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.