"New Hire Reporting Form - West Virginia New Hire Reporting Center" - West Virginia

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West Virginia New Hire Reporting Form
Federal and state legislation requires all West Virginia employers, both public and private, to report to the New
Hire Reporting Center all newly hired, rehired, or returning to work employees. Information about new hire
www.WV-newhire.com
reporting and online reporting is available on our website:
To ensure the highest level of accuracy, please print neatly in
Send completed forms to:
capital letters and avoid contact with the edges of the boxes.
West Virginia New Hire Reporting Center
The following will serve as an example:
PO Box 640098 Atlanta, GA 30364
ABC
123
Fax: (877) 625-4675
EMPLOYER INFORMATION
Federal Employer ID Number (FEIN): (Please enter the same FEIN used to report the employee's quarterly wages)
Employer Name:
Employer Address:
Employer City:
State:
Zip Code:
Employer Phone (optional):
Extension:
Employer Fax (optional):
Employer Contact Person Name (optional):
Email Address:
EMPLOYEE INFORMATION
Employee Social Security Number (SSN):
Employee First Name:
Middle Initial
Employee Last name:
Employee
Address:
Employee City:
State:
Zip Code:
Start Date MMDDYYYY:
Date of Birth MMDDYYYY (optional):
Is medical insurance available
Y/N
to employee? (optional):
Reports must be submitted within 14 days of hire or rehire date.
REPORTS WILL NOT BE PROCESSED IF REQUIRED INFORMATION IS MISSING
Questions? Call us toll-free at (877) 625-4669
West Virginia New Hire Reporting Form
Federal and state legislation requires all West Virginia employers, both public and private, to report to the New
Hire Reporting Center all newly hired, rehired, or returning to work employees. Information about new hire
www.WV-newhire.com
reporting and online reporting is available on our website:
To ensure the highest level of accuracy, please print neatly in
Send completed forms to:
capital letters and avoid contact with the edges of the boxes.
West Virginia New Hire Reporting Center
The following will serve as an example:
PO Box 640098 Atlanta, GA 30364
ABC
123
Fax: (877) 625-4675
EMPLOYER INFORMATION
Federal Employer ID Number (FEIN): (Please enter the same FEIN used to report the employee's quarterly wages)
Employer Name:
Employer Address:
Employer City:
State:
Zip Code:
Employer Phone (optional):
Extension:
Employer Fax (optional):
Employer Contact Person Name (optional):
Email Address:
EMPLOYEE INFORMATION
Employee Social Security Number (SSN):
Employee First Name:
Middle Initial
Employee Last name:
Employee
Address:
Employee City:
State:
Zip Code:
Start Date MMDDYYYY:
Date of Birth MMDDYYYY (optional):
Is medical insurance available
Y/N
to employee? (optional):
Reports must be submitted within 14 days of hire or rehire date.
REPORTS WILL NOT BE PROCESSED IF REQUIRED INFORMATION IS MISSING
Questions? Call us toll-free at (877) 625-4669