Sep 1, 2019 | Global Documents |
Florida New Hire Reporting Form Florida New Hire Reporting Center PO Box 6500 Tallahassee, FL 32314-6500 capital letters and avoid contact with the edges of the boxes. The following will serve as an example: EMPLOYER INFORMATION Federal Employer ID Number (FEIN) (Please use the same FElN that appears on your quarterly wage reports you submit to the State): Is (will) medical insurance be available to employee? Y/N Florida Employer Unemployment Compensation (UCT-6) Number: *optional information Employer Name: Employer Address: Employer City: Employer State: Zip Code (5 digit): Employer Phone: Extension: Employer Fax: Contact Name: EMPLOYEE INFORMATION Employee Social Security Number (SSN): Employee First Name: Middle Initial: Employee Last Name: Employee Address: Employee City: Employee State: Zip Code (5 digit): Reports must be submitted within 20 days of date of hire or rehire REPORTS WILL NOT BE PROCESSED IF REQUIRED INFORMATION IS MISSING Questions? Call us at (850) 656-3343 or toll-free 1 (888) 854-4791 Rev (01/10) To ensure the highest level of accuracy, please print neatly in Send completed forms to: FAX: (850) 656-0528 or toll-free fax 1 (888) 854-4762 Date of Hire: Date of Birth: ABC 123 * * STF BXRB1001 Social Security number disclosure is mandatory based on Title 42 United States Code sections 666(a)(13), 653a, and 654a(e), and on Section 409 . 2577, Florida Statutes. W e collect social security numbers for child support purposes . For more information go to http://dor. myflorida. com/dor/privacy. html
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