SD EForm -  0778 V1     Complete and use the button at the end to print for mailing.                HELP
                                                        
                 SOUTH DAKOTA NEW HIRE REPORTING FORM 
                                                        
                     DATE:
 
    EMPLOYER FEIN:                    
 
          EMPLOYER NAME:              
 
   EMPLOYER ADDRESS:                  
 
                      CITY:                             STATE:     
                     
                        ZIP:          
 
     CONTACT:                                           PHONE #:   
 
  EMPLOYEE SSN:                       
 
          EMPLOYEE NAME:              
                              (Last)                               (First)                  (Middle)
   EMPLOYEE ADDRESS:                  
 
                        CITY:                           STATE:   
                     
                        ZIP:                            HIRE DATE:                     
                     
  EMPLOYEE SSN:                       
 
          EMPLOYEE NAME:              
                              (Last)                               (First)                  (Middle)
   EMPLOYEE ADDRESS:                  
 
                        CITY:                           STATE:   
                     
                        ZIP:                            HIRE DATE:                     
                     
  EMPLOYEE SSN:                       
 
          EMPLOYEE NAME:              
                              (Last)                               (First)                  (Middle)
   EMPLOYEE ADDRESS:                  
 
                        CITY:                           STATE:   
                     
                        ZIP:                            HIRE DATE:                     
                     
  EMPLOYEE SSN:                       
 
          EMPLOYEE NAME:              
                              (Last)                               (First)                  (Middle)
   EMPLOYEE ADDRESS:                  
 
                        CITY:                           STATE:   
                     
                        ZIP:                            HIRE DATE:                     
                     
Mail:  New Hire Reporting Center                         Fax:    1-888-835-8659 (Toll Free) 
          SD Department of Labor and Regulation           1-605-626-2842 (Local) 
          P.O. Box 4700                                 Phone: 1-888-827-6078 (Toll Free) 
          Aberdeen, SD 57402-4700                        1-605-626-2942 (Local) 

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