DATA REQUIRED:
Every employer is required to report six mandatory data elements within 20 days of any newly hired/rehired employee's first day of work.
| Employee | Employer |
|---|---|
| - Name | - Name |
| - Social Security Number | - Federal Employer Identification Number |
| - Mailing Address | - Mailing Address |
| * Date of Hire or Rehire (Optional) | |
| * Date of Birth (Optional) | |
*We also encourage employers to report
two optional data elements