Form Cssd 04 1050 – Fill Out and Use This PDF

The CSSD 04 1050 form, known as the Alaska New Hire Reporting Form, is a crucial document used by employers to report newly hired or rehired employees to the Child Support Services Division (CSSD) in Alaska. It requires a comprehensive array of information about the employer and the employee, including social security numbers, which, under AS 25.27.075(b), must be provided for the purpose of establishing and enforcing child support obligations. To ensure compliance and assist in the enforcement of child support, it's vital for employers to accurately complete and submit this form.

Ensure your contributions to child support enforcement by clicking the button below to fill out the form.

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Form Cssd 04 1050 PDF Details

Ensuring accurate and timely reporting of new hires is an integral part of managing employment and is mandatory under certain regulations. The CSSD 04 1050 form, commonly known as the Alaska New Hire Reporting Form, is a crucial document for employers in Alaska to become familiar with. This form is an essential tool for the Child Support Services Division (CSSD), designed to assist in establishing and enforcing child support obligations. Employers need to fill out comprehensive details about themselves and their new or rehired employees, ranging from basic contact information to more sensitive data such as Social Security numbers. This information, mandated by AS 25.27.075(b), is not only vital for child support enforcement but also plays a role in ensuring employees receive proper benefits, including health insurance where applicable. The form facilitates a seamless communication channel between employers and the CSSD, offering multiple submission methods, including mail and fax, to accommodate diverse business operations. Understanding the layout, requirements, and objectives of the CSSD 04 1050 form is pivotal for employers to comply with state regulations, support the state's effort in child support enforcement, and maintain accurate employee records.

Question	Answer
Form Name	Form Cssd 04 1050
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	new hire reporting alaska, Michigan, reporting, of

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Alaska New Hire Reporting Form

Send completed form to:

MS 13 New Hire Reporting Section

CHILD SUPPORT SERVICES DIVISION

550 W 7th AVE STE 310

ANCHORAGE AK 99501-6699

Employer Information Contact Name

Or fax to:	(907)	787-3197
Message Line:	(907)	269-6685
Toll free in Alaska:	1 (877)	269-6685
For information call:	(907)	269-6089

Contact Title

Submission Date (Year / Month / Date)	Contact Phone Number		Contact Fax Number	Contact Email address

Employer Federal Identification Number (FEIN)		Employer AK Department of Labor Number		Do you provide Health Insurance to your Employee?

000

Yes

Employer Name

Employer - Doing Business As / Also Known As

Employer Payroll Mailing Address

City

State

Zip Code

Employer Physical Address “Same” if same as mailing address

City

State

Zip Code

Employee Information

Employee Social Security Number * Employee First Name

M.I.

Employee Last Name

Employee Street Address

City

State

Zip Code

Year

Month

Day

Year

Month

Day

Employee

/ Rehire

Employee

Date of Hire

Date of Birth

*You are required to provide the social security numbers of your newly hired or rehired employees pursuant to AS 25.27.075(b). The Child Support Services Division will use the social security numbers only for the purpose of establishing and enforcing child support.

Employee Social Security Number * Employee First Name

M.I. Employee Last Name

Employee Street Address

City

State

Zip Code

Year

Month

Day

Year

Month

Day

Employee Date of Hire

/Rehire

Employee

Date of Birth

Employee Social Security Number * Employee First Name

M.I.

Employee Last Name

Employee Street Address

City

State

Zip Code

		Year	Month	Day	Year	Month	Day
Employee	/				Employee
Date of Hire	/	Rehire			Date of Birth
CSSD 04-1050 (Rev 06/04/14)

New Hire Reporting – continued

Employer Name	Employer Federal Identification Number (FEIN)	Submission Date (Year / Month / Date)

Employee Social Security Number *			Employee First Name			M.I.	Employee Last Name
Employee Street Address					City		State	Zip Code
			Year	Month	Day		Year	Month	Day
Employee	/						Employee
Date of Hire	/	Rehire					Date of Birth
Employee Social Security Number *			Employee First Name			M.I.	Employee Last Name
Employee Street Address					City		State	Zip Code
			Year	Month	Day		Year	Month	Day
Employee	/	Rehire					Employee
Date of Hire	/	Rehire					Date of Birth
Employee Social Security Number *			Employee First Name			M.I.	Employee Last Name
Employee Street Address					City		State	Zip Code
			Year	Month	Day		Year	Month	Day
Employee	/	Rehire					Employee
Date of Hire	/	Rehire					Date of Birth
Employee Social Security Number *			Employee First Name			M.I.	Employee Last Name
Employee Street Address					City		State	Zip Code
			Year	Month	Day		Year	Month	Day
Employee	/						Employee
Date of Hire	/	Rehire					Date of Birth
Employee Social Security Number *			Employee First Name			M.I.	Employee Last Name
Employee Street Address					City		State	Zip Code
			Year	Month	Day		Year	Month	Day
Employee	/	Rehire					Employee
Date of Hire	/	Rehire					Date of Birth
CSSD 04-1050 (Rev 06/04/14)

Form Cssd 04 1050 – Fill Out and Use This PDF

Form Cssd 04 1050 PDF Details

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