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Mployee Name Employee Address City State SSN Date of Birth Zip Date of Hire Employee Name Employee Address City State SSN Date of Birth Zip Date of Hire Employee Name Employee Address City SSN State Date of Birth MAIL OR FAX THIS REPORT TO: Fax Number: (803) 898-9100 Web site: www.scnewhire.com Zip Date of Hire South Carolina Department of Social Services New Hire Reporting Program Post Office Box 1469 Columbia, SC 29202-1469.

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