Employer Information Form – Fill Out and Use This PDF

Updated: Nov 8, 2026

The Employer Information form serves as a critical tool for reporting new hires, as mandated by law, to the Indiana New Hire Reporting Center. It collects essential details about the employer, such as the Federal ID Number and contact information, along with comprehensive employee data, including social security numbers, employment start dates, and optional health insurance availability. By ensuring accurate and timely submission of this form, employers contribute to the maintenance of Indiana’s employment records, which is crucial for various state functions like child support enforcement.

To simplify your reporting process and ensure compliance with state requirements, you can easily fill out and submit the Employer Information form. Click the button below to get started.

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Employer Information Form PDF Details

In the realm of employment and workforce management, the significance of accurate documentation cannot be overstressed, especially when it involves the onboarding of new hires. The Employer Information form plays a pivotal role in this process, serving as a critical tool for businesses in Indiana to report newly hired employees to the Indiana New Hire Reporting Center. Located in Indianapolis and easily reachable through various means, including phone, fax, and online platforms, this form captures comprehensive details about both the employer and the employee. For employers, it necessitates the provision of their federal ID number (also known as the UI number), name, income withholding address, and contact information, which includes a phone number, fax number, and email address. On the flip side, it collects essential data regarding the employee, such as their social security number, insurance availability, personal details (including an optional date of birth), and employment start date. This methodical collection of data not only streamlines the process of incorporating new employees into the system but also ensures that businesses remain compliant with state laws, promoting a smoother and more efficient administrative process.

Question	Answer
Form Name	Employer Information Form
Form Length	1 page
Fillable?	Yes
Fillable fields	23
Avg. time to fill out	15 sec
Other names	indiana new reporting, indiana new hire reporting form 2021, indiana new hire forms 2021, indiana new hire

How to Fill Out Employer Information form

Employer Information form at a glance

What it is: Employer Information form for the Indiana New Hire Reporting Center.

Where and when to file: Mail Reports to the Indiana New Hire Reporting Center, P.O. Box 3429, Trenton, NJ 08619.

A filled-in Employer Information form example: an employer reports one new employee

How to fill out Employer Information form, box by box

Employer Information

Enter the Employer Federal ID Number under Employer Information.

Enter the Employer Name.

Enter the Employer Address (income withholding address).

Enter the Employer City, State and Zip.

Contact First Name and Contact Last Name

Enter the Contact First Name and the Contact Last Name.

Enter the Phone Number, the Fax Number and the Email Address.

Employee Information

Under Employee Information, enter the Social Security Number. Is Health Insurance Available? is optional: yes or no.

Enter the Employee First Name, MI and the Employee Last Name.

Enter the Employee Address, Employee City, State and Zip.

Enter the Start Date. The Date of Birth is optional.

More rules for Employer Information form

Toll Free Phone: (866) 879-0198. Toll Free Fax: (800) 408-1388. www.IN-NewHire.com.

Common questions about Employer Information form

Where do I file it?

Mail Reports to the Indiana New Hire Reporting Center, P.O. Box 3429, Trenton, NJ 08619.

Sources

[1] Employer Information form, Indiana New Hire Reporting Center (the Official source link on this page).