| Field | Type | Length | Start Position | End Position | Status | Comments |
| Record Identifier | A/N | 2 | 1 | 2 | M | ‘W4” |
| Employee SSN | N | 9 | 3 | 11 | M | As reported by employee, no dashes. |
| Employee First Name | A | 16 | 12 | 27 | M | No special characters (i.e. punctuation) |
| Employee Middle Name | A | 16 | 28 | 43 | O | If non-blank, must be at least 1 character. No punctuation |
| Employee Last Name | A | 30 | 44 | 73 | M | No punctuation, except hyphens |
Employee Address
Street Address (line 1) | A/N | 40 | 74 | 113 | M | Non-blank |
| Street Address (line 2) | A/N | 40 | 114 | 153 | O | If the address line is less than 40 characters do not concatenate into one line. |
| Street Address (line 3) | A/N | 40 | 154 | 193 | O | |
| City | A | 25 | 194 | 218 | M | At least 2 characters, no punctuation except hyphens |
| State | A | 2 | 219 | 220 | M | Valid state or territory abbreviation |
| Zip Code (1) | N | 5 | 221 | 225 | M | Must be numeric |
| Zip Code (2) | A/N | 4 | 226 | 229 | O | If present, must be numeric |
Employee Foreign Address
Foreign Country Code | A/N | 2 | 230 | 231 | O | M for foreign address. Refer to U.S. Department of Commerce FIPS code manual, National Institute of Standards and Technology, FIPS PUB 10-4 (April 1995) |
| Foreign Country Name | A/N | 25 | 232 | 256 | O | If present, at least two characters |
| Foreign Zip Code | A/N | 15 | 257 | 271 | O | |
| Employee Date of Birth | N | 8 | 272 | 279 | M | Format - YYYYMMDD |
| Employee Date of Hire | N | 8 | 280 | 287 | M | Format - YYYYMMDD |
| Employee State of Hire | A | 2 | 288 | 289 | M | Alphabetic state or territory abbreviation |
| Federal EIN | N | 9 | 290 | 298 | M | Federal Employer ID Number, no dashes |
| State EIN | A/N | 12 | 299 | 310 | O | If present must include no punctuation. If less than 12 characters, left justify |
| Employer Name | A/N | 45 | 311 | 355 | M | At least two characters |
Employer Address
Street Address (line 1) | A/N | 40 | 356 | 395 | M | FEIN address from W4
At least two characters |
| Street Address (line 2) | A/N | 40 | 396 | 435 | O | If the address line is less than 40 characters do not concatenate into one line. |
| Street Address (line 3) | A/N | 40 | 436 | 475 | O | |
| City | A | 25 | 476 | 500 | M | At least two characters |
| State | A | 2 | 501 | 502 | M | Valid state or territory abbreviation |
| Zip Code (1) | N | 5 | 503 | 507 | M | Must be numeric |
| Zip Code (2) | A/N | 4 | 508 | 511 | O | If present, must be numeric |
Employer Foreign Address
Foreign Country Code | A/N | 2 | 512 | 513 | O | M for foreign address. Refer to FIPS PUB 10-4 (April 1995) |
| Foreign Country Name | A/N | 25 | 514 | 538 | O | If present at least two characters |
| Foreign Zip Code | A/N | 15 | 539 | 553 | O | |
Employer Optional Address
Street Address (line 1) | A/N | 40 | 554 | 593 | O | Address where income withholding orders should be sent. |
| Street Address (line 2) | A/N | 40 | 594 | 633 | O | If the address line is less than 40 characters do not concatenate into one line. |
| Street Address (line 3) | A/N | 40 | 634 | 673 | O | |
| City | A | 25 | 674 | 698 | O | If present, at least two characters |
| State | A | 2 | 699 | 700 | O | If present, valid state or territory abbrev. |
| Zip Code (1) | A/N | 5 | 701 | 705 | O | If present, must be numeric |
| Zip Code (2) | A/N | 4 | 706 | 709 | O | If present, must be numeric |
Employer Optional Foreign Address
Foreign Country Code | A/N | 2 | 710 | 711 | O | Refer to FIPS PUB 10-4 (April 1995) |
| Foreign Country Name | A/N | 25 | 712 | 736 | O | If present, at least two characters |
| Foreign Zip Code | A/N | 15 | 737 | 751 | O | |
| Medical Insurance | A/N | 1 | 752 | 752 | O | “Y” for Yes or “N” for No depending on insurance availability from the employer. |
Georgia Employer Data
Employer Phone Number | A/N | 10 | 753 | 762 | O | With area code, left justified, no punctuation |
| Filler | A/N | 8 | 763 | 770 | | Spaces. Currently in use internally. |
| Employer Multi-State | A/N | 1 | 771 | 771 | O | “Y” for Yes, reporting as a multistate employer to GA or “N” for No |
| Filler | A/N | 14 | 772 | 785 | | Spaces. Currently in use internally. |
| Name of Medical Insurance Company | A/N | 16 | 786 | 801 | O | Provide the name of Medical Insurance Company, if medical insurance is available to the Employee, to prevent future inquiries regarding medical coverage. |