New Client Intake

Complete all sections for onboarding a new group.

Group Demographic Information

Group / Company Name

Tax ID

Corporation Type

S Corp

LLC

C Corp

Other

Street Address (Situs State)

Total Group Size (# of lives)

Authorize to Contact Payroll Company

MEC Included

Client Contacts

VP Information

Name

Title

Phone

Owner Information

Name

Title

Phone

Payroll Contact Information

Name

Title

Phone

Team Management Information

Name

Title

Phone

Primary Billing Contact

Name

Title

Phone

Payroll Information

Frequency

Paycheck Issue Day

Payroll Submission Lead Time (e.g. 3 business days)

Payroll Calendar Provided

Payroll Vendor / System Information

Vendor

Vendor Contact Name

Contact Email

Company Code

USHC & Compliance

Will USHC be handling open enrollment?

Will USHC be monitoring compliance?

If No — how will compliance be handled?

Additional Locations Requiring Separate Banking FEIN

Yes — there are additional locations