Form UITL-39 "Employee-Leasing Company Application, Annual Report, and Certification" - Colorado

What Is Form UITL-39?

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

Form Details:

  • Released on April 1, 2012;
  • The latest edition provided by the Colorado Department of Labor and Employment;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form UITL-39 by clicking the link below or browse more documents and templates provided by the Colorado Department of Labor and Employment.

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Download Form UITL-39 "Employee-Leasing Company Application, Annual Report, and Certification" - Colorado

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Colorado Department of Labor and Employment, Unemployment Insurance Employer Services, P.O. Box 8789, Denver, CO 80201-8789
303-318-9100 (Denver-metro area) or 1-800-480-8299 (outside Denver-metro area)
EMPLOYEE-LEASING COMPANY APPLICATION, ANNUAL REPORT, AND CERTIFICATION
This report must be completed and signed by the employee-leasing company and an independent counsel. Send the completed and signed report to
Unemployment Insurance (UI) Employer Services at the above address.
Payment of a nonrefundable fee of $500 must accompany this completed application. Make your check payable to the Colorado State
Treasurer, and, if applicable, include your employer account number on your check. Do not send cash.
Colorado Employer (PEO) Account Number
Owner, Partners, or Corporate Name
Trade Name (Doing Business As)
In Care of Name
Street Address
City
State
ZIP Code
Business Telephone Number
Complete the form after determining whether all of the following three conditions apply to your business or a portion of your business.
You provide services to a work-site employer under a written contract that gives you certain rights and responsibilities for specified employees
1.
of that work-site employer; and
2.
The specified employees must know of and consent to the staffing contract.
3.
With regard to such rights and responsibilities, you are given the right to direct and control specified employees, with the intent to assign such
employees on a long-term basis to a work-site employer and not reassign the employees to a series of limited-term assignments.
Such rights and responsibilities that may be shared with the work-site employer include, but are not limited to:
A. Setting the employees’ rate of pay.
B. Paying the employees from your own account or from the work-site employer’s account.
C. Discharging, reassigning, or hiring employees for the work-site employer and yourself.
D. Providing programs such as professional guidance, which include employment training, safety, and compliance matters.
E. Reporting, withholding, and paying any applicable taxes with respect to the employees’ wages.
F.
Maintaining employees’ records.
G. Directing and controlling the employees.
H. Addressing employee complaints, claims, or requests, except as provided by a collective-bargaining agreement.
I.
Providing workers’ compensation insurance coverage and UI coverage.
Check the box that describes your business activity and follow the respective instructions.
I meet the above three conditions and report and pay Colorado UI premiums on the work-site employees under my employer account number.
You must sign below and return this completed form (independent counsel Bar Identification (ID) Number and signature is
required). You are required to provide work-site employer and employee information. Please complete the reverse side of this form. You
are required to provide work-site employer and employee information to include name, social security number, and gross wages.
I meet the above three conditions and report and pay the Colorado UI premiums on the work-site employees under each work-site
employer’s account number. You must sign below and return this completed form (independent counsel Bar ID Number and
signature is required). Please complete the reverse side of this form. You are required to provide work-site employer and employee
information to include name, social security number, and gross wages.
I do not meet the above three conditions at the present time. (Please check the appropriate box.) I am currently:
a management
company;
a temporary-help contracting firm;
other ____________________________. You must sign below and return this form
to the above address (independent counsel signature is not required).
The above employer is authorized to sponsor health-coverage plans and may provide the insurance carrier with the certification stating that all of the specified law
requirements to be considered an employer or coemployer under the provisions of the Colorado Employment Security Act (CESA) 8-70-114 (2) have been met.
I certify that the above employer is in compliance with the rights and responsibilities set forth in CESA 8-70-114 (2)(e).
Independent Counsel Name and Bar ID Number (Printed)
Independent Counsel Signature
Date
Coemployer Name (Printed)
Coemployer Signature
Date
Work-Site Employer Name (Printed)
Employer Signature
Date
UITL-39 (R 04/2012)
Colorado Department of Labor and Employment, Unemployment Insurance Employer Services, P.O. Box 8789, Denver, CO 80201-8789
303-318-9100 (Denver-metro area) or 1-800-480-8299 (outside Denver-metro area)
EMPLOYEE-LEASING COMPANY APPLICATION, ANNUAL REPORT, AND CERTIFICATION
This report must be completed and signed by the employee-leasing company and an independent counsel. Send the completed and signed report to
Unemployment Insurance (UI) Employer Services at the above address.
Payment of a nonrefundable fee of $500 must accompany this completed application. Make your check payable to the Colorado State
Treasurer, and, if applicable, include your employer account number on your check. Do not send cash.
Colorado Employer (PEO) Account Number
Owner, Partners, or Corporate Name
Trade Name (Doing Business As)
In Care of Name
Street Address
City
State
ZIP Code
Business Telephone Number
Complete the form after determining whether all of the following three conditions apply to your business or a portion of your business.
You provide services to a work-site employer under a written contract that gives you certain rights and responsibilities for specified employees
1.
of that work-site employer; and
2.
The specified employees must know of and consent to the staffing contract.
3.
With regard to such rights and responsibilities, you are given the right to direct and control specified employees, with the intent to assign such
employees on a long-term basis to a work-site employer and not reassign the employees to a series of limited-term assignments.
Such rights and responsibilities that may be shared with the work-site employer include, but are not limited to:
A. Setting the employees’ rate of pay.
B. Paying the employees from your own account or from the work-site employer’s account.
C. Discharging, reassigning, or hiring employees for the work-site employer and yourself.
D. Providing programs such as professional guidance, which include employment training, safety, and compliance matters.
E. Reporting, withholding, and paying any applicable taxes with respect to the employees’ wages.
F.
Maintaining employees’ records.
G. Directing and controlling the employees.
H. Addressing employee complaints, claims, or requests, except as provided by a collective-bargaining agreement.
I.
Providing workers’ compensation insurance coverage and UI coverage.
Check the box that describes your business activity and follow the respective instructions.
I meet the above three conditions and report and pay Colorado UI premiums on the work-site employees under my employer account number.
You must sign below and return this completed form (independent counsel Bar Identification (ID) Number and signature is
required). You are required to provide work-site employer and employee information. Please complete the reverse side of this form. You
are required to provide work-site employer and employee information to include name, social security number, and gross wages.
I meet the above three conditions and report and pay the Colorado UI premiums on the work-site employees under each work-site
employer’s account number. You must sign below and return this completed form (independent counsel Bar ID Number and
signature is required). Please complete the reverse side of this form. You are required to provide work-site employer and employee
information to include name, social security number, and gross wages.
I do not meet the above three conditions at the present time. (Please check the appropriate box.) I am currently:
a management
company;
a temporary-help contracting firm;
other ____________________________. You must sign below and return this form
to the above address (independent counsel signature is not required).
The above employer is authorized to sponsor health-coverage plans and may provide the insurance carrier with the certification stating that all of the specified law
requirements to be considered an employer or coemployer under the provisions of the Colorado Employment Security Act (CESA) 8-70-114 (2) have been met.
I certify that the above employer is in compliance with the rights and responsibilities set forth in CESA 8-70-114 (2)(e).
Independent Counsel Name and Bar ID Number (Printed)
Independent Counsel Signature
Date
Coemployer Name (Printed)
Coemployer Signature
Date
Work-Site Employer Name (Printed)
Employer Signature
Date
UITL-39 (R 04/2012)
WORK-SITE EMPLOYERS
Colorado Employer (PEO) Account Number
Federal Employer Identification Number
If you report all workers’ wages under the work-site employer’s account number, you do not have to submit any wage
information if all wages for the quarters requested below were submitted correctly via file transfer protocol, via the Internet,
or on Form UITR-1a, Unemployment Insurance Report of Workers’ Wages.
As an employee-leasing company, you must provide all requested information for each work-site employer and its
employees. Use additional forms for each work-site employer.
A computer-generated report is acceptable and may be submitted in place of this page if it includes all of the required
information. A sample template is available online. Go to www.colorado.gov/cdle/ui, click on Forms & Publications,
click on Employer Forms, and then click on “Sample Spreadsheet of Work-Site Employers and Employees (Employee-
Leasing Companies).” If you submit a computer-generated report, it must follow the same format as the sample template.
If you submit all required reports for the work-site employer under your employee-leasing company’s account number, you
must break out the chargeable wages paid and premiums assessed for each work-site employer individually. In addition to
the information requested below, for each work-site employer, you must submit the employee names, social security
numbers, and wages earned for all work-site employees who performed work during the calendar quarters listed below.
Work-Site Employer Unemployment Insurance Account
Work-Site Federal Employer Identification
Number of Employees
Number
Number
Owner, Partners, or Corporate Name
Trade Name (Doing Business As)
Telephone Number
Work-Site Address (Must be a Colorado Street Address)
City
State
ZIP Code
First Quarter
Chargeable Wages Paid
Premiums
Second Quarter
Chargeable Wages Paid
Premiums Assessed
January—March
Assessed
April—June
Third Quarter
Chargeable Wages Paid
Premiums
Fourth Quarter
Chargeable Wages Paid
Premiums Assessed
July—September
Assessed
October—December
Work-Site Employer Unemployment Insurance Account
Work-Site Federal Employer Identification
Number of Employees
Number
Number
Owner, Partners, or Corporate Name
Trade Name (Doing Business As)
Telephone Number
Work-Site Address (Must be a Colorado Street Address)
City
State
ZIP Code
First Quarter
Chargeable Wages Paid
Premiums
Second Quarter
Chargeable Wages Paid
Premiums Assessed
January—March
Assessed
April—June
Third Quarter
Chargeable Wages Paid
Premiums
Fourth Quarter
Chargeable Wages Paid
Premiums Assessed
July—September
Assessed
October—December
You can make a copy of this page if more space is needed.
UITL-39 Reverse (R 04/2012)
2
Colorado Employer (PEO) Account Number
Federal Employer Identification Number
If you do not have an unemployment insurance (UI) account number, you must attach a completed Form UITL-100, Application for
Unemployment Insurance Account and Determination of Employer Liability when you return this application. To download the form
go to www.colorado.gov/cdle/ui and click on Forms & Publications.
1. Provide the requested information for all owners and/or officers of a corporation. (Attach additional sheets of paper as necessary.)
Name
Title
Percent of Ownership or Interest
2. What percentage of your business is devoted to employee leasing?
3. How many work-site employers are contracted with your employee-leasing company in Colorado?
4. Do you specialize in providing employee-leasing services for any specific business or industry?
Yes
No
If Yes, specify the types of business or industry
5. Are you currently using any work-site employer’s UI account number for premium and wage reporting purposes?
Yes
No
NOTE: If the employee-leasing company fails to make an election, the employee-leasing company shall report UI premiums for
covered employees under the respective UI accounts and rates for each work-site employer. In the future if your company is
already electing to report and pay UI premiums as the employing unit under your own UI account and rate, you will be permitted
to change the election one time after the initial election to report UI premiums under each work-site employer. Your election to
report UI premiums under the UI accounts and rates for each work-site employer is final and may not be reversed.
6. Are the owners or officers of any work-site employer also employees of your employee-leasing company?
Yes
No
7. Do you share ownership or interest with any work-site employers?
Yes
No
If Yes, provide the work-site employer names and your percentage of ownership or interest. (Attach additional sheets of
paper as necessary.)
8. Does your employee-leasing company and any work-site employer have common officers of a corporation?
Yes
No
If Yes, provide the work-site employer names and officer names and titles. (Attach additional sheets of paper as necessary.)
9. Are your employee-leasing company and any of the work-site employers operated in whole or in part by related family members of
either the employee-leasing company or work-site employers?
Yes
No
If Yes, provide the names and job titles of the family members and the name of the business the family member operates
(Attach additional sheets of paper as necessary.)
For UI premium purposes, the Colorado Employment Security Act (CESA) 8-70-114 (2)(a) allows a coemployer such as an employee-
leasing company, a management company, a temporary-help contracting firm, or any business that provides employees to a work-site
employer—to be considered the employing unit of workers provided to a work-site employer. CESA 8-70-114 (2)(e) requires that
each coemployer maintain a list of its work-site employers and their respective workers and have that list available for inspection.
3
UITL-39a (R 04/2012)
Colorado Employer (PEO) Account Number
Federal Employer Identification Number
10. To obtain certification as an employee-leasing company conducting business in Colorado, you must provide evidence of
your ability to pay UI premiums for all work-site employees. You must select one of the following methods by which you will
provide this securitization to the UI Program:
Execute and file a surety bond, letter of credit, or cash escrow equal to 50 percent of the total UI premiums
assessed during the previous calendar year. The initial security amount for a new employee-leasing company is
equal to the standard UI rate (.0170) multiplied by 50 percent of its projected chargeable payroll for the current
calendar year as estimated by the employee-leasing company.
NOTE: Before the security amount can be determined, you must complete and return this form Employee-Leasing
Company Application, Annual Report and Certification, and a list of work-site employers and work-site
employees as described on page two. Upon review of this document, the UI Program will send you Form UITL-
73, Employee Leasing Company’s Election to Submit Security, for your completion and return with the required
security.
Provide the most recent independently audited financial statement prepared by a certified public accountant using
generally accepted accounting principles, which demonstrates that you have an accounting working capital of not
less than $100,000. The financial statement must be no older than 13 months.
NOTE: If you select this option, you must include the required independently audited financial statement when
you return your completed application.
Receive and provide an annual accreditation by a qualified, bonded, and independent assurance organization as
approved by the Colorado Department of Labor and Employment.
NOTE: If you select this option, your accreditation as an employee-leasing company (signed by you and the
assurance organization) must be received along with your completed application. The accreditation must provide
certification of compliance with all applicable laws and regulations of the Colorado Employment Security Act
(CESA) and the Regulations Concerning Employment Security.
Please use your Colorado Employer (PEO) Account Number when filing this report. You may mail your completed report to the
address on page one or fax it to 303-318-9206.
If the coemployer fails to file the required Colorado UI quarterly premium reports or fails to pay the Colorado UI premiums, the
coemployer’s status as the employing unit shall be revoked and the work-site employer shall be held liable for filing the reports and
paying the premiums due on the workers listed on the reports, as provided in CESA 8-70-114 (3)(a).
I acknowledge that I have read and understood the rights, requirements, and responsibilities set forth for employee-leasing
companies and work-site employers under CESA 8-70-114 and 8-76-104 (8).
I certify that the information provided as part of this application is true, correct, and complete to the best of my knowledge.
Colorado Employer Name (Printed)
Signature
Title
Date
E-mail Address
Telephone Number
If this is an annual recertification it must be received by June 30, and if your application is denied you will receive an appealable decision
that will include your legal rights.
If you have any questions or need additional information, contact Employer Services Liability at one of the telephone numbers on page one
or via e-mail to UI.Leasing@state.co.us.
4
UITL-39a Reverse (R 04/2012)
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