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Get FL New Hire Reporting form 2002

Florida New Hire Reporting Form Send completed forms to PO Box 6500 Tallahassee FL 32314-6500 Fax 850 656-0528 or toll-free fax 1 888 854-4762 To ensure the highest level of accuracy please print neatly in capital letters and avoid contact with the edges of the boxes. The following will serve as an example A B C EMPLOYER INFORMATION Federal Employer ID Number FEIN Please use the same FEIN that appears on your quarterly wage reports you submit to the State Is medical insurance available to employee Y/N Florida Employer Unemployment Compensation UI Number Employer Name Employer Address Please indicate the address where the Income Deduction Orders should be sent. Employer City Employer State Employer Phone Extension Zip Code 5 digit Employer Fax Email Employee Social Security Number SSN Employee First Name Middle Initial Employee Last Name Date of Hire Date of Birth 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 08/02. The following will serve as an example A B C EMPLOYER INFORMATION Federal Employer ID Number FEIN Please use the same FEIN that appears on your quarterly wage reports you submit to the State Is medical insurance available to employee Y/N Florida Employer Unemployment Compensation UI Number Employer Name Employer Address Please indicate the address where the Income Deduction Orders should be sent. Employer City Employer State Employer Phone Extension Zip Code 5 digit Employer Fax Email Employee Social Security Number SSN Employee First Name Middle Initial Employee Last Name Date of Hire Date of Birth 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 08/02. .

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