New Hire Reporting form                                                                                                                  Colorado State Directory of New Hires
(Rev. 062-3 )                                                                                                                            PO Box 13089 
                                                                                                                                         Sacramento, CA 95813-3089
                                                                                                                                         Fax:(303) 297-2595
Colorado State Directory of New Hires
Federal law requires public (State and local) and private employers to report all newly hired or rehired employees who are 
working in Colorado to the State of Colorado.1This form is recommended for use by all employers who do not report                                        
electronically.                                                                                                                                         

OO  A newly-hired employee means a natural person who is employed by an                   OO Employers who report electronically and have employees working in two or 
employer in this state for compensation, which employer is required to report the 
compensation to the Federal Internal Revenue Service. "Employee" includes a self-employed    more states may register as a multi-state employer and designate a single state 
or contracted employee for whom the employer is required to report compensation to the       to which new hire reports will be transmitted. Information regarding multi-state 
Federal Internal Revenue Service. A new employee is an individual not previously employed    registration is available online at: http://www.acf.hhs.gov/programs/cse/ 
by you, and a rehired employee is an individual who was previously employed by you but       newhire/employer/private/newhire.htm#multi or call (410) 277-9470. 
separated from employment for at least 60 consecutive days.                               OO Reports will not be processed if mandatory information is missing. Such reports 
OO  Reports must be submitted within 20 days of hire date (i.e., the date services           willl be rejected and you must correct and resubmit them. 
     areif rst performed for pay).
•     This form may be photocopied as necessary. Many                                     OO For optimum accuracy, please print neatly in all capital letters and avoid contact 
     employers preprint employer information on the form and have                            with the edge of the box. See sample below. 
     the employee complete the necessary information during the 
     hiring process.                                                  
. OO Online and other electronic reporting options are available at:                         A B  C  1  2 3 
     https://newhire.state.co.us/ 
                                                                                                                              Social Security Number: 
      EMPLOYEE or SELF-EMPLOYED/CONTRACT 
                           EMPLOYEE Information (Mandatory) 
    First Name:                                                                                                               Middle Initial: 

    Last Name: 

    Address: 

    City:                                                                                                                     State: 

    Zip Code:                                                                                                                 Hire Date: 
                                                        Self-Employed or Contract Employee: 
                                                                   Check box for "Yes," leave blank for "No."
  OPTIONAL                 Date of Birth: 

                                                                                                                              Federal Employer Identification Number (FEIN): 
    EMPLOYER Information (Mandatory) 

    Employer Name: 

    Address: 

    City:                                                                                                                     State: 

    Zip Code: 

  OPTIONAL                 Contact Name: 

                           Contact Phone:                                                                     Contact Fax: 

                           Contact Email: 

     1 Ref: Social Security Act section 453A and the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 (P.L. 104-193), effective October 1, 1997.