The New York LS 665 form is a critical document for Professional Employer Organizations (PEOs) operating within New York State, serving as a Request for Registration. It delineates requirements for both initial registration and renewal processes for individual PEOs or PEO Groups, which are entities majority-owned by the same parent organization. Essential for compliance, this form encompasses a myriad of details including general information, ownership, group specifics, submission instructions, and responsibilities toward maintaining registration status.
Navigating the obligations and procedural steps for registering a Professional Employer Organization (PEO) in New York involves understanding the complexities of the LS 665 form, a mandatory document issued by the New York State Department of Labor's Division of Labor Standards Permit and Certificate Unit. This form serves as a foundation for both individual PEOs and PEO groups—those majority-owned by a single entity—requiring initial registration or renewal within the state. It meticulously gathers details about the organization's general and ownership information, including the name, business type, federal employer identification number, and physical and mailing addresses. Moreover, it demands comprehensive disclosure of all entities with significant ownership and a thorough history of the organization's presence and operations within New York. Affirmation of compliance with the New York Professional Employer Act, alongside submission of financial statements vetted by an independent certified public accountant to demonstrate a minimum net worth, underscores the form's role in ensuring PEOs operate responsibly. Additionally, it mandates adherence to New York Workers’ Compensation and Disability Insurance regulations, reinforcing the state's commitment to worker protection. With submission instructions and responsibilities outlined, the LS 665 form ultimately facilitates the formal acknowledgment of PEOs, allowing them to contribute effectively to New York's labor market under strict regulatory compliance.
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 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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Filling out the New York LS 665 form is a critical step for professional employer organizations (PEOs) looking to operate within New York State. This document is designed to gather essential information about the PEO or PEO group, such as ownership details, operational structure, and compliance with state laws. The form is divided into various sections including type of request, general and ownership information, group information (if applicable), submission instructions, and responsibilities after registration. The process is thorough and requires detailed information to ensure compliance with the New York Department of Labor standards. Following the step-by-step instructions will simplify the process of completing the form accurately.
After submitting the LS 665 form, it’s important to stay compliant with ongoing responsibilities, including quarterly submissions certifying tax payments and updates to client lists. Maintaining accurate and current information ensures continued operation without interruptions.
The LS 665 form is used by Professional Employer Organizations (PEO) to request registration or renewal of registration to operate within New York State. It ensures that PEOs comply with legal requirements and are authorized to conduct business in the state.
Both individual PEOs and PEO Groups (two or more PEOs majorly owned by the same entity) need to file the LS 665 form. It is mandatory for any such organization seeking to initiate or continue its services in New York.
Yes, the form accommodates both initial registration requests and renewal requests for an individual PEO or a PEO Group.
In this section, applicants need to disclose the name of the PEO or the parent organization, any additional names under which the PEO operates, type of business organization, Federal Employer Identification Number (FEIN), contact details of the principal administrative office, and addresses of any additional offices in New York.
The form asks for details of any persons or entities that hold a five percent or greater interest in the PEO or its parent organization at the time of application, as well as similar information on ownership in the past five years.
PEO Groups are required to list all member PEOs, including their FEINs and addresses, additional names under which they operate, and addresses of their offices in New York.
Registered PEOs must submit quarterly statements certified by an independent CPA about timely payment of all applicable federal and state payroll taxes for New York employees. Additionally, a current client list must be submitted quarterly, showing all changes since the last submission.
The completed LS 665 form along with all required attachments should be mailed to the New York State Department of Labor, Division of Labor Standards Permit and Certificate Unit, at the provided address in Albany, NY. Prior to submission, ensure the declaration and group guaranty, if applicable, are completed.
When filling out the New York LS 665 form for Professional Employer Organization (PEO) registration, careful attention to detail is crucial. There are common mistakes made during this process which can delay approval or result in rejection. Understanding these pitfalls can help applicants navigate through the process more efficiently.
One of the first errors involves the type of request section. Applicants often forget to check whether they are filing for an Initial or a Renewal registration. This seems simple but is a necessary detail that sets the stage for the rest of the application.
Moreover, overlooking the submission instructions and responsibilities detailed in sections E and F of the form can result in an application that is not only incomplete but also not in compliance with the New York Department of Labor’s standards. Especially important is the adherence to the specific guidelines for submitting financial documentation and proof of insurance coverage.
Inaccuracy in such aspects of the application, including the failure to sign the document by an authorized person or not including a list of all New York clients, disregards the legal declaration and guaranty requirements, putting the applicant at risk of denial. In essence, ensuring that all sections of the LS 665 form are filled out correctly and thoroughly, accompanied by the necessary documentation, is crucial for a successful registration as a Professional Employer Organization in New York.
When submitting the New York LS 665 form, which is essential for the registration of a Professional Employer Organization (PEO) or a PEO Group, several accompanying documents are commonly required to ensure compliance with New York State's regulatory framework. These documents play a vital role in establishing the credibility, financial stability, and operational legality of the PEO, serving to protect both the organization and its clients.
These documents collectively ensure that a PEO or PEO Group is thoroughly vetted and meets all legal and financial standards set forth by New York State. By requiring such comprehensive documentation, the state aims to maintain a high standard of operation for PEOs, thereby protecting the interests of employees, employers, and the organizations themselves.
The New York LS 665 form, a Professional Employer Organization Request for Registration, bears similarity to several other documents used in various regulatory, business, and legal contexts. One analogous document is the Uniform Business License Application often used by states to streamline the process of applying for multiple business licenses and permits. Both forms serve as a centralized application method to ease administrative burdens on businesses seeking to comply with state regulations, yet they cater to different audiences—general businesses versus specific professional employer organizations.
Another related document is the IRS Form SS-4, Application for Employer Identification Number (EIN). Both the LS 665 form and the IRS Form SS-4 are necessary for business operations within the United States, with the LS 665 form focusing on the state-level registration of PEOs in New York and the SS-4 form being used to obtain an EIN from the federal government for tax identification purposes.
The Articles of Incorporation for a Corporation closely parallels portions of the LS 665 form, particularly in gathering foundational information about a business entity. Both documents capture essential business details, like the organization's name, type, and principal office address. However, the Articles of Incorporation are primarily involved in legally establishing a corporation, whereas the LS 665 is specific to registering a PEO with New York State's labor authorities.
Form I-9, Employment Eligibility Verification, also shares conceptual similarities with the LS 665 form. Each form plays a critical role in employment procedures within the United States—Form I-9 ensures individuals are authorized to work in the U.S., while the LS 665 is part of the regulatory framework for PEOs that manage HR responsibilities, including hiring, for other businesses.
The Business License Renewal Forms that many local and state governments require businesses to submit periodically resonate with the renewal aspect of the LS 665 form. Both sets of documents necessitate the submission of updated information to maintain legal operation status within their respective jurisdictions, emphasizing the ongoing compliance obligations of businesses.
The Workers' Compensation Insurance Application is akin to the LS 665 form in its necessity for businesses employing individuals within New York. While the LS 665 form encompasses a PEO's broader operational authorization, including its compliance with workers' compensation requirements, the Workers' Compensation Insurance Application specifically addresses the procurement of the necessary insurance to cover employee injuries.
The Limited Liability Company (LLC) Operating Agreement, although not a form submitted to a state agency, outlines the internal operations of an LLC much like how portions of the LS 665 detail the operational and financial setups of PEOs. Both documents are pivotal for clarifying the structure and practices of business entities, ensuring clear guidelines are in place.
Form DS-160, Online Nonimmigrant Visa Application, while primarily for immigration processes, shares the procedural nature of providing detailed personal and business-related information with the LS 665 form. Each form gathers comprehensive data for evaluation by a respective federal or state authority, although they serve distinctly different purposes—visa applications versus PEO registration.
The New York State Liquor Authority (NYSLA) License Application presents another document with procedural and regulatory resemblances to the LS 665 form. Each application process requires detailed disclosures about the applicants' business operations, ownership structure, and compliance intentions, catering to specific regulatory needs—alcohol licensing versus professional employer organization registration.
Lastly, the Certificate of Insurance Request Form, required by various parties when businesses seek to prove insurance coverage, parallels the LS 665 form’s requirements for proof of workers' compensation and disability insurance. While the focus of the Certificate of Insurance is on evidencing insurance coverage for risk management purposes, the LS 665 includes this as a component of the broader regulatory compliance framework for PEOs operating in New York.
When filling out the New York LS 665 form, it is essential to follow specific dos and don'ts to ensure the process is completed correctly and efficiently. Below are guidelines to assist applicants through this process:
By meticulously adhering to these prescribed dos and don'ts, applicants can effectively navigate the process of filling out the New York LS 665 form. This ensures compliance with the requirements and facilitates a smoother registration or renewal process for Professional Employer Organizations intending to operate within New York State.
There are several misconceptions about the New York LS 665 form that need clarification to ensure accurate understanding and compliance. These errors can lead to confusion among those attempting to navigate the registration process for Professional Employer Organizations (PEOs) in New York State.
This is not correct. The LS 665 form must be submitted by any PEO or PEO group seeking to operate in New York State, regardless of whether their principal office is based in New York or another state. This is important for ensuring that all PEOs operating within the state adhere to the same standards and regulations.
This misconception overlooks an important aspect of the form's purpose. The form is designed for both initial registration and renewal requests by individual PEOs or PEO groups. It's critical for PEOs to understand this to maintain their status as registered Professional Employer Organizations within New York State.
Submitting the LS 665 form doesn't guarantee immediate approval. The review process involves verifying the information provided, ensuring compliance with New York labor laws, and may require additional documentation or clarification. Applicants should prepare for this process and be ready to provide any necessary additional information.
Contrary to this belief, submitting financial statements is a crucial requirement for the LS 665 form. The statements must be prepared by an independent certified public accountant (CPA) within 180 days prior to submission, showcasing a minimum net worth of $75,000. This requirement is in place to ensure that the PEO is financially stable and capable of meeting its obligations.
Understanding these misconceptions is vital for any individual or group applying for PEO registration in New York State. Correct knowledge ensures a smoother application process and compliance with regulations, benefiting both the applicant PEOs and their client companies.
Understanding the New York LS 665 form, essential for Professional Employer Organizations (PEOs) operating in the state, requires attention to detail and adherence to specific guidelines. Here are eight key takeaways to ensure compliance and smooth processing:
Fulfilling these requirements is not just about fulfilling legal obligations. It's about establishing your PEO as a credible, trustworthy partner in New York's business ecosystem. Properly completing and maintaining the LS 665 registration ensures your organization can operate smoothly and effectively, fostering positive relationships with clients, employees, and regulatory bodies.
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