Form 1 Multistate Employer Registration Form

OMB Control No: 0970-0166 OMB Expiration Date: xx/xx/xxxx

Multistate Employer Registration Form for New Hire Reporting

If you are an employer with employees in two or more states and you want to report all new hires to one state, you must register with the U.S. Department of Health and Human Services. You have two options to register.

Note: To report new hires to a single designated state or territory, you must register as a multistate employer.

How to Register as a Multistate Employer or Make Changes to a Previous Registration

Option 1: Register as a new user on the Office of Child Support Enforcement (OCSE) Child Support Portal or login to access the Multistate Employer Registration (MSER).

Option 2: Fill out and email this form to msedb@acf.hhs.gov.

Note: If you are a third-party provider, your clients must have employees in two or more states to register as a multistate employer.

Reporting Requirement

Federal law (42 U.S.C. § 653A(b)(1)(A)) requires employers to provide the following information about newly hired or rehired employees to the State Directory of New Hires in the state where the employee works:

• Employee’s name, address, Social Security number, and the date of hire (the date services for remuneration were first performed by the employee)

• Employer’s name, address, and Federal Employer Identification Number (FEIN)

If you are an employer with employees working in two or more states, and you will transmit the required information or reports magnetically or electronically, you can use this form to designate one state where any employee works to transmit all new hire reports to the State Directory of New Hires.

Cancel Registration

If you are no longer a multistate employer or are a multistate employer but no longer report to a single state, select the Cancel Registration check box below.

Registration Information

Note: All required fields are followed by a red asterisk (*).

1. Enter your company's FEIN without a hyphen. This is the nine-digit number used by the IRS to identify your company.

FEIN *:

2. Enter today's date in MM/DD/YYYY format.

Date *

3. Enter your company's legal name. This is the name associated with the FEIN in item 1.

Employer Name *:

Enter your company's address, including city, state, and ZIP code. This is the address associated with the FEIN in item 1. If your company's FEIN address is a foreign address, enter the country's name and postal code.

Employer Address *:

City *: State *:

ZIP Code *:

^{(For foreign addresses only)} Country Name: _{Country Postal Code:}

Is this also the address for mailing Income Withholding for Support Orders (IWOs)? ^{Yes No}

Enter your name, work email address and phone number.

Name *:

Email:

Phone:

Subsidiary Information

To enter information about all your company's subsidiaries (subsidiaries are companies owned or controlled by another company):

• Go to https://www.acf.hhs.gov/css/training-technical-assistance/organization-multiple-fein-templates to access the OCSE Portal Organization FEIN Template to list your subsidiaries and submit with this form.

Designate Reporting State

4. Select the state or U.S. territory to submit new hires to. You cannot report new hires to the OCSE Child Support Portal. You must report new hires to the Reporting State agency.

You must have at least one employee working in the state or territory you designate.

Reporting State or U.S. territory *

Select Operating States

5. Select all other states and U.S. territories where you have one or more employees currently working.

• Do not include the previously selected reporting state from #5.

• *Select at least one other state or territory to register as a multistate employer.

All States and Territories
Alabama	Alaska	Arizona	Arkansas	California	Colorado
Connecticut	Delaware	District of Columbia	Florida	Georgia	Guam
Hawaii	Idaho	Illinois	Indiana	Iowa	Kansas
Kentucky	Louisiana	Maine	Maryland	Massachusetts	Michigan
Minnesota	Mississippi	Missouri	Montana	Nebraska	Nevada
New Hampshire	New Jersey	New Mexico	New York	North Carolina	North Dakota
Ohio	Oklahoma	Oregon	Pennsylvania	Puerto Rico	Rhode Island
South Carolina	South Dakota	Tennessee	Texas	Utah	Vermont
Virgin Islands	Virginia	Washington	West Virginia	Wisconsin	Wyoming

6. Sign this form.

By completing this form, I certify the information provided is accurate and that I am authorized to complete this form on my company's behalf.

Signature of the person completing this form*: Date*:

Submitting this form to the U.S. Department of Health and Human Services, or by registering as a Multistate Employer on the OCSE Portal, meets the requirement to supply written notice about your choice to report new hire information to only one state and to identify that state (42 U.S.C. § 653A(b`)(1)(B)).

Where to Submit This Form

Email the completed form to: msedb@acf.hhs.gov.

You may also register and make changes to a previous MSER via the OCSE Child Support Portal (https://ocsp.acf.hhs.gov/csp/home/employer)

For general information about the employer's role in the child support program, visit the OCSE Employer Services website at https://www.acf.hhs.gov/css/employers.

Note: If your company merges with or acquires another company or has other changes that may affect this reporting requirement, send a revised form with the new or updated information. You can also update this information online at https://ocsp.acf.hhs.gov/csp/home/employer.

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this voluntary information collection is for multistate employers to register to submit their new hire reports to one state or make changes to a previous registration. Public reporting estimated burden for this collection of information is estimated to average .050 hours to submit the MSER form per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. As provided by 42 U.S.C. § 653(m)(2), confidential information collected for this program is accessed only by authorized users. A federal agency may not conduct or sponsor an information collection without a valid OMB Control Number. No individual or entity is required to respond to, nor shall an individual or entity be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, without a current valid OMB Control Number. If you have any comments on this collection of information, please contact OCSEFedSystems@acf.hhs.gov.

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