Form 150-211-055 "Combined Employer's Registration" - Oregon

What Is Form 150-211-055?

This is a legal form that was released by the Oregon Department of Revenue - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2015;
  • The latest edition provided by the Oregon Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 150-211-055 by clicking the link below or browse more documents and templates provided by the Oregon Department of Revenue.

ADVERTISEMENT
ADVERTISEMENT

Download Form 150-211-055 "Combined Employer's Registration" - Oregon

Download PDF

Fill PDF online

Rate (4.3 / 5) 88 votes
Clear Form
Combined Employer’s Registration
For agency use only
BIN
See instructions below
You can register online with the Oregon Business Registry (OBR) at https://secure.sos.state.or.us/cbrmanager/
*
Business name
Type of ownership (check one):
Corporation
LLC (Limited Liability Co.)
Government–Local
Sub-chapter S Corp.
recognized by IRS as a:
Government–State
Assumed business name
Sole Prop. (Individual)
Corp, or
Government–Federal
LLP (Limited Liability Part.)
Individual
Political Campaign
(Sole Prop.), or
*
Partnership—General
Partnership
Other
Federal employer identification number (FEIN)
(describe below):
Partnership—Limited
Non-profit 501(c)(3)
___________________
(attach federal exemption)
Pension and Annuity
___________________
Business telephone number
Fax number
Trust / Estate
Other Nonprofit
___________________
Ext.
Contact person authorized to discuss your payroll account with us
Recognized Indian Tribe
Nature and principal products of your business (i.e., retail—men’s clothing;
services—janitorial; etc.). Be specific.
Contact’s telephone number
Ext.
Check if any employees are:
Courtesy Withholding
Business mailing address
Agricultural
Working on fishing vessels
Domestic (in-home workers)
Does any domestic worker request withholding?
Yes
No
City
State
ZIP code
Type of return to be filed (see instructions)
OQ (Oregon Quarterly)
WA (Federal 943 filers only)
OA (Domestic)
E-mail address
Check here to authorize us to initiate e-mail exchange of tax information.
Enter number of employees (approximate)
Withholding
LLC Member ______ Owner/Officer ______ Employees ______
Tax
*
Physical address where work is performed in Oregon
Employee home address
*
Date employees were/will first be paid for work in Oregon
Must be
Month _________ Day ________ Year _______________
completed
City
State
ZIP code
Are employees working in these areas? (see instructions)
TriMet (Portland and surrounding metropolitan areas)
Transit
Do you have any other locations in Oregon?
LTD (Eugene and Springfield areas)
Tax
Date employees first paid for services performed within district(s)
No
Yes, list additional locations on a separate sheet & attach to this form
TriMet __________________ LTD __________________
Off site payroll service, accountant, or bookkeeper (attach Power of Attorney form)
In what calendar quarter did/will your payroll first exceed $1,000
or $20,000 agricultural labor? (see instructions)
Contact person at the off site payroll service, accountant, or bookkeeper
Quarter ___________ Year_______________
Unemployment
Tax
Telephone No.
Date first Oregon employee was/will be hired
Mailing address for off site payroll service (send:
forms
billings to this address?)
Month _________ Day ________ Year _______________
Employees need to be covered by a workers’ compensation (WC) policy?
C/O
Yes
No, but I choose to have coverage
City
State
ZIP code
Workers’
(Check the reason you don’t need a WC policy)
Benefit Fund
No, employees are covered by federal WC
Assessment
Bank reference/branch address
No, only owners/corporate officers
No, other
_______________________________________
(explain)
Date of acquisition
FEIN or BIN of acquired business
Did you acquire/transfer all
Yes
No or part
Yes
No of the Oregon business
operations of an ongoing business? How many employees transferred? _________________
List acquired business name, previous owner, and telephone number
Identification of owners, partners, corporate officers, etc.
(List additional owners on a separate sheet and attach to this form)
*
*
Social Security number
Social Security number
FEIN
Telephone number
FEIN
Telephone number
Name
Name
Home address
Home address
City
State
ZIP code
City
State
ZIP code
Responsible for:
Responsible for:
Filing tax returns
Paying taxes
Hiring/firing
Filing tax returns
Paying taxes
Hiring/firing
Determining which creditors to pay first
Determining which creditors to pay first
Authorization
I certify the above statements to be true and correct. I authorize the Employment Department, the Department of Revenue, and the Department of Consumer & Business
Services to verify any of the above information with regard to this business. I will notify each agency if there is a change or cancellation of the above authorized representative.
Signature
Date
Signature
Date
X
X
* Must be filled in as required by
Fax to: 503-947-1528 or Mail to: Oregon Employment Department
OAR 150-305.100.
875 Union St NE Rm 107
Salem OR 97311
Retain a copy for your records.
150-211-055 (Rev. 12-15)
Clear Form
Combined Employer’s Registration
For agency use only
BIN
See instructions below
You can register online with the Oregon Business Registry (OBR) at https://secure.sos.state.or.us/cbrmanager/
*
Business name
Type of ownership (check one):
Corporation
LLC (Limited Liability Co.)
Government–Local
Sub-chapter S Corp.
recognized by IRS as a:
Government–State
Assumed business name
Sole Prop. (Individual)
Corp, or
Government–Federal
LLP (Limited Liability Part.)
Individual
Political Campaign
(Sole Prop.), or
*
Partnership—General
Partnership
Other
Federal employer identification number (FEIN)
(describe below):
Partnership—Limited
Non-profit 501(c)(3)
___________________
(attach federal exemption)
Pension and Annuity
___________________
Business telephone number
Fax number
Trust / Estate
Other Nonprofit
___________________
Ext.
Contact person authorized to discuss your payroll account with us
Recognized Indian Tribe
Nature and principal products of your business (i.e., retail—men’s clothing;
services—janitorial; etc.). Be specific.
Contact’s telephone number
Ext.
Check if any employees are:
Courtesy Withholding
Business mailing address
Agricultural
Working on fishing vessels
Domestic (in-home workers)
Does any domestic worker request withholding?
Yes
No
City
State
ZIP code
Type of return to be filed (see instructions)
OQ (Oregon Quarterly)
WA (Federal 943 filers only)
OA (Domestic)
E-mail address
Check here to authorize us to initiate e-mail exchange of tax information.
Enter number of employees (approximate)
Withholding
LLC Member ______ Owner/Officer ______ Employees ______
Tax
*
Physical address where work is performed in Oregon
Employee home address
*
Date employees were/will first be paid for work in Oregon
Must be
Month _________ Day ________ Year _______________
completed
City
State
ZIP code
Are employees working in these areas? (see instructions)
TriMet (Portland and surrounding metropolitan areas)
Transit
Do you have any other locations in Oregon?
LTD (Eugene and Springfield areas)
Tax
Date employees first paid for services performed within district(s)
No
Yes, list additional locations on a separate sheet & attach to this form
TriMet __________________ LTD __________________
Off site payroll service, accountant, or bookkeeper (attach Power of Attorney form)
In what calendar quarter did/will your payroll first exceed $1,000
or $20,000 agricultural labor? (see instructions)
Contact person at the off site payroll service, accountant, or bookkeeper
Quarter ___________ Year_______________
Unemployment
Tax
Telephone No.
Date first Oregon employee was/will be hired
Mailing address for off site payroll service (send:
forms
billings to this address?)
Month _________ Day ________ Year _______________
Employees need to be covered by a workers’ compensation (WC) policy?
C/O
Yes
No, but I choose to have coverage
City
State
ZIP code
Workers’
(Check the reason you don’t need a WC policy)
Benefit Fund
No, employees are covered by federal WC
Assessment
Bank reference/branch address
No, only owners/corporate officers
No, other
_______________________________________
(explain)
Date of acquisition
FEIN or BIN of acquired business
Did you acquire/transfer all
Yes
No or part
Yes
No of the Oregon business
operations of an ongoing business? How many employees transferred? _________________
List acquired business name, previous owner, and telephone number
Identification of owners, partners, corporate officers, etc.
(List additional owners on a separate sheet and attach to this form)
*
*
Social Security number
Social Security number
FEIN
Telephone number
FEIN
Telephone number
Name
Name
Home address
Home address
City
State
ZIP code
City
State
ZIP code
Responsible for:
Responsible for:
Filing tax returns
Paying taxes
Hiring/firing
Filing tax returns
Paying taxes
Hiring/firing
Determining which creditors to pay first
Determining which creditors to pay first
Authorization
I certify the above statements to be true and correct. I authorize the Employment Department, the Department of Revenue, and the Department of Consumer & Business
Services to verify any of the above information with regard to this business. I will notify each agency if there is a change or cancellation of the above authorized representative.
Signature
Date
Signature
Date
X
X
* Must be filled in as required by
Fax to: 503-947-1528 or Mail to: Oregon Employment Department
OAR 150-305.100.
875 Union St NE Rm 107
Salem OR 97311
Retain a copy for your records.
150-211-055 (Rev. 12-15)
Instructions for Combined Employer’s Registration
Who must register
Transit taxes
Only individuals or firms with employees need to file a Combined
Employer’s Registration report. Corporate officers are considered
TriMet tax is an employer-paid excise tax based on payrolls for
employees, including those in subchapter “S” corporations.
services performed in Multnomah and parts of Washington and
Clackamas counties. Please refer to the map in the Oregon Business
Note: The definition of “employee” differs among Oregon state
Guide.
agencies. If you have questions, refer to the Oregon Business Guide
booklet or call the appropriate agency.
LTD (Lane Transit District) covers the Eugene/Springfield area
of Lane county. This excise tax is based on the same principle as
Other locations in Oregon
TriMet. Please refer to the map in the Oregon Business Guide.
In-state and out-of-state employers who have employees working
If you have more than one place of business in Oregon, on a sepa-
in these districts are subject to these taxes. If your total business
rate sheet, list each location. Attach the sheet to this registration
activity is conducted outside of these areas, then you are not liable
form.
for these taxes.
If your business is a nonprofit organization and you have employ-
Nature and principal products
ees working in these districts, you must send a copy of your 501(c)
Describe the nature of your business in Oregon and state the prin-
(3) exemption with the completed registration as proof of exemp-
cipal products produced or activity (sales or service) performed.
tion from transit taxes.
If you are engaged in more than one activity, specify which is the
Need more information? Call 503-945-8091 or 503-378-4988. Or visit
primary activity, product, or service.
our website at: www.oregon.gov/dor.
If more space is needed, please write the information on a separate
sheet and attach it to this registration form.
State unemployment tax
Additional owner/officer information
State unemployment tax is an employer paid tax that finances the
List information on additional owners, partners, officers, etc., on a
Oregon unemployment insurance program. Generally employers
separate sheet and attach it to this registration form.
must pay into the Unemployment Insurance Trust Fund if they:
• Have one or more employees in each of 18 weeks during a cal-
Previous owner
endar year, or
• Have total payroll of $1,000 or more in a calendar quarter (after
If you acquired all or part of the business operations of the previous
January 1, 2008).
owner, or if there was an entity change, mark “yes.”
Exceptions:
If you acquired all or part of the previous business, but did not
Agricultural labor is reportable if you have paid $20,000 or more
assume any of the liabilities, mark “yes.” If the previous owner
in total cash wages in a calendar quarter or have 10 or more em-
retained any part of the business, mark “yes.”
ployees during 20 weeks of a calendar year. You are considered to
On a separate sheet, describe the part of the business retained by
be subject effective the beginning of that calendar year.
the previous owner. Attach the sheet to this registration form.
Agricultural employers subject to unemployment tax may choose
to file withholding quarterly.
Withholding
Domestic/household service is subject if you have paid $1,000 or
more in total cash wages in a calendar quarter. You are considered
Oregon law requires that all wages, salaries, commissions, bonuses,
to be subject effective the beginning of that calendar year.
fees, or other items of value paid to an individual for services as an
Partial transfers. If an employing enterprise sells, transfers, or ac-
employee are subject to having Oregon tax withheld.
quires all or part of a trade or business (including employees), such
transactions must be reported to the Employment Department, Tax
Courtesy withholding—is for an employer who has hired an Or-
Section, within 60 days of the date the transaction becomes final.
egon resident that works outside of Oregon only.
Need more information? Call 503-947-1488. TTY (nonvoice) 503-
Agricultural—is for employers who plant, cultivate or harvest
947-1495.
seasonal crops. These may include field/forage crops, seed of
grass, cereal grain, vegetable crops, flowers and others. This doesn’t
Workers’ Benefit Fund Assessment
include livestock.
Domestic —withholding is not required for a domestic employee. If
your domestic employee has requested withholding and you have
This form doesn’t register you for workers’ compensation
insurance, which is mandatory for most employers. For
agreed to withhold, mark the “yes’’ box on the front of this form
assistance determining subjectivity, call 503-947-7815 or visit:
and file Form OA.
www.cbs.state.or.us/wcd/communications/wcins.html.
Employers file returns and pay withholding taxes based on their
This form registers you for the Workers’ Benefit Fund (WBF) assess-
federal filing requirements.
ment. This fund benefits injured workers and employers helping
941, 941-M, or 945
If you file federal form:
them return to work. Individuals subject to the WBF assessment are:
OQ–
Oregon Quarterly Combined Tax Report
File Oregon form:
• All paid workers for whom the employer is required to provide
943
If you file federal form:
workers’ compensation insurance coverage, and
WA–
*
Annual Withholding Tax Return for
File Oregon form:
• All paid individuals (workers, owners, officers) who may oth-
Agricultural Employers.
erwise be nonsubject, but the employer chooses to cover under
*If you file Form 943 you may file Form WA or Form OQ. If you’re
workers’ compensation insurance.
also subject to state unemployment, Workers’ Benefit Fund Assess-
• All paid individuals performing personal support work who
ment, or transit taxes, you must file a Form OQ quarterly.
are eligible for workers’ compensation insurance coverage
under HB 3618 (2010).
Need more information? Call 503-945-8091 or 503-378-4988. Or visit
our website at: www.oregon.gov/dor.
Need more information on WBF? Call 503-378-2372.
150-211-055 (Rev. 12-15)
Page of 2