Wyoming New Hire Reporting Form
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1WYOMING NEW HIRE REPORTING FORM
Send Completed form to:
Or Fax to: 1-800-921-9651
Wyoming New Hire Reporting Center
For More Information: 307-638-1675
PO Box 1408
1-800-970-9258
Cheyenne, WY 82003-1408
EMPLOYER INFORMATION
(Please Print or Type)
Federal Employer Identification Number (FEIN)
(Please use the same FEIN for which listed employee(s) quarterly wages will be reported.
Employer Name
Street Address
City/State/ZIP Code
Contact Name and Telephone No.
EMPLOYEE INFORMATION
(Please Print or Type)
Name
Name
Address
Address
City
State
Zip
City
State
Zip
SSN
SSN
Name
Name
Address
Address
City
State
Zip
City
State
Zip
SSN
SSN
Are healthcare benefits available to employee?*
Yes
No
Are healthcare benefits available to dependents of employee?*
Yes
No
Please Visit Our Web Site for reporting your New Hires on line
@
*Optional
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Parent category: Business