North Carolina New Hire Reporting Form

North Carolina New Hire Reporting Form

Effective October 1, 1997, North Carolina employers are required to report certain information about employees who have been newly hired, rehired, or have returned to work. Employers must either (1) complete this form, (2) submit a copy of the employee’s IRS W-4 form with the employee’s date of birth and date of hire filled out on this form, or (3) submit the information by magnetic tape or floppy diskette.This form may be reproduced as necessary.
EMPLOYER INFORMATION
Federal Employer ID Number (FEIN):
(Please enter the same FEIN used to report the employee’s quarterly wages.)
State ID:
Employer Name (Include middle initial):
Employer Payroll Address:
Employer City:
Employer State:
Zip Code (5 digit):
Employer Phone (optional):
Employer Fax (optional):
Email Address:
EMPLOYEE INFORMATION
Employee Social Security Number (SSN):
Is this employee an Independent Contractor?

YesNo
Employee Name (Include middle initial):
Employee Address:
Employee City:
Employee State:
Zip Code (5 digit):
Date of Hire:
Date of Birth:
Reports must be submitted within 20 days of date of hire or rehire. Failure to report could result in a fine.

REPORTS WILL NOT BE PROCESSED IF REQUIRED INFORMATION IS MISSING.

Call 1-888-514-4568 to obtain information about submitting new hire reports electronically, or visit our website at www.ncnewhires.com to report you new hires online.
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