OMB Control No: 09700166 Expiration Date: 07312022MULTISTATE EMPLOYER REGISTRATION FORM FOR NEW HIRE REPORTING Employers who have employees working in two or more states may use this form to register.
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How to fill out the HHS OMB 0970-0166_DSA online
The HHS OMB 0970-0166_DSA form is essential for multistate employers to report new hire information to a designated state. This guide provides step-by-step instructions to help users accurately complete the form online, ensuring compliance with federal requirements.
Follow the steps to successfully fill out the form.
- Click ‘Get Form’ button to obtain the form and open it for editing. This will enable you to fill in your information accurately.
- Begin by entering your company's Federal Employer Identification Number (FEIN), ensuring not to include any hyphens. This unique nine-digit number is used by the IRS to identify your company.
- Next, fill in today's date in the MM/DD/YYYY format to signify when the form is completed.
- Enter your company's name as it appears with the FEIN. This identifies your organization for reporting purposes.
- Complete the section for your company's address, including city, state, and ZIP code. If the address is international, specify the country name and postal code.
- If your company has subsidiaries, refer to the Multiple FEIN Spreadsheet and enter the requested information about each subsidiary.
- Indicate the state or U.S. territory designated for reporting new hire information. Ensure that this state is one where your employees work.
- Select additional states or U.S. territories where your company has employees, ensuring at least one option is chosen aside from the designated state.
- Provide your name, title, work phone number, work email address, and an optional work fax number to facilitate communication.
- Finally, sign the form to certify that the information provided is accurate and that you are authorized to complete the form on behalf of your company.
- Once the form is completed, you can save changes, download, print, or share it as necessary.
Complete your form online today to ensure compliance and streamline your reporting process.
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