Empire State Apprenticeship Tax Credit Program - Employer Application

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Empire State Apprenticeship Tax Credit Program - Employer Application

Empire State Apprenticeship Tax Credit Program - Employer Application

Governor Andrew M. Cuomo

* Indicates required fields

Questions? Need assistance? Call (877) 226-5724 or E-mail

To apply, you must be a sponsor of an active or probationary NYS Registered Apprenticeship (RA) program or a signatory of an active or probationary NYS RA group program. You must submit one Employer Application form for each trade.

I am a: *

Name of NYS RA Sponsor*

Sponsor Code*

The Sponsor Code may be found on the Sponsor's Apprenticeship Training Program Registration Agreement (Form AT-10)

Name of NYS RA Trade*

One Employer Application form must be submitted for each trade.

ATP Code*

The ATP (trade) Code may be found on the Sponsor’s Apprenticeship Training Program Registration Agreement (Form AT-10)

Name of Employer applying for this tax credit*

Industry Sector *

Employer Physical Address *

Address Line 1

Address Line 2

City *

State *

Zip *

Employer Mailing Address ( Same as Physical Address)*

Mailing Address Line 1

Mailing Address Line 2

City *

State *

Zip *

Contact information of person submitting the form

Name*

Job Title*

E-mail*

Confirm E-mail*

Phone Number*

( ) - ext

Fax Number

( ) -

If you are a third party submitting this application on behalf of the employer, please provide the following contact information for a representative at the business.

Business Name

Business Representative Name

E-mail

Confirm E-mail

Phone Number

( ) - ext

Preferred Contact Method by Department of Labor *

Phone E-mail

For efficiency purposes we will be communicating via email unless businesses request differently.

Terms of Service Agreement

An Empire State Apprenticeship Tax Credit Final Report will be submitted for each of the qualified apprentices being claimed.
I agree to allow The NYS Department of Tax and Finance to share my wage records with the NYS Department of Labor (NYSDOL). However, any information shared as a result of this agreement shall not be available for disclosure or inspection under the state freedom of information law.
I agree to allow NYSDOL and its agents access to any and all books and records they may require to monitor compliance.
I understand I must reapply for this tax credit each tax year.
I understand that submission of this form does not guarantee entitlement to the tax credit.
I understand that if awarded a preliminary certificate of tax credit that I will need to submit a final report to NYSDOL for tax credit determination.
To the best of my knowledge, this information is true, correct and complete. I am aware that there are significant civil and criminal penalties for filing false documents or other information with the government.

By checking this box and submitting this form, I agree to the above Terms of Service Agreement.

Empire State Apprenticeship Tax Credit Program Overview