Form Nhr - New Hire And Independent Contractor Reporting Form

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Form NHR
Rev. 01/2010
Massachusetts
New Hire and Independent
Department of
Revenue
Contractor Reporting Form
TO ENSURE ACCURACY, PRINT (OR TYPE) NEATLY IN UPPER-CASE LETTERS AND NUMBERS, USING A DARK, BALLPOINT PEN.
Employee Information
*
*
FIRST NAME
MI
LAST NAME
S
S
N
*
D
H
R
*
OCIAL
ECURITY
UMBER
ATE OF
IRE OR
EINSTATEMENT
-
-
/
/
A
*
DDRESS
C
/T
*
S
*
Z
*
+4 (O
)
ITY
OWN
TATE
IP
PTIONAL
IT’S THE LAW! - Massachusetts regulations require employers with 25 or more employees to report their new hires
and independent contractors electronically.
For more information, go to and select the For Businesses tab located at the top of the page.
Employer Information
E
I
N
*
-
MPLOYER
DENTIFICATION
UMBER
C
N
*
ORPORATE
AME
P
A
I
W
O
*
AYROLL
DDRESS TO WHICH THE
NCOME
ITHHOLDING
RDER WILL BE SENT
P
A
(Continued)
AYROLL
DDRESS
C
/T
*
S
*
Z
*
+4 (O
)
ITY
OWN
TATE
IP
PTIONAL
*
NOTE: All fields on this form with an
are mandatory fields. Please ensure all information entered is legible and
accurate prior to submitting the form to DOR.
Helpful Hint: Once you have completed your employer information, you may copy this form to save time when
reporting future new hires and independent contractors.
Send Completed Form NHR to:
Massachusetts Department of Revenue, PO Box 55141, Boston, MA 02205-5141 or,
you may fax the completed form to 617-376-3262.

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