Please use the same FEIN that appears on quarterly wage reports.
If SUIN not issued yet, please write “APPLIEDFOR” in
the above box. If Exempt, write “EXEMPT”.
Maryland State Directory of New Hires
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:
A B
Send completed forms to:
Maryland State Directory of New Hires
PO Box 1316
Baltimore, MD 21203-1316
Fax: (410) 281-6004 or to
ll-free fax 1 (888) 657-3534
EMPLOYER INFORMATION
Employer Name:
Employer Address:
Federal Employer Id Number (FEIN):
Employer City: Employer State: Zip Code (5 digit):
Contact Name (optional):
EMPLOYEE INFORMATION
Employee Social Security Number (SSN):
Are health care benefits available to employee? (Y/N):
Employee First Name:
Middle Initial
(optional):
Employee Last Name:
Employee Address:
Employee City: Employee State: Zip Code (5 digit):
Date of Birth mm/dd/yyyy (optional):
Reports must be submitted within 20 days of the date of hire or rehire
Questions? Call us at (410) 281-6000 or toll-free 1 (888) MDHIRES (634-4737). Report online at www.mdnewhire.com
Rev (03/18)
C 1 2 3
State Unemployment Insurance Number (MD Only SUIN):
Date of Hire (mm/dd/yyyy):
Employee Salary (Dollars and Cents): Hourly Monthly Yearly
Employee Gender (M)ale/(F)emale:
Email (optional):
Employer Phone (optional):
Employer Fax (optional):
Employer's Payroll Address (Please indicate the Employer's Payroll Address if different than the Employer's Address)
