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               NEW HIRE REPORTING INFORMATION                                                                   Date
               DEPARTMENT OF HEALTH AND HUMAN SERVICES 
               CHILD SUPPORT  
               SFN 1018 (6-2023)                                    Clear Fields

Mail to:                                                           Fax to: 
                                                                    
     Child Support                                                  Child Support  
     Department of Health and Human Services            OR          Department of Health and Human Services 
     PO Box 7190                                                    Fax #: (701) 328-5497 
     Bismarck, ND 58507-7190                                        Total Pages Faxed: 

All Employers Must Report All New Hires 
This form may only be used by employers with 24 or fewer employees.
  l 24 or fewer employees - complete this form or visit www.childsupportnd.gov to report new hires electronically. 
  l 25 or more employees - report new hires electronically.  Visit www.childsupportnd.gov to learn more and to report  
     new hires.

Part 1:  Employer Information
Employer Name                                                       For SDNH office use only

Address

City                                  State  ZIP Code

Federal Employer Identification Number

Part 2:  Employee Information
                                                                              Health                                             Employee  
                                                        Employee Social 
         Employee Name                Employee Address                     Insurance                            Employee  
                                                                                                                                 Date of Birth 
                                                        Security Number    Offered to this                      Date of Hire
                                                                           Employee?                                             (optional)

                                                                              Yes
 1
                                                                              No

                                                                              Yes
 2
                                                                              No

                                                                              Yes
 3
                                                                              No

                                                                              Yes
 4
                                                                              No

                                                                              Yes
 5
                                                                              No

Disclosure of the social security number is required pursuant to 42 USC 653a(b)(1)(A) and is requested for the purpose of data matching with the state 
case registry. Failure to disclose this information will affect compliance with new hire reporting requirements.

(Use continuation sheet to report additional new hires.)
Employer Representative                                                                                         Telephone Number 

         INSTRUCTIONS FOR COMPLETING THIS FORM MAY BE FOUND ON THE REVERSE SIDE



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 SFN 1018 (6-2023)
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                            INSTRUCTIONS FOR COMPLETING THE NEW HIRE REPORT

This form may only be used by employers with 24 or fewer employees to report new hires.
 l Employers with 24 or fewer employees may report new hires on this form or electronically. 
 l Employers with 25 or more employees must report new hires electronically.

Visit www.childsupportnd.gov to learn more and to report new hires.  A waiver of the electronic reporting requirement may 
be requested by contacting Child Support.
Step 1:  Enter the date you will be mailing or faxing the form.  If faxing, also enter the number of pages.
Under Part 1:
Step 2:   (REQUIRED) Enter the employer's name. 
Step 3: (REQUIRED) Enter the employer's address.  Be sure the address is complete, including street address or PO 
        Box, and city, state, and ZIP code. 
Step 4:   (REQUIRED) Enter the Federal Employer Identification Number.  This is also referred to as an EIN, FEIN, or 
        Federal tax identification number.  This is the same number as Box 10 of the W-4 form.

Under Part 2, for each newly hired employee:
Step 5:   (REQUIRED) Enter the employee's name. 
Step 6: (REQUIRED) Enter the employee's address.  Be sure the address is complete, including street address or PO 
        Box, and city, state, and ZIP code. 
Step 7:    (REQUIRED) Enter the employee's social security number. 
Step 8:   (REQUIRED) Enter "Yes" if you offer health insurance to the employee.  Enter "Yes" even if the employee is 
        subject to a waiting period for the health insurance.  Enter "No" if you do not offer health insurance to the 
        employee. 
Step 9: (REQUIRED) Enter the employee's date of hire.  The date of hire is the employee's first day of work for pay. 
Step 10:   (OPTIONAL) Enter the employee's date of birth.  
Step 11: (REQUIRED) Enter the name and telephone number of the employer representative and send the completed form 
        to the address or fax number on the top of the form.  If faxing the form, do not also mail it.  Please be sure the 
        correct side of the form is faxed.

What is a newly hired employee? 
A newly hired employee is an employee who was not previously employed by you or was previously employed by you but 
was separated from that previous employment for at least 60 days in a row and has now returned to work for you. 
 
How do I know if I am an employer who needs to report new hires? 
The definition of "employer" for new hire reporting purposes is the same definition used for federal income tax wage 
withholding purposes (as defined by section 3401(d) of the Internal Revenue Code of 1986) and includes any governmental 
entity and any labor organization.  As a general rule, if an employer is required to give an employee a W-2 form showing the 
amount of taxes withheld, the employer must comply with the new hire reporting requirements. 
 
How do I know if the person I just hired needs to be reported? 
The definition of "employee" for new hire reporting purposes is the same definition used for federal income tax wage 
withholding purposes (as defined by Chapter 24 of the Internal Revenue Code of 1986).  As a general rule, if an employee 
is given a W-2 form showing the amount of taxes withheld, that employee fits the definition for new hire reporting. 
 
When must I report? 
The report must be made no later than 20 days after the employee's date of hire. 
 
If you have any questions, please contact:
 Child Support                                  Telephone: (701) 328-6524 
 Department of Health and  Human Services       For TTY service: 711
 PO Box 7190 
 Bismarck, ND  58507-7190

IF YOU WOULD LIKE TO RECEIVE THIS FORM IN AN ALTERNATE FORMAT (SUCH AS LARGE 
PRINT OR BRAILLE), PLEASE CALL 701-328-6524 TO MAKE ARRANGEMENTS.

             Your cooperation helps our nation's children - Thank You !



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SFN 1018 (6-2023)                                                                Page
Page 3 of 3                                                                                  of

NEW HIRE REPORTING CONTINUATION SHEET
                                                                                 Date
(Use this sheet to report additional new hires.) 
Employer Name                                                                    Telephone Number 

                                                                 Health                           Employee  
Employee Name     Employee Address                               Insurance       Employee  
                                                 Employee Social 
                                                                                                  Date of Birth 
                                                 Security Number Offered to this Date of Hire
                                                                 Employee?                        (optional)

                                                                 Yes
                                                                 No

                                                                 Yes
                                                                 No

                                                                 Yes
                                                                 No

                                                                 Yes
                                                                 No

                                                                 Yes
                                                                 No

                                                                 Yes
                                                                 No

                                                                 Yes
                                                                 No

                                                                 Yes
                                                                 No

                                                                 Yes
                                                                 No

                                                                 Yes
                                                                 No

                                                                 Yes
                                                                 No

                                                                 Yes
                                                                 No

                                                                 Yes
                                                                 No

                                                                 Yes
                                                                 No






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