Form Rts-1sa - List Of Employees To Be Transferred
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1RTS-1SA
R. 12/15
Rule 73B-10.037
List of Employees to be Transferred
Florida Administrative Code
Effective 12/15
Print or type in blue or black ink.
Successor Name:
RT* Account No.:
Predecessor Name:
RT Account No.:
Contact Name:
Telephone No.:
Form RTS-1SA should list employees, who work or have worked for the transferred unit(s) from the date the unit was first
reported by the predecessor(s) through the date of acquisition. The list must be in social security number sequential order
and include employees’ names. The Employer’s Annual Federal Unemployment (FUTA) Tax Return (Form 940) and
Employer’s Quarterly Report Form (RT-6, formerly UCT-6) cannot be used in lieu of Form RTS-1SA. In addition, if the
predecessor was an Employee Leasing Company that had not updated its client list to delete clients who left prior to the
transfer, please submit a list of the client companies that left prior to the transfer.
If transferring more than ten employees, this information must be submitted electronically. For more information call
800-352-3671 Monday through Friday, 8 a.m. through 7 p.m., ET.
List of Employees to be Transferred to the Successor
Social Security
Employee’s Name
Number
(print or type last name first)
1
2
3
4
5
6
7
8
9
10
Social security numbers (SSNs) are used by the Florida Department
Please attach this form to your RTS-1S
of Revenue as unique identifiers for the administration of Florida's
(formerly UCS-1S) and
taxes. SSNs obtained for tax administration purposes are
Mail to:
confidential under sections 213.053 and 119.071, Florida Statutes,
Account Management
and not subject to disclosure as public records. Collection of your
Florida Department of Revenue
SSN is authorized under state and federal law. Visit our Internet site
P.O. Box 6510
at and select "Privacy Notice" for more
Tallahassee, FL 32314-6510
information regarding the state and federal law governing the
collection, use, or release of SSNs, including authorized exceptions.
* Formerly Unemployment Tax
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