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Get MD New Hire Registry Reporting Form 2002-2022

Maryland New Hire Registry Reporting Form Send completed forms to PO Box 1316 Baltimore MD 21203-1316 Fax 410 281-6004 or toll-free fax 1 888 657-3534 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 State Unemployment Insurance Number MD Only SUIN Please use the same FEIN that appears on quarterly wage reports. Employer Name If SUIN not issued yet please write APPLIEDFOR in the above box. If Exempt write EXEMPT. Employer Address Please indicate the address where the Income Withholding Orders should be sent Employer City Employer State Zip Code 5 digit Employer Fax optional Employer Phone optional Contact Name optional Email optional Employee Social Security Number SSN Date of Hire mm/dd/yyyy Middle Initial Employee First Name optional Employee Last Name Date of Birth mm/dd/yyyy optional Employee Salary Dollars and Cents Are health care benefits available to employee Y/N Hourly Zip Code 5 digit Monthly Yearly Employee Gender M ale/ F emale Reports must be submitted within 20 days of the date of hire or rehire Rev 09/02 Questions Call us at 410 281-6000 or toll-free 1 888 MDHIRES 634-4737. The following will serve as an example A B C EMPLOYER INFORMATION Federal Employer Id Number FEIN State Unemployment Insurance Number MD Only SUIN Please use the same FEIN that appears on quarterly wage reports. Employer Name If SUIN not issued yet please write APPLIEDFOR in the above box. If Exempt write EXEMPT. Employer Name If SUIN not issued yet please write APPLIEDFOR in the above box. If Exempt write EXEMPT. Employer Address Please indicate the address where the Income Withholding Orders should be sent Employer City Employer State Zip Code 5 digit Employer Fax optional Employer Phone optional Contact Name optional Email optional Employee Social Security Number SSN Date of Hire mm/dd/yyyy Middle Initial Employee First Name optional Employee Last Name Date of Birth mm/dd/yyyy optional Employee Salary Dollars and Cents Are health care benefits available to employee Y/N Hourly Zip Code 5 digit Monthly Yearly Employee Gender M ale/ F emale Reports must be submitted within 20 days of the date of hire or rehire Rev 09/02 Questions Call us at 410 281-6000 or toll-free 1 888 MDHIRES 634-4737. The following will serve as an example A B C EMPLOYER INFORMATION Federal Employer Id Number FEIN State Unemployment Insurance Number MD Only SUIN Please use the same FEIN that appears on quarterly wage reports. Employer Name If SUIN not issued yet please write APPLIEDFOR in the above box. If Exempt write EXEMPT. Employer Address Please indicate the address where the Income Withholding Orders should be sent Employer City Employer State Zip Code 5 digit Employer Fax optional Employer Phone optional Contact Name optional Email optional Employee Social Security Number SSN Date of Hire mm/dd/yyyy Middle Initial Employee First Name optional Employee Last Name Date of Birth mm/dd/yyyy optional Employee Salary Dollars and Cents Are health care benefits available to employee Y/N Hourly Zip Code 5 digit Monthly Yearly Employee Gender M ale/ F emale Reports must be submitted within 20 days of the date of hire or rehire Rev 09/02 Questions Call us at 410 281-6000 or toll-free 1 888 MDHIRES 634-4737. .

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