New Hire Reporting form                                                                                                                                                                                 Colorado State Directory of 
(Rev. 01-22               )                                                                                                                                                                             New Hires
                                                                                                                                                                                                        P.O. Box 2920
Colorado State Directory of New Hires                                                                                                                                                                   Denver CO,        80201 2920-  
                                                                                                                                                                                                        Fax:(303  297 2595) -
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 employeemeans                                        a natural person who employedis    by an                                          OO Employers who report electronically and have employees working in two or 
employer in statethis for compensation, employerwhich    requiredis 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. newA                   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.