Wyoming New Hire Reporting Form 
 
  Federal and state legislation (Wyoming Statute Section 27-1-115), effective October 1, 1997 requires all Wyoming employers, 
  both public and private, to report to the State of Wyoming all newly hired, rehired, or returning to work employees. Information 
  about new hire reporting and online reporting is available on our Web site:  www.wy-newhire.com.  
 
  Send completed forms to:                               To ensure the highest level of accuracy, please print neatly  
  Wyoming New Hire Reporting Center                      in capital letters and avoid contact with the edges of the  
  PO Box 1408                                            boxes. The following will  
  Cheyenne, WY  82003-1408                               serve as an example:  
  Fax: (800) 921-9651                                                                            1  2   A B                        C
  
                                    EMPLOYER INFORMATION  
 
  Federal Employer ID Number (FEIN) (Please use the same FEIN that appears on your quarterly wage reports you submit to the State): 
 
         - 
 
  Employer Name: 
 
  Employer Address: (Please indicate the address where the Income Withholding Order should be sent). 
 
  Employer City:                                                               Employer State:          Zip Code (5 digit):
 
  Employer Phone (optional):             Extension:                            Employer Fax (optional): 
 
  Email: 
 
                                    EMPLOYEE INFORMATION  
  Employee Social Security Number (SSN): 

               - 
                          -   
                                                                                                          Middle Initial:
  Employee First Name: 
 
  Employee Last Name: 
 
  Employee Address: 
 
  Employee City:                                                               Employee State:  Zip Code (5 digit): 
 
  Start Date:                 Date of Birth (optional): 
 
                    Reports must be submitted within 20 days of date of hire or rehire. 
        REPORTS WILL NOT BE PROCESSED IF REQUIRED INFORMATION IS MISSING 

                          Questions?  Call us toll free at: (800) 970-9258