General Services Agency


Employers covered by the Health Care Security Ordinance (HCSO) and the Fair Chance Ordinance must submit the 2014 Employer Annual Reporting Form by April 30, 2015.

Failure to report on Health Care Expenditures constitutes a violation of §14.3 (b) of Chapter 14 of the San Francisco Administrative Code. Violators shall be subject to a penalty of $500 per quarter until the Form is submitted. In addition, the new Fair Chance Ordinance, which became effective August 13, 2014, also requires covered employers to report on compliance with that law.

Please note that you will not be able to save this form and return to it later. Before you begin, carefully read the Instructions and review the information you will need to complete the form.

If you need additional assistance, call (415) 554-7892.

Enter your Business Account Number and click "Validate.” This number can be found on the business registration certificate(s) issued by the San Francisco Treasurer & Tax Collector, on the letter recently mailed to you about submitting this Form, or on the San Francisco Data website.
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Please enter your 7-digit Business Account Number.

Business Account Number          

Business Name:  
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