Form 6 - Utah New Hire Registry Reporting Form (Page 2 of 2) in pdf

INSTRUCTIONS

This form was created to report new hires by mail or fax. While we

encourage employers to utilize this form, larger employers should consider submitting

New Hire information on CD.

We also strongly recommend entering the data on our

web site or using an EFT (Electronic File transfer), or SSH (server to server),

this benefits both the employer and us. For further information on electronic

reporting, please refer to the New Hire Registry Handbook or visit our web site.

You can contact us at (801) 526-9235 or 1-800-222-

2857 toll free.

REPORTING: Please typewrite or machine print using a dark simple print font with 10

to 12 pitch font. If hand-printed, use black ink CAPITAL LETTERS with clear character

separation within the individual character boxes. The following examples are provided

for machine print and hand-writing:

ROBERT

123456789

Typeprint :

First Name

SSN

R O B E R T

1 2 3 4 5 6 7 8 9

Handwriting:

First Name

SSN

IMPORTANT: This form is your MASTER COPY. For ease of use, we suggest that the

“REQUIRED EMPLOYER INFORMATION” portion of the form be completed before making

photocopies. Make adequate copies for your future use.

REQUIRED ITEMS

must be completed. Forms submitted with missing data will be

returned. The following information is provided for clarification:

Federal Employer ID Number: The 9-digit federal employer identification number

used for Federal tax reporting. Do not place a hyphen between numbers.

Employer’s Name: List the employer’s legal name. If there is insufficient space on

this line, you may extend the name into the first line of the Employer’s Street Address

as long as the second line provided for the address is sufficient for the whole address.

Employer’s Address: The address where child support payment orders are sent.

Employee’s Social Security Number: The 9-digit number issued by the Social

Security Administration. Do not place hyphens between numbers. Forms and reports

without a social security number will not be accepted.

Date of Hire/Rehire:

This is the date labor or services for compensation are first performed

by the employee. The date of rehire is the date labor or services for compensation are

first performed by an employee who was previously employed by the employer, but has

been separated from that employment for at least 60 consecutive days.

OPTIONAL ITEMS

Employee’s Date of Birth: Provide the date by month, day and year with no hyphens.

Submission of New Hire Reports:

You may choose the filing method that is most

convenient for you. You may also submit a copy of the Employee’s W-4 Form or a

printed list. An employer who fails to timely report the hiring or rehiring of an

employee as required by law is subject to a civil penalty of $25 to $500 for each such

failure. All of the required information must be provided within 20 calendar days of the

employee’s first day of work. Submit all data using the address, fax number or web site

printed on the front of the form.

Form 6 - Utah New Hire Registry Reporting Form Page 2

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