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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.

QuestionAnswer
Form NameArizona New Hire Reporting Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesFEIN, hire, OPTIONAL, fillable

Form Preview Example

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: 1-888-282-0502 toll-free fax

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

For information please visit our web-site at www.az-newhire.com

or call us toll-free at 1-888-282-2064

The Arizona New Hire Reporting Center is an authorized agent of the Arizona Department of Economic Security

Rev 03/2010

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