Form IA900 "Power of Attorney" - New York

What Is Form IA 900?

Form IA 900, Power of Attorney, is used in matters relating to Unemployment Insurance for an employer in the state of New York. Once the form is completed you will need to mail or fax the form to the New York State Department of Labor, Unemployment Insurance Division, and will allow the person listed to act on your behalf for Unemployment Insurance matters. Each representative will need to have a separate form completed.

The form is currently still in use and was last revised in September 2015. It is issued by the New York State Department of Labor, Unemployment Insurance (UI) Division. A fillable IA 900 Form is available for download below.

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Form IA 900 Instructions

The IA 900 Form is divided into 6 sections across two pages. For the Official Instructions to this form please see here.

  1. The first section asks for the employer's information, including the UI Employer Registration Number and the Federal Identification Number (FIN;
  2. The second section asks for the person or firm listed as the Power of Attorney followed by a series of checkboxes detailing what the Power of Attorney will be responsible for;
  3. The third section discusses the retention and revocation of a power of attorney and that by completing this form any previous person or firm acting as Power of Attorney for the same employer will be revoked;
  4. The fourth section asks for the employer's signature or a person who is a partner or corporate officer of the company;
  5. The fifth section is an acknowledgment of the power of attorney and only one of the four sections will be completed, depending on the type of company (individual, company, limited liability company, or partnerships/LLP);
  6. The sixth section is to be completed by the representative and is a declaration of what their duty will be to the employer completing this form, and will require a date and signature of confirmation.
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Download Form IA900 "Power of Attorney" - New York

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New York State Department of Labor
For office use only
Unemployment Insurance (UI) Division
POA #:
Initials:
Power of Attorney
Read the Instructions for Filing a Power of Attorney, (IA 900.1), before you complete this form. They:
Explain how to complete this form and
Define the extent of the powers being granted
1. Employer information
Employer legal name
UI Employer Registration Number
Mailing address
Federal Identification Number
City, village, town or post office
State
Zip code
2. Power of Attorney (POA) information (List only one POA per form)
Firm name
Contact name
Mailing address
Phone and fax numbers
I appoint the above named to represent me for the following designated purposes:
a)
All UI matters
Check this box if you checked box a) above and want your mail sent to the POA address listed above
b)
UI matters limited to contribution rates, elements used to calculate UI rates and under/overpayment information
c)
Filing agent matters limited to contribution rates and account under/over payment information
d)
UI benefit claim matters limited to information specific to a claim for UI benefits filed against my UI employer account
e)
UI matters limited to acting on my behalf with a UI Employer Services Representative regarding audits,
investigations and enforcement actions
f)
UI matters limited to acting on my behalf for UI Administrative Proceedings and Court Appeals
My representative is also authorized to receive disclosures of, and review and inspect confidential Federal tax information
and to perform any and all acts that I (we) can perform with respect to those tax matters as they bear on unemployment
insurance matters.
Note: Confidential Federal tax information shall include any and all information provided to the Department by the Internal
Revenue Service.
3. Retention/Revocation of prior power(s) of attorney
Filing this power of attorney automatically revokes all existing power(s) of attorney with any representatives authorized for
the same designated purposes with the UI Division. Previously filed power(s) of attorney for other designated UI purposes
remain in effect with this Division unless you revoke them in writing.
4. Employer’s signature
If the employer named above is other than an individual: I certify that I am acting in the capacity of a corporate officer, partner
(except a limited partner), member or manager of a limited liability company, or fiduciary on behalf of the employer. I have the
authority to execute this power of attorney on behalf of the employer. If the matter concerns an individual proprietorship the
owner must sign. If the matter concerns a partnership, LLP, LLC, corporation or other entity the individual signing the consent
must have the authority to bind the entity. If signed by a corporate officer, partner, member, guardian, tax matters partner,
executor, receiver, administrator, or trustee on behalf of the employer, I certify that I have the authority to execute this form on
behalf of the employer.
Signature
Employer’s phone and fax numbers
Date
Print the name of the person signing this form if not the employer(s) named above
Title, if applicable
Affix corporate seal if applicable
IA 900 (09/15)
New York State Department of Labor
For office use only
Unemployment Insurance (UI) Division
POA #:
Initials:
Power of Attorney
Read the Instructions for Filing a Power of Attorney, (IA 900.1), before you complete this form. They:
Explain how to complete this form and
Define the extent of the powers being granted
1. Employer information
Employer legal name
UI Employer Registration Number
Mailing address
Federal Identification Number
City, village, town or post office
State
Zip code
2. Power of Attorney (POA) information (List only one POA per form)
Firm name
Contact name
Mailing address
Phone and fax numbers
I appoint the above named to represent me for the following designated purposes:
a)
All UI matters
Check this box if you checked box a) above and want your mail sent to the POA address listed above
b)
UI matters limited to contribution rates, elements used to calculate UI rates and under/overpayment information
c)
Filing agent matters limited to contribution rates and account under/over payment information
d)
UI benefit claim matters limited to information specific to a claim for UI benefits filed against my UI employer account
e)
UI matters limited to acting on my behalf with a UI Employer Services Representative regarding audits,
investigations and enforcement actions
f)
UI matters limited to acting on my behalf for UI Administrative Proceedings and Court Appeals
My representative is also authorized to receive disclosures of, and review and inspect confidential Federal tax information
and to perform any and all acts that I (we) can perform with respect to those tax matters as they bear on unemployment
insurance matters.
Note: Confidential Federal tax information shall include any and all information provided to the Department by the Internal
Revenue Service.
3. Retention/Revocation of prior power(s) of attorney
Filing this power of attorney automatically revokes all existing power(s) of attorney with any representatives authorized for
the same designated purposes with the UI Division. Previously filed power(s) of attorney for other designated UI purposes
remain in effect with this Division unless you revoke them in writing.
4. Employer’s signature
If the employer named above is other than an individual: I certify that I am acting in the capacity of a corporate officer, partner
(except a limited partner), member or manager of a limited liability company, or fiduciary on behalf of the employer. I have the
authority to execute this power of attorney on behalf of the employer. If the matter concerns an individual proprietorship the
owner must sign. If the matter concerns a partnership, LLP, LLC, corporation or other entity the individual signing the consent
must have the authority to bind the entity. If signed by a corporate officer, partner, member, guardian, tax matters partner,
executor, receiver, administrator, or trustee on behalf of the employer, I certify that I have the authority to execute this form on
behalf of the employer.
Signature
Employer’s phone and fax numbers
Date
Print the name of the person signing this form if not the employer(s) named above
Title, if applicable
Affix corporate seal if applicable
IA 900 (09/15)
5.
Acknowledgment of the power of attorney
You must have this Power of Attorney witnessed before a notary public unless the appointed representative is licensed
to practice in New York State as an attorney-at-law, certified public accountant, or public accountant, or is a New York State resident
enrolled as an agent to practice before the Internal Revenue Service.
The person(s) signing as the above employer appeared before me and executed this power of attorney.
Acknowledgment — individual
Acknowledgment — corporate
State ___________________ SS: _______________________
State _______________________ SS: ________________________
County of __________________________________________
County of _______________________________________________
On this ___________________ day of ___________________
On this ________________________ day of ___________________
before me personally came, ___________________________
before me personally came, ________________________________
to me known to be the person(s) described in the foregoing
to me known, who, being by me duly sworn, did say that he/she
Power of Attorney; and he/she/they acknowledged that
resides at (insert address) __________________________________
he/she/they executed the same.
that he/she is the _________________________________________
of _____________________________________________________
the corporation described in
the foregoing Power of
Attorney; and that he/she/they
Notary Signature
Date
Notary Signature
Date
signed his/her/their name(s)
thereto by authority of the
board of directors of said
corporation.
Stamp
Stamp
Acknowledgment — limited liability company
Acknowledgment — partnerships/LLP
State ___________________ SS: _______________________
State _______________________ SS: _______________________
County of __________________________________________
County of _______________________________________________
On this ___________________ day of ___________________
On this ________________________ day of ___________________
before me personally came, ___________________________
before me personally came, ________________________________
to me known, who, being by me duly sworn, did say that
to me known, who, being by me duly sworn, did say that
he/she/they/it reside(s) at (insert address) ________________
he/she/they/it reside(s) at (insert address) _____________________
__________________________________________________
________________________________________________________
that he/she/they is (are) a member(s) or manager(s) of the
that he/she/they/it is (are) a partner(s) of _______________________
limited liability company
________________________
described in the
the partnership described
foregoing Power of
Notary Signature
Date
in the foregoing Power of
Notary Signature
Date
Attorney; and that
Attorney; and that
he/she/ they is (are)
he/she/they/it is (are)
empowered to and did
empowered to and did
execute the same.
execute the same.
Stamp
Stamp
6. Declaration of representative (to be completed by representative)
I agree to represent the above-named employer in accordance with this power of attorney.
I affirm that my representation will not violate
the provisions of the Ethics in Government Act or Section 2604(d) of the New York City Charter. These provisions restrict appearances by
former government employees before his or her former agency. I have read a summary of these restrictions in the instructions to this form.
I am (check all that apply and sign):
1.
an attorney-at-law licensed to practice in New York State
4.
an agent enrolled to practice before the Internal Revenue
Service PTIN#: ____________________
2.
a certified public accountant duly qualified to practice in
5.
an employee not a corporate officer (if the employer is a
New York State PTIN#: ____________________
corporation)
6.
Other
3.
a public accountant enrolled with the New York State
Education Department PTIN#: ____________________
Designation
Representative’s
(use number(s)
Federal Identification Number (FEIN) or
Signature
Date
from above list)
UI Employer Registration Number
IA 900 (09/15) back
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