Fillable Oregon New Hire Reporting Form Oregon New Hire Reporting Form (CSF 010580)

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Oregon New Hire Reporting Form Oregon New Hire Reporting Form (CSF 010580)

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Page 1 of 3- OREGON NEW HIRE REPORTING FORM
CSF 01 0580 (Rev. 01/01/14)
Oregon New Hire Reporting Form
Now accepting new hire reporting information via the Employer Portal website at www.oregonchildsupport.gov/employers.
You can get additional information or download this form by visiting this website.
Mail or Fax completed form to: Telephone: (503) 378-2868
Department of Justice, Division of Child Support Toll Free (866) 907-2857
Employer New Hire Reporting Fax: (503) 378-2863
4600 25
th
Ave NE, Suite 180, Salem, OR 97301 Toll Free Fax: (877) 877-7415
Reports must be submitted no later than 20 days after the hire/rehire date
Required Information *
Employer Information Please use the same FEIN used to report quarterly wage information
* Employer Federal Identification Number (FEIN)
State Identification Number
Submission Date
* Employer Name
DBA (Doing Business As) Name
* Employer Street/Mailing Address
* Contact Name
* Employer City
* State
* Zip Code
* Contact Phone Number
Email:
* Should the Child Support Program mail income withholding orders to the above address? Yes [ ] No [ ]
If No, please provide payroll office address and contact person information below.
Contact Name
City
State
Zip Code
Contact Phone Number/fax number
Email:
* By reporting health insurance availability information below, your company may avoid receiving unnecessary forms.
Do you offer any employees the option of purchasing dependent or family health care coverage as a benefit of their employment or is
coverage available through a union? Yes [ ] No [ ]
Union name and phone number:
If yes, is there a waiting period for eligibility? Yes [ ] No [ ] If Yes, how long?
*Employee=s name and SSN must exactly match what is on their SSN card. Please identify first, middle, and last name.
Employee Information
* Social Security Number
*First Work Date
Date of Birth
* First Name
Middle Name
* Last Name
* Employee Street/Mailing Address
* City
* State
* Zip Code
Employee email address
Home phone
Cell phone
Print
Reset
Page 2 of 3- OREGON NEW HIRE REPORTING FORM
CSF 01 0580 (Rev. 01/01/14)
New Hire Reporting - continued
* Employer Name
* Employer Federal ID Number
* Contact Name
* Contact Phone Number
* Social Security Number
*First Work Date
Date of Birth
* First Name
Middle Name
* Last Name
* Employee Street/Mailing Address
* City
* State
* Zip Code
Employee email address
Home phone
Cell phone
* Social Security Number
*First Work Date
Date of Birth
* First Name
Middle Name
* Last Name
* Employee Street/Mailing Address
* City
* State
* Zip Code
Employee email address
Home phone
Cell phone
* Social Security Number
*First Work Date
Date of Birth
* First Name
Middle Name
* Last Name
* Employee Street/Mailing Address
* City
* State
* Zip Code
Employee email address
Home phone
Cell phone
* Social Security Number
*First Work Date
Date of Birth
* First Name
Middle Name
* Last Name
* Employee Street/Mailing Address
* City
* State
* Zip Code
Employee email address
Home phone
Cell phone
Page 3 of 3 - OREGON NEW HIRE REPORTING FORM
CSF 01 0580 (Rev. 01/01/14)
Instructions
How to fill out the New Hire Reporting Form
Employer Info:
Please make sure you use the same Federal Tax ID Number (FEIN) that you use to report your quarterly wage
information.
Including a contact person and phone number is required. Including email address is optional but extremely helpful,
particularly if there is missing required information or the required information is unclear and employer services need
to contact the employer.
Different address and contact information for withholding orders?
Please fill out this box if your company has a payroll service or another address where income withholding orders
should be sent.
Is health care coverage available?
If your company doesn’t offer dependent or family health care coverage to any of your employees, please mark the
ANo@ box. If your company does offer dependent or family health care coverage to any of your employees, or if your
employee is represented by a union and the union offers dependent or family health care coverage to any of your
employees, please mark the AYes@ box. If yes is marked, please provide the waiting period, if any, and provide the
union=s name, telephone number and the waiting period, if known.
Employee:
Please make sure the employee=s name and the Social Security Number match the employee=s Social Security card,
including first, middle and last names.
Dates of birth are optional but very helpful in verification of employment and missing or unclear new hire information.
An employee address should be a valid address as used by the U.S. Postal Service.
Reporting Helpful Hints
Oregon law [ORS 25.790, OAR 137-55-4040] requires all employers to submit their new hire reports within 20 days after the
employee=s hire date. This includes rehires. ARehire@ means to re-employ any individual who was laid off, separated, furloughed,
granted a leave without pay, or terminated from employment for more than 60 days.
If you have never reported before, please report only those current employees for whom you have not reported quarterly wage
information to the Oregon Employment Department. Do not submit a list of all current employees as this creates unnecessary
processing of duplicate information.
We have a variety of methods available for use in reporting:
$ www.oregonchildsupport.gov/employers. Use this secure Employer Portal via our website.
$ Electronic filing through FilesDirect.com. This secure website is free and user friendly. Contact employer services at
1-866-907-2857 for file specifications.
$ Complete, print and fax or mail the information on the PDF form found on our website at:
www.oregonchildsupport.gov/forms/docs/csf010580.pdf (Our contact information is on the top of the attached form.)
Complete the attached form making sure the information is legible. Keep in mind that if the report is faxed, it can distort the
information received.
Due to security concerns, we are not accepting new hire reports via e-mails.
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Oregon New Hire Reporting Form Oregon New Hire Reporting Form (CSF 010580)

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Completed 20 November 2019

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