Form W-11 Employee Affidavit for HIRE Act Benefits
This file contains the Form W-11, which is used to confirm that an employee is a qualified employee under the HIRE Act. It outlines the necessary requirements and instructions for completion. Retain this form for your records and do not submit it to the IRS.
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How do I fill this out?
To fill out the W-11 form, start by providing your personal information, including your name and Social Security number. Next, indicate your first date of employment and the name of your employer. Finally, ensure that you sign the affidavit declaration under penalties of perjury.

How to fill out the Form W-11 Employee Affidavit for HIRE Act Benefits?
1
Provide your name and Social Security number.
2
Enter your first date of employment.
3
Write the name of your employer.
4
Sign the form declaring the statements are true.
5
Keep the form for your records.
Who needs the Form W-11 Employee Affidavit for HIRE Act Benefits?
1
New employees who want to claim the HIRE Act benefits.
2
Employers seeking to validate new hires for tax exemptions.
3
Payroll departments managing employee tax information.
4
HR personnel needing to complete employee documentation.
5
Tax professionals advising clients on tax benefits.
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1
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2
Click on the text fields to edit your information.
3
Adjust any dates or signatures as necessary.
4
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What are the instructions for submitting this form?
Submit this form by keeping it in your records as it is not required to be sent to the IRS. Ensure that each employee completes their part and signs under penalties of perjury. To maintain proper documentation, you might want to keep a copy accessible along with other payroll records.
What are the important dates for this form in 2024 and 2025?
The HIRE Act was applicable for employers who hired qualified employees after February 3, 2010, and before January 1, 2011. Ensure to keep track of any IRS updates for ongoing compliance. No significant changes to deadlines are expected in 2024 and 2025 regarding this form.

What is the purpose of this form?
Form W-11 serves to help employers validate their hiring of qualified employees under the HIRE Act. This affidavit confirms that an employee meets specific criteria, including prior unemployment status. It ultimately provides essential documentation for claiming payroll tax exemptions and retention credits.

Tell me about this form and its components and fields line-by-line.

- 1. Employee Name: The full name of the employee filling out the form.
- 2. Social Security Number: The employee's unique social security identification.
- 3. First Date of Employment: The official start date of the employee with the employer.
- 4. Name of Employer: The official name of the company employing the individual.
- 5. Employee Signature: The employee must sign here to affirm the truthfulness of the information provided.
What happens if I fail to submit this form?
Failure to submit the W-11 form may result in disqualification from accessing tax benefits under the HIRE Act. Employers could face challenges in claiming exemptions and credits if the form is not accurately completed. This could lead to increased tax liability without the benefits.
- Loss of Tax Benefits: Inability to claim payroll tax exemptions or credits.
- Increased Tax Liability: Potentially higher taxes due to non-compliance.
- Legal Repercussions: Possible penalties for failure to adhere to tax regulations.
How do I know when to use this form?

- 1. New Employee Hiring: Validate tax benefits for newly hired employees.
- 2. Payroll Management: Streamline the payroll processing for qualified employees.
- 3. Tax Compliance: Meet IRS requirements for tax benefit claims.
Frequently Asked Questions
What is the purpose of the W-11 form?
The W-11 form certifies that an employee qualifies for tax benefits under the HIRE Act.
Who needs to fill out the W-11 form?
New employees who were unemployed and wish to claim tax benefits should fill out this form.
How do I download the PDF?
After editing, simply click the download button to save your PDF.
Can I share the completed PDF?
Yes, you can easily share the PDF via link or email.
Is the W-11 form mandatory?
If you want to claim HIRE Act benefits, completing the W-11 form is necessary.
What if I make a mistake on the form?
You can edit the PDF anytime prior to saving it.
Are there any penalties for misinformation?
Yes, providing fraudulent information may lead to penalties.
How do I sign the PDF?
Use the signature tool in PrintFriendly to electronically sign your document.
Can I print the W-11 form?
Absolutely! After editing, use the print option to obtain a paper copy.
What if I need assistance?
You can contact our support team for any help with the form.
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