STATE OF SOUTH CAROLINA
NEW HIRE REPORTING FORM

EMPLOYER IDENTIFICATION

EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER CITY STATE ZIP
EMPLOYER FEDERAL ID NO. EMPLOYER PHONE NO.

NEW OR REHIRED EMPLOYEE INFORMATION

EMPLOYEE NAME
EMPLOYEE ADDRESS
CITY STATE ZIP
DATE OF HIRE SSN DATE OF BIRTH
 
EMPLOYEE NAME
EMPLOYEE ADDRESS
CITY STATE ZIP
DATE OF HIRE SSN DATE OF BIRTH
 
EMPLOYEE NAME
EMPLOYEE ADDRESS
CITY STATE ZIP
DATE OF HIRE SSN DATE OF BIRTH
 
EMPLOYEE NAME
EMPLOYEE ADDRESS
CITY STATE ZIP
DATE OF HIRE SSN DATE OF BIRTH

Mail completed form to: South Carolina Department of Social Services, Child Support Enforcement Division, Attn: New Hire Reporting Program, PO Box 1469, Columbia, SC 29202-1469. Or fax completed form to: (803) 898-9100. Phone: (803) 898-9235 or 1-888-454-5294.