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The New York LS 665 form serves as a crucial document for Professional Employer Organizations (PEOs) seeking registration in the state. This form is essential for both initial and renewal applications, allowing PEOs to operate legally within New York. It requires detailed information about the PEO, including its ownership structure, business organization type, and contact details. Applicants must specify whether they are filing as an individual PEO or as part of a group, which consists of multiple PEOs under common ownership. Ownership disclosures are a significant component of the application, necessitating the identification of individuals or entities holding a substantial interest in the organization. Furthermore, the form mandates the submission of various supporting documents, such as financial statements, proof of insurance, and a comprehensive client list. Adhering to submission instructions is critical, as the application must be completed accurately and submitted within specified timeframes to ensure compliance with New York labor laws. Ultimately, the LS 665 form not only facilitates the registration process but also underscores the regulatory framework governing PEO operations in New York.

Similar forms

The New York LS 665 form is essential for Professional Employer Organizations (PEOs) seeking registration. Several other documents share similarities with this form, particularly in terms of purpose and information requirements. Here’s a look at eight such documents:

  • IRS Form 941: This form is used to report payroll taxes withheld from employees. Like the LS 665, it requires detailed information about ownership and business structure.
  • New York State Business Registration Application (Form DOS-1000): This document registers a business entity in New York. Both forms require the business name, address, and ownership details.
  • New York State Employer Registration for Unemployment Insurance (Form NYS-100): This form registers employers for unemployment insurance. Similar to the LS 665, it collects information about the business and its owners.
  • Form W-2: Used to report wages paid to employees, it requires accurate information about the business and its employees, echoing the LS 665's focus on accurate reporting.
  • New York State Workers’ Compensation Insurance Application: This application is necessary for obtaining workers' compensation insurance. Both forms require information about the business structure and ownership.
  • Form 990: Nonprofit organizations use this form to report financial information to the IRS. It similarly demands detailed ownership and financial information, much like the LS 665.
  • New York State Sales Tax Registration Application (Form ST-100): This form registers a business for sales tax collection. It also requires ownership and business structure information, akin to the LS 665.
  • Partnership Agreement: This document outlines the terms of a partnership. It often includes ownership details and business structure, paralleling the ownership information required in the LS 665.

Understanding these documents can help streamline the registration process and ensure compliance with state and federal regulations. Each plays a crucial role in maintaining transparency and accountability in business operations.

Form Preview

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)

Initial

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.

Person or Entity

% Ownership

Address

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.

Person or Entity

% Ownership

Address

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

Address

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.

LS 665 (06/20)

Page 2 of 4

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

Division of Labor Standards

Permit and Certificate Unit

State Office Campus

Building 12, Room 185B

Albany, NY 12240

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.

LS 665 (06/20)

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

 

Signature of Chief Executive Officer, Partner,

 

 

Sole Proprietor or Member

Print name of above signatory

LS 665 (06/20)

Page 4 of 4

Common mistakes

Filling out the New York LS 665 form can be a straightforward process, but mistakes can lead to delays or even denials of your application. One common mistake is failing to indicate the correct type of request. Applicants must clearly check whether they are submitting an initial or renewal request for an individual Professional Employer Organization (PEO) or a PEO Group. Neglecting this step can cause confusion and result in processing delays.

Another frequent error is incomplete or inaccurate information in the General Information section. This includes missing details such as the Federal Employer Identification Number (FEIN) or the complete physical address of the Principal Administrative Office. Each piece of information is crucial for the application to be processed efficiently. Providing incorrect addresses or failing to list all additional offices can lead to complications down the line.

Many applicants overlook the importance of the Ownership Information section. It is essential to list all persons or entities that own a five percent or greater interest in the PEO. Failing to do so can raise red flags and potentially jeopardize the application. Additionally, not including past owners from the last five years can result in an incomplete submission, which may lead to rejection.

Lastly, not attaching the required documentation is a significant mistake. Applicants must include proof of Workers’ Compensation and Disability Insurance, a client list, and a financial statement prepared by an independent CPA. Omitting these documents can halt the application process. Ensuring all necessary attachments are included will help streamline the review and approval of the application.

More About New York Ls 665

  1. What is the New York LS 665 form?

    The New York LS 665 form is a request for registration for Professional Employer Organizations (PEOs) in New York State. It is used by both individual PEOs and groups of PEOs to register and operate legally in the state.

  2. Who needs to fill out this form?

    Any individual PEO or a group of PEOs that wish to operate in New York must complete the LS 665 form. This includes both new applicants and those seeking to renew their registration.

  3. What information is required on the form?

    The form requires general information about the PEO or group, ownership details, addresses of offices, and fiscal year dates. It also asks for financial statements and proof of insurance. Make sure to provide accurate and complete information to avoid delays.

  4. How do I submit the LS 665 form?

    Once you have completed the form and gathered all necessary attachments, mail it to the New York State Department of Labor at the address provided on the form. Ensure that all required documents are included to facilitate processing.

  5. What are the deadlines for submission?

    For initial registrations, submit the form before starting operations in New York. For renewals, the application must be submitted within 180 days after the end of the PEO's fiscal year. Missing these deadlines may affect your ability to operate legally.

  6. What attachments are needed with the application?

    You will need to include several documents, such as a copy of your corporate filing receipt, a client contract, a list of New York clients, financial statements, and proof of Workers' Compensation and Disability Insurance. Each document must meet specific requirements outlined in the form.

  7. What happens after I submit the form?

    After submission, the Department of Labor will review your application. If everything is in order, you will receive confirmation of your registration. Keep in mind that you are responsible for submitting quarterly statements and updates regarding your clients.

  8. Who can I contact for assistance?

    If you have questions while completing the LS 665 form, you can email PEOinfo.LS@labor.ny.gov or call (518) 457-1942. They can provide guidance and clarify any uncertainties you may have.

Misconceptions

Misconceptions about the New York LS 665 form can lead to confusion for applicants. Here are ten common misunderstandings and clarifications regarding this form:

  1. It is only for new PEOs. Many believe the LS 665 form is solely for new Professional Employer Organizations (PEOs). In reality, it is also required for renewing existing registrations.
  2. All PEOs can use the same form. Some think that the same LS 665 form applies to all PEOs. However, there are specific sections for individual PEOs and PEO groups, and applicants must select the appropriate type.
  3. Only large companies need to register. A common belief is that only large PEOs must complete this form. In fact, any PEO operating in New York, regardless of size, must register.
  4. The LS 665 is just a simple application. Many underestimate the complexity of the LS 665 form. It requires detailed ownership information, financial statements, and proof of insurance, among other documentation.
  5. Submitting the form is enough to operate. Some applicants think that submitting the LS 665 form alone allows them to operate. However, they must also meet ongoing compliance requirements after registration.
  6. The application process is quick and easy. Many assume that the registration process is straightforward. It can take time to gather the necessary documents and ensure compliance with all requirements.
  7. Financial statements are optional. There is a misconception that financial statements are not necessary for the application. In fact, a reviewed or audited financial statement is a mandatory part of the submission.
  8. PEOs can ignore tax obligations. Some believe that once registered, PEOs do not need to worry about payroll taxes. This is incorrect; PEOs must certify timely payment of all applicable federal and state payroll taxes.
  9. Only the owner needs to sign the application. It is often thought that only one signature is required. However, the application must be signed by an authorized representative of the PEO, which could be an officer, partner, or member.
  10. Client lists are not confidential. Some applicants worry that their client lists will be public. In truth, the list of clients submitted with the application is kept confidential by the Department of Labor.

Key takeaways

  • Before filling out the New York Ls 665 form, determine whether you are applying for an initial registration or a renewal. This distinction is crucial and must be marked clearly on the first page of the form.

  • Gather all necessary information about your Professional Employer Organization (PEO) or parent organization. This includes the name, address, and ownership details, as well as the Federal Employer Identification Number (FEIN).

  • Be prepared to provide a comprehensive list of all New York clients, including their names, addresses, and types of business. This information is confidential and will be used to verify compliance with state regulations.

  • Ensure that you attach required documents, such as proof of Workers’ Compensation and Disability Insurance, a financial statement prepared by a certified public accountant, and any necessary corporate filings. Missing documents can delay your application.

  • After submitting the form, remember your ongoing responsibilities. You must provide quarterly statements certifying the timely payment of payroll taxes and update the client list to reflect any changes since the last submission.

New York Ls 665: Usage Guide

Filling out the New York LS 665 form is a crucial step for Professional Employer Organizations (PEOs) looking to register or renew their registration in New York State. This process requires careful attention to detail, as accurate information is essential for compliance with state regulations. Below are the steps to guide you through completing the form effectively.

  1. Choose the Type of Request: On the first page, check the appropriate box for either "Initial" or "Renewal," and specify if it is for an individual PEO or a PEO Group.
  2. Provide General Information: Fill in the name of the individual PEO or the parent organization. Include any additional business names, select the type of business organization, and enter the Federal Employer Identification Number (FEIN).
  3. Complete the Address Section: Enter the physical address of the Principal Administrative Office. If the mailing address differs, provide that as well. Also, include the telephone, fax, and email address.
  4. List Additional Offices: Specify the current address of each additional office in New York. If needed, use a separate sheet for this information. Also, list addresses of offices maintained in New York over the past five years.
  5. Fill Out Ownership Information: If privately held, list all individuals or entities owning 5% or more of the PEO. Include their ownership percentage and addresses. If publicly traded, list those owning 50% or more.
  6. Group Information (if applicable): For group applicants, list all PEOs in the group, including their FEIN and addresses. Provide any additional business names and addresses of offices maintained in New York.
  7. Review Submission Instructions: Ensure you have all necessary attachments, such as corporate filing receipts, client contracts, financial statements, and proof of insurance. Follow the specific guidelines for each attachment.
  8. Complete the Declaration: Sign and date the declaration, affirming that you are authorized to file the request and that the information provided is accurate.
  9. Group Guaranty (if applicable): Each member of a PEO Group must complete and sign the guaranty section, ensuring all legal obligations are met.
  10. Mail the Completed Form: Send the completed form along with all attachments to the specified address: New York State Department of Labor, Division of Labor Standards, Permit and Certificate Unit, State Office Campus, Building 12, Room 185B, Albany, NY 12240.