Field | Type | Length | Start Position | End Position | Opt'l/Req'd | Comments |
EMPLOYEE-NAME-GROUP EMPLOYEE-FIRST-NAME | A | 16 | 1 | 16 | M | AT LEAST 1 CHAR, NO SPECIAL CHARS. |
EMPLOYEE-MID-NAME | A | 16 | 17 | 32 | O | IF NON BLANK AT LEAST CHAR, NO SPECIAL CHARS |
EMPLOYEE-LAST-NAME | A | 30 | 33 | 62 | M | AT LEAST 1 CHAR, NO SPECIAL CHARS.
|
EMPLOYEE-SUFFIX | A | 3 | 63 | 65 | O | SR, JR, I, II, III, IV, V |
EMPLOYEE-FIRST-SSN | N | 9 | 66 | 74 | M | AS REPORTED BY EMPLOYEE |
EMPLOYEE-ADDRESS-GROUP EMPLOYEE-ADDRESS-1 | A/N | 40 | 75 | 114 | M | NON BLANK |
EMPLOYEE-ADDRESS-2 | A/N | 40 | 115 | 154 | O | IF ADDRESS < 40 CHARS DO NOT CONCATENATE INTO 1 LINE |
EMPLOYEE-ADDRESS-3 | A/N | 40 | 155 | 194 | O | |
EMPLOYEE-ADDRESS-CITY | A | 25 | 195 | 219 | M | AT LEAST 2 CHAR, NO SPECIAL CHARS. |
EMPLOYEE-ADDRESS-STATE | A | 2 | 220 | 221 | M | VALID STATE OR TERRITORRY ABBREVIATION |
EMPLOYEE-ADDRESS-ZIP-1 | N | 5 | 222 | 226 | M | MUST BE NUMERIC.
|
EMPLOYEE-ADDRESS-ZIP-EXT | A/N | 4 | 227 | 230 | O | IF NOT PRESENT ZERO FILL, IF PRESENT MUST BE NUMERIC |
EMPLOYEE-FOREIGN-ADDRESS-GROUP EMPLOYEE-COUNTRY-CODE | A/N | 2 | 231 | 232 | M | IF FOREIGN ADDRESS, REFER TO U.S. DEPARTMENT OF COMMERCE FIPS CODE MANUAL, NATIONAL INSTITUTE OF STANDARS AND TECHNOLOGY, FIPS PUB 10-4 (APRIL 1995) |
EMPLOYEE-COUNTRY-NAME | A/N | 25 | 233 | 257 | O | IF PRESENT AT LEAST 2 CHARS. |
EMPLOYEE-COUNTRY-ZIP | A/N | 15 | 258 | 272 | O | |
EMPLOYEE-MARITAL-STATUS | A | 1 | 273 | 273 | O | M=MARRIED, S=SINGLE |
EMPLOYEE-HIRE-DATE | N | 8 | 274 | 281 | R | CCYYMMDD, FIRST DAY EMPLOYEE WORKS FOR PAY |
EMPLOYER-NAME | A/N | 45 | 282 | 326 | M | AT LEAST TWO CHARACTERS |
EMPLOYER-ADDRESS-GROUP EMPLOYER-ADDRESS-1 | A/N | 40 | 327 | 366 | M | EMPLOYER ADDRESS FROM W-4 NON BLANK |
EMPLOYER-ADDRESS-2 | A/N | 40 | 367 | 406 | O | IF ADDRESS < 40 CHARS DO NOT CONCATENATE INTO 1 LINE |
EMPLOYER-ADDRESS-3 | A/N | 40 | 407 | 446 | O | |
EMPLOYER-ADDRESS-CITY | A | 25 | 447 | 471 | M | AT LEAST 2 CHAR, NO SPECIAL CHARS. |
EMPLOYER-ADDRESS-STATE | A | 2 | 472 | 473 | M | VALID STATE OR TERRITORY ABBREVIATION |
EMPLOYER-ADDRESS-ZIP-1 | N | 5 | 474 | 478 | M | MUST BE NUMERIC |
EMPLOYER-ADDRESS-ZIP-EXT | N | 4 | 479 | 482 | O | IF NOT PRESENT ZERO FILL, IF PRESENT MUST BE NUMERIC |
EMPLOYER-FOREIGN-ADDRESS-GROUP EMPLOYER-COUNTRY-CODE | A/N | 2 | 483 | 484 | M | IF FOREIGN ADDRESS, REFER TO U.S. DEPARTMENT OF COMMERCE FIPS CODE MANUAL, NATIONAL INSTITUTE OF STANDARS AND TECHNOLOGY, FIPS PUB 10-4 (APRIL 1995) |
EMPLOYER-COUNTRY-NAME | A/N | 25 | 485 | 509 | O | IF PRESENT AT LEAST 2 CHARS |
EMPLOYER-COUNTRY-ZIP | A/N | 15 | 510 | 524 | O | |
FEDERAL-EIN | N | 9 | 525 | 533 | M | FEDERAL EMPLOYER IDENTIFICATION NUMBER |
STATE-EIN | A/N | 12 | 534 | 545 | R | STATE EIN AND LEFT JUSTIFY |
EMPLOYEE-OCUPATION | A | 20 | 546 | 565 | R | JOB TITLE |
EMPLOYEE-SALARY | N | 9 | 566 | 574 | O | GROSS AMT PAID PER EMPLOYEE-SALARY-FREQUENCY, LAST 2 POSITIONS ARE DECIMAL PLACES NOT NEGATIVE VALUES ZEROES ARE ALLOWED. |
EMPLOYEE-SALARY-FREQUENCY | A | 2 | 575 | 576 | O | AN=ANNUAL BI=BIWEEKLY BM=BIMONTHLY OT=ONE TIME QT=QUARTERLY SA=SEMI-ANNUAL SM=SEMI-MONTHLY WK=WEEKLY |
EMPLOYEE-HIRE-STATE | A | 2 | 577 | 578 | O | VALID STATE OR TERRITORRY ABBREVIATION IN WHICH EMPLOYEE IS HIRED TO WORK |
EMPLOYEE-BIRTH-DATE | N | 8 | 579 | 586 | O | CCYYMMDD, IF NOT PRESENT ZERO FILL. |
EMPLOYEE-INSURANCE-IND | A | 1 | 587 | 587 | O | Y=YES THE EMPLOYEE AND/OR FAMILY HAS PURCHASED INSURANCE THROUGH EMPLOYER N=NO THE EMPLOYEE AND/OR FAMILY HAS NOT PURCHASED INSURANCE THROUGH EMPLOYER |
EMPLOYEE-SERVICE-ADDRESS-GROUP SERVICE-ADDRESS-1 | A/N | 40 | 588 | 627 | O | THIS IS THE EMPLOYER ADDRESS TO WHICH THE INCOME ASSIGNMENT SHOULD BE SENT IF DIFFERENT FROM THE EMPLOYER-ADDRESS-GROUP NON BLANK |
SERVICE-ADDRESS-2 | A/N | 40 | 628 | 667 | O | IF ADDRESS < 40 CHARS DO NOT CONCATENATE |
SERVICE-ADDRESS-3 | A/N | 40 | 668 | 707 | O | |
SERVICE-ADDRESS-CITY | A | 30 | 708 | 732 | O | AT LEAST 2 CHAR, NO SPECIAL CHARS. |
SERVICE-ADDRESS-STATE | A | 2 | 733 | 734 | O | VALID STATE OR TERRITORY ABBREVIATION |
SERVICE-ADDRESS-ZIP-1 | N | 5 | 735 | 739 | O | MUST BE NUMERIC |
SERVICE-ADDRESS-ZIP-EXT | N | 4 | 740 | 743 | O | IF NOT PRESENT ZERO FILL; IF PRESENT MUST BE NUMERIC |
SERVICE-FOREIGN-ADDRESS-GROUP SERVICE-COUNTRY-CODE | A/N | 2 | 744 | 745 | O | IF FOREIGN ADDRESS, REFER TO U.S. DEPARTMENT OF COMMERCE FIPS CODE MANUAL, NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY, FIPS PUB 10-4 (APRIL 1995) |
SERVICE-COUNTRY-NAME | A/N | 25 | 746 | 770 | O | IF PRESENT AT LEAST 2 CHARS |
SERVICE-COUNTRY-ZIP
| A/N | 15 | 771 | 785 | O | |
EMPLOYER-CONTACT-FIRST-NAME
| A | 16 | 786 | 801 | O | NAME OF CONTACT WHO WILL ADMINISTER INCOME ASSIGNMENT.
|
EMPLOYER-CONTACT-LAST-NAME
| A | 21 | 802 | 822 | O | NAME OF CONTACT WHO WILL ADMINISTER INCOME ASSIGNMENT.
|
EMPLOYER-CONTACT-PHONE-NUM
| N | 10 | 823 | 832 | O | INCLUDE AREA CODE, NO HYPHENS, PHONE NUMBER OF EMPLOYER-CONTACT.
|
FILLER
| A | 300 | 833 | 1132 | M | SPACES TO BE USED FOR FUTURE VERSIONS.
|