your business is a corporation, LLC or LLP, you must make any legal name change with the Department of State (DOS). Contact
DOS by telephone at (518) 473-2492 or write to 41 State Street, Albany, NY 12231. DOS processes the name change and notifies us
of the change.
B. If your business is a partnership and there is a change in partners, does your partnership agreement allow for a change in partners
without dissolving the partnership?
Yes No Enter date of change:
(mmddyy)
Name of new partnership:
C. If your trade name (doing business as) changed, provide the new name:
5. If your business is a
• corporation and there is a change in corporate officers or
• partnership and there is a change in partners (including LLPs and RLLPs) or
• LLC or PLLC and there is a change in members
mark if an officer/partner/member was added (Add) or removed (Del.) in the section below.
Add Del. Name Social Security account no. Title Residence
Address corrections are on the reverse side. Sign the back of this form.
IA 15 (01/18) Page 1 of 2
Part C – Address/Telephone Information
Fill in any changes to your mailing addresses or physical location. If you want to have your UI mail sent to an address other than
your place of business, complete number 4 below.
1. Mailing Address: This is your business mailing address where your Withholding Tax (WT) and Unemployment
Insurance (UI) mail will be delivered. If you elect to have your UI mail sent to an address other than your
place of business, complete under number 4 below.
Street or PO Box: _______________________________________________________________________________
City:_______________________________________________________ State: _________ZIP Code:____________
Telephone: ( ) - ext:________________
2. Physical Address: This is the physical location of your business, if different from the Mailing Address in number 1.
Street: ________________________________________________________________________________________
City:_______________________________________________________ State: _________ZIP Code:____________
3. Location of Books/Records: This is the physical location where your Books and Records are maintained.
Street: ________________________________________________________________________________________
City:_______________________________________________________ State: _________ZIP Code:____________
Telephone: ( ) - ext:________________
Optional Addresses
4. Agent Address (C/O): Complete this if all your UI mail should be sent to an address other than your business
address.
C/O: __________________________________________________________________________________________
Street or PO Box: _______________________________________________________________________________
City:_______________________________________________________ State: _________ZIP Code:____________
Telephone: ( ) - ext:________________
5. LO 400 Form - Notice of Entitlement and Potential Charges Address: If completed, this is where the LO 400 will
be sent. (It is mailed each time a former employee files a claim for Unemployment Insurance benefits.)
C/O: __________________________________________________________________________________________
Street or PO Box: _______________________________________________________________________________
City:_______________________________________________________ State: _________ZIP Code:____________
Telephone: ( ) - ext:________________
I certify that the information on this form is true, correct, and complete to the best of my knowledge.
Signature Title
( )
Telephone number Date
IA 15 (01/18) Page 2 of 2
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Unemployment Insurance Program Change Of Business Information For (New York)

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Completed 15 July 2020

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