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Multistate Employer Registration Form & Instructions

OMB 0970-0166

Published: July 25, 2013
Information About:
Employers
Topics:
Employer Responsibilities, Multistate Employer Reporting, New Hire Reporting
Types:
Forms

This form is provided to employers who have employees in two or more states and wish to register to submit their new hire reports to one state or to make changes to their previous registration.

Federal law requires employers to provide to the State Directory of New Hires of the state in which a newly hired employee works, a report that contains the employee's name, address, Social Security number, and the date of hire (the date services for remuneration were first performed by the employee) as well as the employer's name, address and Federal Employer Identification Number (FEIN) (42 USC 653A(b)(1)(A)).

If you are an employer with employees in two or more states AND you will transmit the required reports magnetically or electronically, Federal law allows you to comply with the new hire reporting requirement by exercising one of the following options (42 USC 653A(b)(1)(B)):

  • Option #1: Send the new hire reports to the State Directory of New Hires of the state in which each newly hired employee works.
  • Option #2: Designate one state in which any employee works and transmit ALL new hire reports to the State Directory of New Hires of that state. You must notify the Secretary of the U.S. Department of Health and Human Services in writing of your choice to report to only one state and identify the chosen state (42 USC 653A(b)(1)(B)).

For Option #2: Complete this form to identify/register your entity as a multistate employer for new hire reporting.