Instructions For Completing The Form printable pdf download

Instructions For Completing The Form

Instructions for Completing the Form

Unless noted as optional, all required information must be included on the

form.

Please type or print legibly in black or blue ink.

This form may be duplicated.

FEIN:

Federal Employer Identification Number

Employer Name:

Legal name of the employer

Contact Name:

Person authorized to answer questions on the

New Hire Report (this should be someone from

the employer)

Contact Phone Number:

Phone number for the contact person

Employee Social

The number assigned by the Social Security

Security Number:

Administration

Date of Birth:

Optional Item – date of birth for the new hire

Date of Hire:

The first day the new hire performs services for

wages

Employee Name:

First, Middle, and Last name of the new hire

Employee Address:

Permanent address of the new hire

Pennsylvania New Hire Reports may be submitted through the mail or via

ê ê

FAX.

Mailing Address:

Commonwealth of Pennsylvania

New Hire Reporting Program

PO Box 69400

Harrisburg, PA 17106-9400

FAX Number:

717-657-HIRE

717-657-4473

1-866-748-4473 (TOLL FREE)

Customer Service Telephone

Number:

1-888-PAHIRES

1-888-724-4737

Instructions For Completing The Form

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