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                            Oregon New Hire Reporting Form 
Now accepting new hire reporting information via the Employer Portal website at www.oregonchildsupport.gov/employers. 
You can get additional information or download this form by visiting this website. 
 
Mail or Fax completed form to:                                       Telephone:                   (503) 378-2868 
Department of Justice, Division of Child Support                     Toll Free                    (866) 907-2857 
Employer New Hire Reporting                                          Fax:                 (503) 378-2863 
        th
4600 25  Ave NE, Suite 180, Salem, OR 97301                          Toll Free Fax:   (877) 877-7415 
                            Reports must be submitted no later than 20 days after the hire/rehire date 
                                                         Required Information * 
Employer Information                                             Please use the same FEIN used to report quarterly wage information 
                                                                                                  
 * Employer Federal Identification Number (FEIN)          State Identification Number            Submission Date  
  
 * Employer Name                                                   DBA (Doing Business As) Name 
  
 * Employer Street/Mailing Address                                                               * Contact Name  
  
 * Employer City                                          * State  * Zip Code                    * Contact Phone Number  
                                                                                                  
                                                                                                 Email: 
* Should the Child Support Program mail income withholding orders to the above address?  Yes [   ]    No [   ] 
   If No, please provide payroll office address and contact person information below.                    
                                                                                                  
 Payroll Office Mailing Address                                                                  Contact Name  
  
  City                                                   State       Zip Code                    Contact Phone Number/fax number  
                                                                                                  
                                                                                                 Email: 
* By reporting health insurance availability information below, your company may avoid receiving unnecessary forms. 
Do you offer any employees the option of purchasing dependent or family health care coverage as a benefit of their employment or is 
coverage available through a union?  Yes [   ]  No [   ] 
 
Union name and phone number:                                                                                                                  
                                                                     
 If yes, is there a waiting period for eligibility? Yes [   ]    No [   ]     If Yes, how long?                                                                      
 
*Employee=s name and SSN must exactly match what is on their SSN card. Please identify first, middle, and last name.                                            
 
Employee Information 
                                                                                                    
 * Social Security Number           *First Work Date                                               Date of Birth  
  
 * First Name                        Middle Name                                                   * Last Name 
  
 * Employee Street/Mailing Address  * City                                                        * State                                     * Zip Code 
                                                                                                   
 Employee email address             Home phone                                                    Cell phone  
                                                                                                   
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 New Hire Reporting - continued 
  
  * Employer Name                            * Employer Federal ID Number  * Contact Name 
                                                                            
                                                                           * Contact Phone Number 
  
  * Social Security Number          *First Work Date                       Date of Birth 
   
  * First Name                       Middle Name                           * Last Name 
   
  * Employee Street/Mailing Address * City                                * State    * Zip Code 
                                                                           
  Employee email address            Home phone                            Cell phone 
   
  * Social Security Number          *First Work Date                       Date of Birth 
   
  * First Name                       Middle Name                           * Last Name 
   
  * Employee Street/Mailing Address * City                                * State * Zip Code 
                                                                           
  Employee email address            Home phone                            Cell phone 
   
  * Social Security Number          *First Work Date                       Date of Birth 
   
  * First Name                       Middle Name                           * Last Name 
   
  * Employee Street/Mailing Address * City                                * State * Zip Code 
                                                                           
  Employee email address            Home phone                            Cell phone 
   
  * Social Security Number          *First Work Date                       Date of Birth 
   
  * First Name                       Middle Name                           * Last Name 
   
  * Employee Street/Mailing Address * City                                * State * Zip Code 
                                                                           
  Employee email address            Home phone                            Cell phone 
                                                                           
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 CSF 01 0580 (Rev. 01/01/14) 

                                                      Instructions 
                             How to fill out the New Hire Reporting Form 
 
Employer Info: 
Please make sure you use the same Federal Tax ID Number (FEIN) that you use to report your quarterly wage 
information. 
 
Including a contact person and phone number is required. Including email address is optional but extremely helpful, 
particularly if there is missing required information or the required information is unclear and employer services need 
to contact the employer. 
 
Different address and contact information for withholding orders? 
Please fill out this box if your company has a payroll service or another address where income withholding orders 
should be sent.  
 
Is health care coverage available? 
If your company doesn’t offer dependent or family health care coverage to any of your employees, please mark the 
ANo @box. If your company does offer dependent or family health care coverage to        any of your employees, or if your 
employee is represented by a union and the union offers dependent or family health care coverage to any of your 
employees, please mark the AYes @box. If yes is marked, please provide the waiting period, if any, and provide the 
union=s name, telephone number and the waiting period, if known.  
 
Employee: 
Please make sure the employee=s name and the Social Security Number match the employee=s Social Security card, 
including first, middle and last names. 
 
Dates of birth are optional but very helpful in verification of employment and missing or unclear new hire information. 
 
An employee address should be a valid address as used by the U.S. Postal Service. 
 
Reporting Helpful Hints 
        
Oregon law [ORS 25.790, OAR 137-55-4040] requires all employers to submit their new hire reports within 20 days after the 
employee=s hire date. This includes rehires. ARehire @means to re-employ any individual who was laid off, separated, furloughed, 
granted a leave without pay, or terminated from employment for more than 60 days. 
 
If you have never reported before, please report only those current employees for whom you have not reported quarterly wage 
information to the Oregon Employment Department. Do not submit a list of all current employees as this creates unnecessary 
processing of duplicate information. 
 
We have a variety of methods available for use in reporting: 
       $  www.oregonchildsupport.gov/employers. Use this secure Employer Portal via our website.  
       $  Electronic filing through FilesDirect.com. This secure website is free and user friendly. Contact employer services at    
           1-866-907-2857 for file specifications.  
       $  Complete, print and fax or mail the information on the PDF form found on our website at:                                               
            www.oregonchildsupport.gov/forms/docs/csf010580.pdf (Our contact information is on the top of the attached form.) 
 
Complete the attached form making sure the information is legible. Keep in mind that if the report is faxed, it can distort the 
information received. 
 
Due to security concerns, we are not accepting new hire reports via e-mails. 

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