Record Identifier Format Version Number Employee First Name Employee Middle Name Employee Last Name Employee Name Suffix Employee SSN# Employee Address Line 1 Employee Address Line 2 Employee Address Line 3 Employee City Employee State Employee Postal Code Employee Zip+4 Employee Country Code Employee Date of Birth Employee Date of Hire Employee State of Hire Is Medical Insurance Available to Employee? Do Employer Benefits Include Medical? Employer FEIN Employer Name Employer DBA Employer Address Line 1 Employer Address Line 2 Employer Address Line 3 Employer City Employer State Employer Postal Code Employer Zip+4 Employer Country Code Employer Phone Number Employer Phone Extension Employer Contact Name Employer Multistate Indicator Employee Salary Employee Salary Frequency