New Ohio Reporting Form

Ohio Department of Job and Family Services
OHIO NEW HIRE REPORTING
Ohio Revised Code section 3121.89 to 3121.8910 requires all Ohio employers, both public and private, to report all contractors
and newly hired employees to the state of Ohio within 20 days of the contract or hire date. Information about new hire reporting
and online reporting is available on our website: www.oh-newhire.com
To ensure the highest level of accuracy, please print neatly in
capital letters and avoid contact with the edges of the boxes.
The following will serve as an example:
Send completed forms to:
Ohio New Hire Reporting Center
PO Box 15309
Columbus, OH 43215-0309
Fax: (614) 221-7088 or toll-free fax (888) 872-1611
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EMPLOYER INFORMATION
Federal Employer ID Number (FEIN) (Please use the same FEIN as the listed employee’s quarterly wages will be reported under):
Employer Name:
Employer Address (Please indicate the address where the Income Withholding Orders should be sent).
Employer City:
Employer State:
Employer Phone (optional):
Zip Code (5 digit):
Employer Fax (optional):
Extension:
Email:
EMPLOYEE OR CONTRACTOR INFORMATION
(Check here if using FEIN for the Contractor)
Social Security Number (SSN)
State of Hire:
First Name:
Middle Initial:
Last Name:
Address:
City:
Date of Hire:
State:
Date of Birth:
Is this a Contractor?
Yes
Date payments will begin for Contractor:
Zip Code (5 digit):
No
Length of time the Contractor will be performing services:
months
REPORTS WILL NOT BE PROCESSED IF REQUIRED INFORMATION IS MISSING
Questions? Call us at (614) 221-5330 or toll-free (888) 872-1490
JFS 07048 (Rev. 12/2013)