Provide Information (WHBR)

Employers may be asked to provide information about an employee or independent contractor's earnings and benefits through a Wage and Health Benefits Report (PDF). When you receive a Wage and Health Benefits Report (WHBR), complete it and return it by mail or fax (518-320-1081) within 10 business days—even if the person named on the form does not work for you.

Fax the completed WHBR to: 518-320-1081

Mail the completed WHBR to:

NYS Child Support Processing Center
PO Box 15368
Albany NY 12212-5368

You must return the form even if the person named on the form never worked for you or no longer works for you.

New York State law (Social Services Law Sections 111-h (9), 111-r, 111-s, and 143) requires that you respond to our request for this information, and you may be fined if you do not return the completed form within 10 business days of the date on the form.

The WHBR contains five sections and requests the following types of information:

  1. Employer Information
  2. Employee Information
  3. Compensation and Non-Health Insurance Benefit Information
  4. Health Insurance Benefit Information
  5. Certification

Section 1. Employer Information

Section 1 asks you to provide your company's or your organization's contact telephone number and email. If any of the other information is incorrect—employer name, Federal Employer Identification Number (FEIN) or mailing address for income withholding orders—please provide the correct information. This helps us make sure that our records are accurate and keeps you from receiving duplicate documents.

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Section 2. Employee Information

Section 2 asks for information about the employee or independent contractor, including date of hire, pay rate, work days and hours, mailing address, and phone number. Please provide all the information you have. This information can help us locate a parent.

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Section 3. Compensation and Non-Health Insurance Benefit Information

Section 3 asks for information about the employee or independent contractor's wages, deductions, and certain specific types of benefits which the employee or independent contractor may be entitled to receive. If the employee no longer works for you, include the most recent year's information. This information helps us to make sure any order for support is fair and reasonable, based on what the parent can afford to pay.

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Section 4. Health Insurance Benefit Information

Section 4 asks for information about health insurance benefits for which the employee or independent contractor may be eligible. Even if the employee is not currently enrolled in a health care plan, please include the costs for any plans your company may offer. If the employee is ordered to provide support and health for dependents in the future, this information helps to determine how much the employee can afford to pay.

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Section 5. Certification

Section 5 asks you to certify that you have completely and accurately provided the information requested, to sign and date the form, and to provide contact information.

You must return the WHBR form within 10 business days of the date on the form.