DWS-UI
Form 6
Rev. 0214
UTAH NEW HIRE REGISTRY REPORTING FORM
Submit this completed form within 20 days of a
new employee’s first day of work to:
Utah New Hire Registry
P.O Box 45247
Salt Lake City UT 84145-0247
Or
FAX to 801-526-4391
You may photo copy this original form for future use
See important instructions on second page
PRINT legibly in ink or TYPE all entries
Please write all entries in CAPS
All required items MUST be completed
Contact Person _________________________
Phone number _________________________
Today’s Date (mm/dd/yyyy) ________________________
REQUIRED EMPLOYER INFORMATION
Federal Employer ID Number (FEIN) ____________________________________________________
Employer’s Business Name ____________________________________________________________
Employer’s Street Address ____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
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City |
State |
ZIP |
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REQUIRED EMPLOYEE INFORMATION |
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Social Security Number |
____________________________________________________________ |
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Employee’s first name |
____________________________________________________________ |
Employee’s middle initial |
____________ |
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Employee’s last name |
____________________________________________________________ |
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Employee’s home address ____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
CityStateZIP
Date of hire/rehire (mm/dd/yyyy) ______________________________________________________
OPTIONAL INFORMATION: Employee’s birthdate (mm/dd/yyyy) ___________________________
140 East 300 South • Salt Lake City, Utah 84111
801-526-9235 • or toll free 800-222-2857 • FAX 801-526-9236 • Relay Utah 711
Spanish Relay Utah 1-888-346-3162 • Equal Opportunity Employer/Programs • jobs.utah.gov
DWS-UIC
Form 6
Rev. 0214
INSTRUCTIONS
This form is used to report new hires by mail or fax. We strongly recommend entering new hire data on our web site at https://jobs.utah.gov/UI/Employer/EmployerHome.aspx. Larger employers may consider submitting new hire information by CD or by uploading a file on our website. For further information about electronic reporting, please refer to the New Hire Registry Handbook or visit our web site, https://jobs.utah.gov/UI/Employer/EmployerHome.aspx. You can contact us at 801-526-9235 or 1-800- 222-2857.
The Form: You may download, complete, and print this form in Acrobat Reader, but you cannot electronically save a completed form, or retain your work on a partially completed work. Alternately, you may print the form and use a typewriter with a dark simple print font with 10 or 12 pitch. If hand- printing, use black ink and print in CAPITAL LETTERS with clear character separation.
REQUIRED ITEMS must be completed. Forms submitted with missing data will be returned.
Federal Employer ID Number: The 9-digit federal employer identification number used for Federal tax reporting. Do not place a hyphen between numbers.
Employer’s Name: List the employer’s legal name.
Employer’s Address: The address where child support payment orders are sent.
Employee’s Social Security Number: The 9-digit number issued by the Social Security Administration. Do not place hyphens between numbers. Forms and reports without a Social Security Number will not be accepted.
Date of Hire/Rehire: This is the date that labor or services for compensation are first performed by the employee. The date of rehire is the date labor or services for compensation are first performed by an employee who was previously employed by the employer, but has been separated from that employment for at least 60 consecutive days.
SUBMISSION OF NEW HIRE REPORTS
You may choose the filing method that is most convenient for you. You may also submit a copy of the employee’s W-4 Form or a printed list.
An employer who fails to timely report the hiring or rehiring of an employee as required by law is subject to a civil penalty of $25 to $500 for each such failure.
All required information must be provided within 20 calendar days of the employee’s first day of work.
Submit all data using the address, fax number or web site printed on the front of the form.
140 East 300 South • Salt Lake City, Utah 84111
801-526-9235 • or toll free 800-222-2857 • FAX 801-526-9236 • Relay Utah 711
Spanish Relay Utah 1-888-346-3162 • Equal Opportunity Employer/Programs • jobs.utah.gov
