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Get MN New Hire Reporting Form 2012

Minnesota New Hire Reporting Form Effective July 1 1996 Minnesota Statute 256. 998 requires all Minnesota Employers both public and private to report all newly hired rehired or returning to work employees to the State of Minnesota within 20 days of hire or rehire date. Information about new hire reporting and online reporting is available on our web site www. mn-newhire. com 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 Send completed forms to PO Box 64212 St* Paul MN 55164-0212 Toll-free fax 800 692-4473 A B C EMPLOYER INFORMATION Federal Employer ID Number FEIN Please use the same FEIN as the listed employee s quarterly wages will be reported under Employer Name Employer Address Please indicate the address where the Income Withholding Orders should be sent. Employer City Employer State Employer Phone Extension Zip Code 5 digit Employer Fax Email Employee Social Security Number SSN Check this box if this is an Independent Contractor 1099 Employee First Name Middle Initial Employee Last Name Date of Hire mm/dd/yyyy Date of Birth mm/dd/yyyy optional REPORTS WILL NOT BE PROCESSED IF REQUIRED INFORMATION IS MISSING Questions Call us at 651 227-4661 or toll-free 800 672-4473 Rev 04/12. com 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 Send completed forms to PO Box 64212 St* Paul MN 55164-0212 Toll-free fax 800 692-4473 A B C EMPLOYER INFORMATION Federal Employer ID Number FEIN Please use the same FEIN as the listed employee s quarterly wages will be reported under Employer Name Employer Address Please indicate the address where the Income Withholding Orders should be sent. The following will serve as an example Send completed forms to PO Box 64212 St* Paul MN 55164-0212 Toll-free fax 800 692-4473 A B C EMPLOYER INFORMATION Federal Employer ID Number FEIN Please use the same FEIN as the listed employee s quarterly wages will be reported under Employer Name Employer Address Please indicate the address where the Income Withholding Orders should be sent. Employer City Employer State Employer Phone Extension Zip Code 5 digit Employer Fax Email Employee Social Security Number SSN Check this box if this is an Independent Contractor 1099 Employee First Name Middle Initial Employee Last Name Date of Hire mm/dd/yyyy Date of Birth mm/dd/yyyy optional REPORTS WILL NOT BE PROCESSED IF REQUIRED INFORMATION IS MISSING Questions Call us at 651 227-4661 or toll-free 800 672-4473 Rev 04/12. com 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 Send completed forms to PO Box 64212 St* Paul MN 55164-0212 Toll-free fax 800 692-4473 A B C EMPLOYER INFORMATION Federal Employer ID Number FEIN Please use the same FEIN as the listed employee s quarterly wages will be reported under Employer Name Employer Address Please indicate the address where the Income Withholding Orders should be sent. Employer City Employer State Employer Phone Extension Zip Code 5 digit Employer Fax Email Employee Social Security Number SSN Check this box if this is an Independent Contractor 1099 Employee First Name Middle Initial Employee Last Name Date of Hire mm/dd/yyyy Date of Birth mm/dd/yyyy optional REPORTS WILL NOT BE PROCESSED IF REQUIRED INFORMATION IS MISSING Questions Call us at 651 227-4661 or toll-free 800 672-4473 Rev 04/12. .

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