Michigan New Hire
Michigan Department of Treasury
P.O. Box 85010
State of Michigan New Hire Reporting Form
Lansing, MI 48908-5010
Phone: (800) 524-9846
Federal law requires public (State and local) and private employers to report all newly hired or rehired employees who are working
in Michigan to the State of Michigan.
This form is recommended for use by all employers who do not report electronically.
A newly hired employee is an individual not previously employed by you, and
Employers who report electronically and have employees working in two or
a rehired employee is an individual who was previously employed by you but
more states may register as a multi-state employer and designate a single state
separated from employment for at least 60 consecutive days.
to which new hire reports will be transmitted. Information regarding multi-state
registration is available online at:
Reports must be submitted within 20 days of hire date (i.e., the date services
or call (410) 277-9470.
are first performed for pay).
Reports will not be processed if mandatory information is missing. Such reports
This form may be photocopied as necessary. Many employers preprint employer
willl be rejected and you must correct and resubmit them.
information on the form and have the employee complete the necessary
information during the hiring process.
For optimum accuracy, please print neatly in all capital letters and avoid contact
with the edge of the box. See sample below.
When reporting new hires with special exemptions, please use the MI-W4 form.
Online and other electronic reporting options are available at:
A B C 1 2 3
Social Security Number:
EMPLOYEE Information (Mandatory)
Date of Birth:
Driver’s License No:
EMPLOYER Information (Mandatory)
Federal Employer Identification Number (FEIN):
Ref: Social Security Act section 453A and the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 (P.L. 104-193), effective October 1, 1997.