Form Nys-209 - Electronic Media Reporting Of Employees Hired Or Rehired (Page 4 of 4) in pdf

Form Nys-209 - Electronic Media Reporting Of Employees Hired Or Rehired Page 4

NYS-209

(6/11)

Page 4 of 4

Electronic Media Transmittal for New Hire Reporting

This transmittal form must be accompanied by:

• your CD-ROM containing all required information, and

• a print dump of the first 10 records of the file being submitted.

Transmitter information

1 Name of transmitter

2 Transmitter’s employer identification number (EIN)

3 Street address of transmitter

City

State

ZIP code

4 Name of technical person to contact about electronic media

Telephone number

(

)

ext.

CD-ROM data

5 Enter the total number of employer

8 If the media contains more than one employer record, enter each EIN and name.

Attach additional sheets if necessary.

records reported

(from record 1F)

EIN

Employer’s name

6 Enter the total number of employee

records reported

7 Enter the last day of the period

being reported

Equipment

9 Manufacturer/model

10 Operating system/version

Stick-on labels

Each CD-ROM must be externally identified with a stick-on label. Each label must contain the following information:

Transmitter ID _____________________________________________

Transmitter name __________________________________________

Last day of period being reported ___________________________

Computer type and operating system ________________________

Form Nys-209 - Electronic Media Reporting Of Employees Hired Or Rehired Page 4