Michigan Department of Treasury
Michigan New Hire
P.O. Box 85010
State of Michigan New Hire Reporting Form
Lansing, MI 48908-5010
Federal law requires public (State and local) and private employers to report all newly hired or rehired employees who are working
Phone: (800) 524-9846
in Michigan to the State of Michigan.
This form is recommended for use by all employers who do not report electronically.
Fax: (877) 318-1659
A newly hired employee is an individual not previously employed by you, and
a rehired employee is an individual who was previously employed by you but
separated from employment for at least 60 consecutive days.
Reports must be submitted within 20 days of hire date (i.e., the date services
are rst performed for pay).
This form may be photocopied as necessary. Many employers preprint employer
information on the form and have the employee complete the necessary
information during the hiring process.
When reporting new hires with special exemptions, please use the MI-W4 form.
Online and other electronic reporting options are available at:
Employers who report electronically and have employees working in two or
more states may register as a multi-state employer and designate a single state
to which new hire reports will be transmitted. Information regarding multi-state
registration is available online at: http://www.acf.hhs.gov/programs/cse/
newhire/employer/private/newhire.htm#multi or call
Reports will not be processed if mandatory information is missing. Such reports
willl be rejected and you must correct and resubmit them.
For optimum accuracy, please print neatly in all capital letters and avoid contact
with the edge of the box. See sample below.
A B C 1 2 3
Date of Birth:
EMPLOYEE Information (Mandatory)
Driver’s License No:
Social Security Number:
EMPLOYER Information (Mandatory)
Federal Employer Identiﬁcation Number (FEIN):
Ref: Social Security Act section 453A and the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 (P.L. 104-193), effective October 1, 1997.