Form Nhr - New Hire And Independent Contractor Reporting Form
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1Massachusetts Department of Revenue
Form NHR
New Hire and Independent Contractor Reporting Form
Employee information
First name
Middle initial (optional)
Last name
Mailing address
City/Town
State
Zip
Social Security number
Date of hire or reinstatement (mm/dd/yyyy)
Employer information
Name of corporation
Account ID number
Payroll address
City/Town
State
Zip
Social Security number
Date of hire or reinstatement (mm/dd/yyyy)
Important notice
Massachusetts regulations require employers with 25 or more employees to report their new hires and independent contractors at mass.gov/dor. Mail
form to: Massachusetts Department of Revenue, PO Box 55141, Boston, MA 02205-5141 or fax to (617) 376-3262.
Rev. 3/15
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