Employer Status Report for
Unemployment Compensation (UC-1A)
You may complete this application on-line. After
completing the application, print it, sign it and mail it.
If you do not wish to complete the application on-line,
you can print it, fill it out in ink and then mail it. If you do so,
please make sure that it is legible.
Return completed form to:
State of Connecticut
Department of Labor
Employment Security Division
200 Folly Brook Blvd.
Wethersfield, CT 06109-1114
Attn: Employer Status Unit
(PDF, 17 KB)
*Please read instructions below for
assistance with completing this form.
State of Connecticut Department of
Labor, Employer Status Report
Employment Security Division,
Wethersfield, CT 06109-1114 Form CONN UC-1AI (Rev. 6/08)
PLEASE READ INSTRUCTIONS BEFORE COMPLETING FORM
The Connecticut Unemployment Compensation law provides that the
Administrator may require from any employer, whether or
not otherwise subject to the law, such reports as are necessary
for the administration of the law. All employers are
required to file an Employer Status Report, Form Conn UC-1A.
Failure to receive a copy of the form does not relieve an
employer of the obligation to file. If space provided
under any item is insufficient for a complete answer, attach an
additional sheet of plain paper and indicate item number.
Enter your Federal Identification Number, found on
Federal Form 941. Enter your telephone number, include
area code, and email address.
Item 2. Enter the trade or
business name under which you operate.
Item 3. Enter the legal name of
the proprietor, partners, corporate name, or LLC name if
different from trade name.
Item 4. Enter on this line the
exact address to which communications are to be directed,
whether the location is in Connecticut or elsewhere.
Item 5. List the trade name and
Connecticut address for each establishment located in
Connecticut if different than item number 4. Do not
enter a Post Office Box number. If you are an
out-of-state employer with no permanent establishment in
Connecticut, give location of present job in Connecticut or
a salesperson’s home address. Attach a separate sheet
Item 6a. Describe the exact
nature of business in the space provided. If business
is construction, list type, for example: carpenter, road,
general building, bridge, etc. If manufacturing, list
principal products and percent of total, for example:
textile machinery 70%, nuts and bolts 20%, hardware 10%.
If trade, state whether wholesale or retail and products
sold, for example: bakery, retail.
Describe function of Connecticut facility: manufacturing,
research facility, sales representative, etc.
Check only one type of business organization. If a
Limited Liability Company, please indicate your filing
status for Federal Income Tax purposes.
If a Corporation or LLC; enter name of the State in which
the entity was incorporated or organized (for LLC's), and
the date of incorporation or organization (for LLC's).
List the name, social security number, title and home
address of the owner, or all of the partners if a
partnership, or the officers if a corporation.
Enter the date on which employer hired first employee
(not pay date) in Connecticut under type of business
organization checked in Item 7. If employer is a
corporation, enter the date when corporation commenced
business or date when corporate officer(s) began performing
services, whichever is earlier. NOTE: Officers who
receive compensation are considered employees under
Connecticut Unemployment Compensation Law.
If you acquired captioned business by purchase, merger
assignment, transfer, receivership, etc. (Example:
proprietor incorporating prior business), state whether you
acquired all of the business or only a part of the business.
If you acquired only part, describe fully what part was
acquired and which part was not and if business is owned by
the same interest as the predecessor, common ownership.
Acquisition can be facilitated by a third party such as a
bank or a court. Please note that when determining
whether all or part of a business has been acquired, refer
only to the previous employer’s business in
If you acquired the business in whole or part show under
(1) name under which previous employer did business, (2)
name(s) of previous owner or partners, (3) if previous
employer was subject to Connecticut Unemployment Law, answer
“yes” and show employer registration number, if known, and
(4) indicate if previous employer will remain in business in
Please indicate current or prior Connecticut Registration
Were you required to file Employer’s
Annual Federal Unemployment Tax Return (Treasury Form 940)
for the business indicated on Item 2? If “yes,”
indicate the years.
You have met the liability requirements
if (a) you have paid $1,500 or more in any quarter of this
calendar year or (b) you had one or more employees for any
part of 20 weeks in this calendar year. If NO, you
must answer questions 15 and 16.
If you have engaged employees and will
(a) pay $1,500 or more in any quarter of this calendar year,
or (b) have one or more employees for any part of 20 weeks
in this calendar year, you will be subject from the first
day you engaged employees. Therefore, you will be
issued a registration number later this year when the
liability requirement is met, retroactive to the first date
employees were engaged. By voluntarily accepting
coverage now, a registration number can be issued
immediately, rather than later this year.
If you have engaged employees and will
not (a) pay $1,500 or more in any quarter of this calendar
year or (b) have one or more employees for any part of 20
weeks in this calendar year, but will next calendar year,
you will be subject commencing January 1 of next year.
Therefore, you will be issued a registration number next
year when the liability requirement is met, retroactive to
January 1. By voluntarily accepting coverage now, a
registration number can be issued in January of next year
immediately, rather than later that year.
Please list gross wages paid by calendar quarter.
Gross wages include but are not limited to:
Applies to Agricultural employers only. For
clarification contact the Employer Status Unit at (860)
Applies to Domestic employers only.
If at any time you have engaged any subcontractors or
concessionaires to perform work in the usual course of your
business, answer “yes” and explain.
Enter bank name, address and account number of your main
Enter the name, address, and phone number of outside
accountant, or payroll service, if applicable.
Enter the total number of employees paid wages in
Connecticut during the payroll period which includes the
12th day of each month of the first quarter of liability.
This report must be signed by the owner, a
partner, corporate officer, or an authorized employee. All
others must provide documentation of authorization (i.e., Power
If there are any questions regarding the status of any
individuals compensated by you, or if any additional information
is needed to complete the Employer Status Report (Form UC-1A),
call or write the Employer Status Unit, Employment Security
Division, 200 Folly Brook Boulevard, Wethersfield, CT 06109-1114
for clarification. Telephone (860) 263-6550. You may
also contact one of our field representatives at a Field Audit
Unit. They are listed in the Blue Pages of your telephone
book under the State of Connecticut, Labor Department,