The Arizona New Hire Reporting Form is a document that all employers in the state of Arizona are required to complete and submit to the Department of Economic Security within 20 days of hiring a new employee. The form collects important information about the new hire, such as their name, address, social security number, and date of hire. Completing and submitting this form is essential for both the employer and the employee, as it helps ensure that the correct taxes are withheld from the employee's paychecks and that they receive any applicable benefits.
We have compiled some basic information regarding the arizona new hire reporting form. It's definitely worth taking the time to learn this before you begin filling out your form.
| Question | Answer |
|---|---|
| Form Name | Arizona New Hire Reporting Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | FEIN, hire, OPTIONAL, fillable |
Arizona New Hire Reporting Form
Mail completed form to: Arizona New Hire Reporting Center
P.O Box 402
Holbrook, MA 02343
Or fax completed form to:
EMPLOYER INFORMATION
Federal Employer Identification Number (FEIN): _______________________________________________________
(Please use the same FEIN for which listed employee(s) quarterly wages will be reported under.)
Employer Name: _________________________________________ DBA: ___________________________________
Contact Name: __________________________ Telephone: _________________ Email: ________________________
Address: _______________________________________________________________________________________
(Please indicate the address where the Income Withholding Order will be sent)
City: _________________________________ State: __________ Zip Code: _________________ +4: _____________
Complete one entry for each new employee
EMPLOYEE INFORMATION
Social Security Number:
Employee First Name: __________________________________ Middle: ____________________________________
Employee Last Name: ______________________________________________________________________________
Employee Address: ________________________________________________________________________________
City: ________________________________________ State: ____________ Zip Code: ____________ +4: _________
*Date of Birth: ________________________________ |
*Date of Hire: ___________________________ |
|
*Is medical insurance an employee benefit? |
Yes ____ |
No ____ |
*Is this employee eligible for an insurance benefit? |
Yes ____ |
No ____ |
* OPTIONAL
EMPLOYEE INFORMATION
Social Security Number:
Employee First Name: __________________________________ Middle: ____________________________________
Employee Last Name: ______________________________________________________________________________
Employee Address: ________________________________________________________________________________
City: ________________________________________ State: ____________ Zip Code: ____________ +4: _________
*Date of Birth: ________________________________ |
*Date of Hire: ___________________________ |
|
*Is medical insurance an employee benefit? |
Yes ____ |
No ____ |
*Is this employee eligible for an insurance benefit? |
Yes ____ |
No ____ |
* OPTIONAL
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The Arizona New Hire Reporting Center is an authorized agent of the Arizona Department of Economic Security
Rev 03/2010