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New Hire Feed

Updated

Report Description 

This feed pulls the data of the newly hired employees for the purpose of required state new hire reporting; both multi-state or reporting to individual states. 

 

Parameters

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Filters

Filter Name Options Explanation
Start Check Date    
End Check Date    
Supplier List of Suppliers  Filters result by supplier
State Code List of States  Filters result by State Code
Include Only EE Worked in State  Yes, No

Yes: Filters the employees that are from the state selected in parameter State Code.

No: Filters the employees that are not from the state selected in parameter State Code.
Include Non W2 Employees  Yes, No

Yes: Filters the employees that are W2 employees

No: Filters the employees that are not W2 employees
No of Days for Rehire    

 

Fields

Field Name Explanation
Employer FEIN Pulls Supplier’s FEIN
Employer Street1 Pulls Supplier’s Street1
Employer Street2 Pulls Supplier’s Street2
Employer City Pulls Supplier’s City
Employer State Pulls Supplier’s State
Employer Zip Code Pulls Supplier’s Zip Code
Employer State EIN Pulls Supplier’s State EIN
Employer Phone Number Pulls Supplier’s Phone Number
Date of Hire

Pulls Employees minimum check date that falls within Start Date and End Date

OR

Pulls the minimum assignment Start Date within StartDateLessDaysForRehire* and End Date

OR

Pulls the HireDate from Employee> Dates if exists and falls between StartDateLessDaysForRehire* and End Date


* StartDateLessDaysForRehire = Start Date – (No of Days for Rehire+1)
Employee SSN Pulls Employee SSN
Employee First Name Pulls Employee’s First Name
Employee Middle Name Pulls Employee Middle Name
Employee Last Name Pulls Employee Last Name
State of Hire Pulls the State of Employee’s Branch
Date of Birth Pulls Employee’s Date of Birth
Sex Pulls Employee’s Gender
Employee Street1 Pulls Employee’s Primary Address: Street1
Employee Street2 Pulls Employee’s Primary Address: Street2
Employee City Pulls Employee’s Primary Address: City
Employee State Pulls Employee’s Primary Address: State
Employee Zip Code Pulls Employee’s Primary Address: Zip Code
Job Title Pulls Employee’s Job Title
Pay Period

Step 1: Pulls the pay period from Order level (For temp orders).

Step 2: Pulls the pay period from Customer Service Info (if the pay period is null)

Step 3: If the Assignment Rate has transaction type “Reg” then pay period = Hourly

Step 4: If the Assignment Rate does not have transaction types “Reg” or “Salary” then it looks for these transaction types in Order Rate. When transaction type = ‘Reg’ then pay period = Hourly.
Pay Rate

Pulls from Assignment Rate. If not present in Assignment Rate, then pulls from Order Rate.

(where the transaction types are Reg and Salary)
Worksite Street1 Pulls Employee’s Worksite Address: Street1
Worksite Street2 Pulls Employee’s Worksite Address: Street2
Worksite City Pulls Employee’s Worksite Address: City
Worksite State Pulls Employee’s Worksite Address: State
Worksite ZipCode Pulls Employee’s Worksite Address: ZipCode
Employer State EIN Pulls Employer State EIN

 

Format for States

Note: Blank values are pulled where the value for field is left empty.

State AK

  • Record Identifier
  • Employee SSN
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Foreign Country Name
  • Employee Foreign Zip Code
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Employer FEIN
  • Employer State EIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Foreign Country Name
  • Employer Foreign Zip Code
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code plus Extension
  • Employer Optional Foreign Country Code (use FIPS code if present)
  • Employer Optional Foreign Country Name
  • Employer Optional Foreign Zip Code
  • Blank Fill

 

State AL

  • Employee SSN
  • Employer Unemployment Compensation Tax Account Number
  • Employee Date of Hire
  • Employee Indicator (N=New Hire, R=Recall, W=Work Refusal)
  • Employee Full Name
  • Employee Street
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employer FEIN
  • Employer Name
  • Employer Street
  • Employer City
  • Employer State
  • Employer Zip Code
  • Blank Fill

 

State AR

  • Record Identifier
  • Format Version Number
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code
  • Employee Zip Code plus Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Blank Fill
  • Employer FEIN
  • Employer State EIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code
  • Employer Zip Code plus Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Phone Number
  • Employer Phone Extension
  • Employer Contact Name
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code
  • Employer Optional Zip Code plus Extension
  • Employer Optional Country Code
  • Employer Optional Phone Number
  • Employer Optional Phone Extension
  • Employer Optional Contact Name
  • Blank Fill

 

State AZ

  • Record Identifier
  • Format Version Number
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code
  • Employee Zip Code plus Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Employee has Health Insurance available (Y=Yes, N=No)
  • Employer Benefits include Health Insurance (Y=Yes, N=No)
  • Employer FEIN
  • Blank Fill
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code
  • Employer Zip Code plus Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Phone Number
  • Employer Phone Extension
  • Employer Contact Name
  • Employer DBA
  • Blank Fill
  • Employer MultiState Indicator (Y=Yes, N=No)
  • Employee Suffix (Jr, Sr, III)
  • Employee Salary (right justify zero fill, decimal necessary)
  • Employee Pay Frequency (H=Hourly, W=Weekly, B=Bi-Weekly, S=Semi-Monthly, M=Monthly, Y=Yearly)
  • Blank Fill

 

State CA

  • Record Identifier (E4)
  • Employer FEIN
  • Employer State EIN
  • Employer Branch Code
  • Employer Name
  • Employer Street
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Blank Fill
  • CountNewEmployee (No. of employees per the value of the branch property: Branch Code )
  • BranchCode (The value of the Branch property ‘Branch Code’. Here the branch is of Employee.)
  • SortOrder
  •  

 

State CO

  • Record Identifier
  • Format Version Number
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code
  • Employee Zip Code plus Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Blank Fill
  • Employer FEIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code
  • Employer Zip Code plus Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Phone Number
  • Employer Phone Extension
  • Employer Contact Name
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code
  • Employer Optional Zip Code plus Extension
  • Employer Optional Country Code
  • Employer Optional Phone Number
  • Employer Optional Phone Extension
  • Employer Optional Contact Name
  • Blank Fill
  • Employer MultiState Indicator (Y=Yes, N=No)
  • Employee Gender
  • Employee is currently employed (Y=Yes, N=No)
  • Employee Earned Income Tax Credit indicator (Y=Yes, N=No, U=Unknown)
  • Employee Suffix
  • Employer Fax Number
  • Employer Contact Email Address
  • Employee Salary (right justify zero fill, decimal necessary)
  • Employee Pay Frequency (H=Hourly, W=Weekly, B=Bi-Weekly, S=Semi-Monthly, M=Monthly, Y=Yearly)
  • Blank Fill
  •  

 

State CT

  • Employer CT UIN
  • Employer FEIN
  • Employer Name 1
  • Employer Name 2
  • Employer Street1
  • Employer Street2
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee SSN
  • Employee Job Title
  • Employee Street1
  • Employee Street2
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Date of Hire
  • Employee Worksite Street1
  • Employee Worksite Street2
  • Employee Worksite City
  • Employee Worksite State
  • Employee Worksite Zip Code
  •  

 

State DC

  • Record Identifier
  • Format Version Number
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code
  • Employee Zip Code plus Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Employee has Health Insurance available (Y=Yes, N=No)
  • Blank Fill
  • Employer FEIN
  • Employer State EIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code
  • Employer Zip Code Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Phone Number
  • Employer Phone Extension
  • Employer Contact Name
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code
  • Employer Optional Zip Code plus Extension
  • Employer Optional Country Code
  • Employer Optional Phone Number
  • Employer Optional Phone Extension
  • Employer Optional Contact Name
  • Blank Fill

 

State DE

  • Record Identifier
  • Employee Last Name
  • Employee First Name
  • Employee Middle Name
  • Employee Street1
  • Employee Street2
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee SSN
  • Employee Date of Hire
  • Employee left during Reporting Period (Y=Yes, N=No, U=Unknown)
  • Employee Date of Birth
  • Employee Gender
  • Employee State of Hire
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer FEIN
  • Blank Fill

 

State FL

  • Record Identifier
  • Format Version Number
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code
  • Employee Zip Code plus Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Employee has Health Insurance available (Y=Yes, N=No)
  • Blank Fill
  • Employer FEIN
  • Employer State UIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code
  • Employer Zip Code Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Phone Number
  • Employer Phone Extension
  • Employer Contact Name
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code
  • Employer Optional Zip Code plus Extension
  • Employer Optional Country Code
  • Employer Optional Phone Number
  • Employer Optional Phone Extension
  • Employer Optional Contact Name
  • Blank Fill
  • Employer MultiState Indicator (Y=Yes, N=No)
  • Blank Fill

 

State GA

  • Record Identifier (H4)
  • State FIPS Code
  • Blank Fill
  • Transmission Type
  • Blank Fill
  • Version Number
  • Date Stamp
  • Batch Number
  • Blank Fill

  • Record Identifier (W4)
  • Employee SSN
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Foreign Country Name
  • Employee Foreign Zip Code
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Employer FEIN
  • Employer State EIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Foreign Country Name
  • Employer Zip Code Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Foreign Country Name
  • Employer Foreign Zip Code
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code plus Extension
  • Employer Optional Foreign Country Code (use FIPS code if present)
  • Employer Optional Foreign Country Name
  • Employer Optional Foreign Zip Code
  • Employer Benefits include Health Insurance (Y=Yes, N=No)
  • Employer Phone Number
  • Blank Fill
  • Employer MultiState Indicator (Y=Yes, N=No)
  • Blank Fill
  • Name of Health Insurance Company

 

State HI

  • Record Identifier (H4)
  • Employer FEIN
  • Employer Name
  • Date Stamp
  • Batch Number
  • Employer Contact Name
  • Employer Phone Number

 

  • Record Identifier (W4)
  • Employer FEIN
  • Date Stamp
  • Batch Number
  • Employee SSN
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Employer FEIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code Extension

 

  • Record Identifier (T4)
  • Employer FEIN
  • Date Stamp
  • Batch Number
  • Data Record Count

 

State IA

  • Record Identifier (A)
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer State EIN
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code plus Extension
  • Employer Phone Number
  • Blank Fill

 

  • Record Identifier (B)
  • Employee Last Name
  • Employee First Name
  • Employee Middle Name
  • Employee Date of Birth
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee has Dependent Insurance available (Y=Yes, N=No)
  • Employee Health Insurance qualification date
  • Employee Date of Hire
  • Blank Fill

 

State ID

  • Record Identifier (1S)
  • Employee SSN
  • Employee Last Name
  • Employee First Name
  • Employee Middle Name
  • Employee Date of Hire
  • Employee Street1
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employer FEIN
  • Blank Fill
  • State FIPS Code
  • Blank Fill

 

  • Record Identifier (2S)
  • Employer State UIN
  • Employer FEIN
  • Employer Name
  • Employer Street1
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Blank Fill

 

State IL

  • Record Identifier
  • Employee SSN
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Blank Fill
  • Employment Status (1=Full-time, 2=Part-time, 3=Seasonal, 6=Self-employed)
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Employer FEIN
  • Blank Fill
  • Blank Fill
  • Blank Fill
  • Blank Fill
  • Blank Fill
  • Blank Fill

 

State IN

  • Record Identifier
  • Format Version Number
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code
  • Employee Zip Code Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Employee has Health Insurance available (Y=Yes, N=No)
  • Blank Fill
  • Employer FEIN
  • Blank Fill
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code
  • Employer Zip Code Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Phone Number
  • Employer Phone Extension
  • Employer Contact Name
  • Blank Fill
  • Employer MultiState Indicator (Y=Yes, N=No)
  • Blank Fill

 

State KS

  • Record Identifier (1=New hires, 2=Separations (optional), 3=Job refusals (optional))
  • Blank Fill
  • Employee SSN
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Blank Fill
  • Employee City
  • Employee State
  • Employee Zip Code Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Date of Hire
  • Employee Return Date
  • Employee Termination Reason Code (1=Quit, 2=Fired, 3=Leave of Absence, 4=Lack of work, 5 = Labor-Dispute, 6=Other)
  • Employee State of Hire
  • Comments
  • Employer FEIN
  • Blank Fill
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Blank Fill
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Blank Fill

 

State KY

  • Record Identifier
  • Format Version Number
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code
  • Employee Zip Code Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Employee has Health Insurance available (Y=Yes, N=No)
  • Blank Fill
  • Employer FEIN
  • Employer State EIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code
  • Employer Zip Code Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Address Type (HOFF=Headquarters Office, LADD=Local Address, PADD=Payroll Address, IADD=Insurance Address, FADD=Foreign Address)
  • Employer Contact First Name
  • Employer Contact Middle Name
  • Employer Contact Last Name
  • Employer Contact Title
  • Employer Contact Email Address
  • Employer Phone Number
  • Employer Phone Extension
  • Employer Fax Number
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code
  • Employer Optional Zip Code Extension
  • Employer Optional Foreign Country Code (use FIPS code if present)
  • Blank Fill

 

State LA

  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Suffix
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Foreign Country Name
  • Employee Foreign Zip Code
  • Employee Marital Status
  • Employee Date of Hire
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Foreign Country Name
  • Employer Foreign Zip Code
  • Employer FEIN
  • Employer State EIN
  • Employee Job Title
  • Employee Salary (right justify zero fill, decimal implied)
  • Employee Pay Frequency (AN=Annual, BI=Bi-Weekly, BM=Bi-Monthly, OT=One Time, QT=Quarterly, SA=Semi-Annual, SM=Semi-Monthly, WK=Weekly)
  • Employee State Of Hire
  • Employee Date of Birth
  • Employee has purchased Health Insurance through employer (Y=Yes, N=No)
  • Employee Optional Street1
  • Employee Optional Street2
  • Employee Optional Street3
  • Employee Optional City
  • Employee Optional State
  • Employee Optional Zip Code plus Extension
  • Employee Optional Foreign Country Code (use FIPS code if present)
  • Employee Optional Foreign Country Name
  • Employee Optional Foreign Zip Code
  • Employer Contact First Name
  • Employer Contact Last Name
  • Employer Phone Number
  • Blank Fill

 

State MA

  • Record Identifier (A)
  • Employer FEIN
  • Employer Name
  • Employer Street1
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Reporting Year
  • Employee Record Count
  • Blank Fill

 

  • Record Identifier (B)
  • Employee SSN
  • Employee Full Name
  • Employee Street1
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Date of Hire
  • Blank Fill

 

State MD

  • Record Identifier
  • Format Version Number
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code
  • Employee Zip Code Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Employee has Health Insurance available (Y=Yes, N=No)
  • Blank Fill
  • Employer FEIN
  • Employer State UIN
  • Blank Fill
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code
  • Employer Zip Code Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Phone Number
  • Employer Phone Extension
  • Employer Contact Name
  • Blank Fill
  • Employee Gender
  • Blank Fill
  • Employer Fax Number
  • Employer Contact Email Address
  • Employee Salary (right justify zero fill, decimal necessary)
  • Employee Pay Frequency (H=Hourly, W=Weekly, B=Bi-Weekly, S=Semi-Monthly, M=Monthly, Y=Yearly)
  • Blank Fill

 

State MI

  • Employee SSN
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employer Name
  • Employer FEIN
  • Employer Street1
  • Employer Street2
  • Employer City
  • Employer State
  • Employer Zip Code Extension
  • Employee Street1
  • Employee Street2
  • Employee City
  • Employee State
  • Employee Zip Code Extension
  • Blank Fill
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee Drivers License

 

State MN

  • Record Identifier
  • Format Version Number
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code
  • Employee Zip Code Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Employee is an Independent Contractor (Y=Yes, N=No)
  • Blank Fill
  • Employer FEIN
  • Blank Fill
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code
  • Employer Zip Code Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Phone Number
  • Employer Phone Extension
  • Employer Contact Name
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code
  • Employer Optional Zip Code Extension
  • Employer Optional Country Code
  • Employer Optional Phone Number
  • Employer Optional Phone Extension
  • Employer Optional Contact Name
  • Blank Fill

 

State MO

  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code Extension
  • Employee Country Code
  • Blank Fill
  • Employee Date of Hire
  • Employment Type (FULL, PART, TEMP)
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Country Code
  • Employer FEIN
  • Blank Fill
  • Blank Fill
  • Blank Fill
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code
  • Employer Optional Country Code
  • Employee Date of Birth
  • Employee State of Hire
  • Employee is eligible for Health Insurance (Y=Yes, N=No)
  • Blank Fill

 

State MS

  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Employee City
  • Employee State
  • Employee Zip Code Extension
  • Employee SSN
  • Employee Date Of Hire
  • Employee Date Of Birth
  • Employee Gender
  • Employee State of Hire
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Country Code
  • Employer FEIN
  • Employer State EIN
  • Employee Salary
  • Employee Pay Frequency (W=Weekly, B=Bi-Weekly, M=Monthly, A=Annual)
  • Employee is eligible for Health Insurance (Y=Yes, N=No)
  • Blank Fill

 

State MT

  • Record Identifier (1)
  • Date Stamp
  • Employee Record Count
  • Blank Fill

 

  • Record Identifier (2)
  • Employer Name
  • Employer FEIN
  • Employer State EIN
  • Employer Street1
  • Employer Street2
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Foreign Country Name
  • Employer Foreign Zip Code
  • Employer Contact Name
  • Employer Phone Number
  • Employer Phone Extension
  • Employer Fax Number
  • Employer Changed Address (Y=Yes)
  • Employer Changed Street1
  • Employer Changed Street2
  • Employer Changed City
  • Employer Changed State
  • Employer Changed Zip Code plus Extension
  • Employer Changed Foreign Country Name
  • Employer Changed Foreign Zip Code
  • Employee Date Of Hire
  • Employee SSN
  • Employee Last Name
  • Employee First Name
  • Employee Middle Name
  • Employee Street1
  • Employee Street2
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Foreign Country Name
  • Employee Foreign Zip Code
  • Employee Optional Street1
  • Employee Optional Street2
  • Employee Optional City
  • Employee Optional State
  • Employee Optional Zip Code plus Extension
  • Employee Optional Foreign Country Name
  • Employee Optional Foreign Zip Code
  • Employee Home Phone Number
  • Employee Work Phone Number
  • Employee Work Phone Extension
  • Employee Date Of Birth
  • Employee State of Hire
  • Employee has Health Insurance available (Y=Yes, N=No)
  • Employee Health Insurance qualification date

 

State NC

  • Employee SSN
  • Employee Last Name
  • Employee First Name
  • Employee Middle Name
  • Employee Street1
  • Employee Street2
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer FEIN
  • Employer State EIN
  • Employee Date Of Hire
  • Employee Date Of Birth
  • Blank Fill

 

State ND

  • Employee SSN
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee City
  • Employee State
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Date Of Birth
  • Employee Date Of Hire
  • Employee State of Hire
  • EMPLOYEE OFFERED HEALTH INSURANCE (Y/N)

 

State NE

  • Record Identifier (HR)
  • Employee Record Count
  • Date Stamp
  • Employer FEIN
  • Blank Fill

 

 

  • Record Identifier (RR)
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Contact Name
  • Employer Phone Number
  • Blank Fill

 

  • Record Identifier (NH)
  • Employee SSN
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee State of Hire
  • Employee Date of Hire
  • Employee Date of Birth
  • Employee is an Independent Contractor (Y=Yes, N=No)
  • Employee has Dependent Insurance available (Y=Yes, N=No)
  • Employee Health Insurance qualification date
  • Blank Fill

 

State NH

  • Record Identifier (E1)
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street2
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Foreign Country Name
  • Employer Foreign Zip Code
  • Employer State EIN
  • Employer FEIN
  • Blank Fill

 

  • Record Identifier (W4)
  • Employee SSN
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Foreign Country Name
  • Employee Date Of Birth
  • Employee Date Of Hire
  • Employee State of Hire
  • Employer State EIN
  • Employee is an Independent Contractor (Y=Yes, N=No)
  • Employer FEIN
  • Blank Fill

 

State NJ

  • Employee SSN
  • Employee Last Name
  • Employee First Name
  • Employee Middle Name
  • Employee Street1
  • Employee Street2
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Foreign Zip Code
  • Employee Date Of Hire
  • Employee Date Of Birth
  • Employee Gender
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Foreign Zip Code
  • Employer FEIN
  • Blank Fill

 

State NM

  • Record Identifier
  • Format Version Number
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code
  • Employee Zip Code Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Employee has Health Insurance available (Y=Yes, N=No)
  • Blank Fill
  • Employer FEIN
  • Blank Fill
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code
  • Employer Zip Code Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Phone Number
  • Employer Phone Extension
  • Employer Contact Name
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code
  • Employer Optional Zip Code Extension
  • Employer Optional Country Code
  • Employer Optional Phone Number
  • Employer Optional Phone Extension
  • Employer Optional Contact Name
  • Blank Fill

 

State NV

  • Employee SSN
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Foreign Country Name
  • Employee Foreign Zip Code
  • Employee Date Of Birth
  • Employee Date Of Hire
  • Employee State of Hire
  • Employer FEIN
  • Employer State EIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Foreign Country Name
  • Employer Foreign Zip Code
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code plus Extension
  • Employer Optional Foreign Country Code (use FIPS code if present)
  • Employer Optional Foreign Country Name
  • Employer Optional Foreign Zip Code
  • Blank Fill
  • Blank Fill

 

State NY

  • Record Identifier (1A)
  • Date Stamp
  • Employer Identification Number (StateEIN or FEIN)
  • Employer Name
  • Employer Street1
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Blank Fill

 

  • Record Identifier (1E)
  • Blank Fill
  • Employer Identification Number (StateEIN or FEIN)
  • Blank Fill
  • Employer Name
  • Blank Fill
  • Employer Street1
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Blank Fill

 

  • Record Identifier (1H)
  • Employee SSN
  • Employee Full Name
  • Employee Street1
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Date of Hire
  • Employee is eligible for Health Insurance (1=Yes, 2=No)
  • Employee Health Insurance eligibility date
  • Blank Fill

 

  • Record Identifier (1T)
  • Employee Record Count
  • Blank Fill

 

  • Record Identifier (1F)
  • Employee Record Count
  • Blank Fill

 

State OH

  • Record Identifier (1)
  • Date Stamp
  • Employee Record Count
  • Blank Fill

 

  • Record Identifier (2)
  • Employee SSN
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Foreign Country Name
  • Employee Foreign Zip Code
  • Employee Date Of Birth
  • Employee Date Of Hire
  • Employee State of Hire
  • Employee Gender
  • Employee left during Reporting Period (Y=Yes, N=No, U=Unknown)
  • Employer FEIN
  • Employee Earned Income Tax Credit indicator (Y=Yes, N=No, U=Unknown)
  • Employer State EIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Foreign Country Name
  • Employer Foreign Zip Code
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code plus Extension
  • Employer Optional Foreign Country Code (use FIPS code if present)
  • Employer Optional Foreign Country Name
  • Employer Optional Foreign Zip Code
  • Employee is an Independent Contractor (Y=Yes, N=No)
  • Employee Independent Contractor date payments will begin
  • Employee Independent Contractor length of time services performed (in months)
  • Blank Fill

 

State OK

  • Employer FEIN
  • Employer OK Account ID Number
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Foreign Country Name
  • Employer Foreign Zip Code
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code plus Extension
  • Employer Optional Foreign Country Code (use FIPS code if present)
  • Employer Optional Foreign Country Name
  • Employer Optional Foreign Zip Code
  • Employer Phone Number
  • Employer Phone Extension
  • Employee SSN
  • Employee Date Of Birth
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Foreign Country Name
  • Employee Foreign Zip Code
  • Employee Occupation
  • Employee Salary
  • Employee Pay Frequency (H=Hourly, W=Weekly, M=Monthly, Y=Yearly, C=Commission)
  • Employee Date Of Hire
  • Employee Hire Type (N=New, R=Recall)
  • Employee has Dependent Insurance available (Y=Yes, N=No)
  • Employee is currently employed (Y=Yes, N=No)
  • Employee State of Hire

 

State PA

  • Record Identifier
  • Employer FEIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Contact First Name
  • Employer Contact Last Name
  • Employer Phone Number
  • Employer Phone Extension
  • Employee SSN
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Date Of Birth
  • Employee State of Hire
  • Employee Date Of Hire
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Blank Fill
  • Blank Fill

 

State RI

  • Record Identifier (HR)
  • Employee Record Count
  • Date Stamp
  • Employer FEIN

 

  • Record Identifier (RR)
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code plus Extension

 

  • Record Identifier (NH)
  • Employee SSN
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee has Health Insurance available (Y=Yes, N=No)
  • Employee Health Insurance qualification date
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire

 

State SC

  • Employer FEIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Phone Number
  • Blank Fill
  • Record Identifier (R)

 

  • Employee SSN
  • Employee Last Name
  • Employee First Name
  • Employee Middle Name
  • Employee Street1
  • Employee Street2
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Date Of Birth
  • Employee Date Of Hire
  • Blank Fill
  • Record Identifier (E)

 

State SD

  • Record Identifier (HD)
  • Employer FEIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Phone Number
  • Employer Benefits include Health Insurance (Y=Yes, N=No)
  • Date Stamp
  • Blank Fill

 

  • Record Identifier (W4)
  • Employee SSN
  • Employee Last Name
  • Employee First Name
  • Employee Middle Name
  • Employee Street1
  • Employee Street2
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee State of Hire
  • Employee Date Of Hire
  • Employee Date Of Birth
  • Blank Fill

 

State TN

  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee SSN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer FEIN
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code
  • Employee Date Of Hire
  • Employee left during Reporting Period (Y=Yes, N=No)
  • Employee Date Of Birth
  • Employee Gender
  • Employee State of Hire
  • Employee Earned Income Tax Credit indicator (Y=Yes, N=No)
  • Employee has Health Insurance available (Y=Yes, N=No)
  • Employer Outlet or Store Number

 

State TX

  • Record Identifier (T4)
  • Employee Record Count
  • Blank Fill

 

  • Record Identifier (W4)
  • Employee SSN
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Foreign Country Name
  • Employee Foreign Zip Code
  • Employee Date Of Birth
  • Employee Date Of Hire
  • Employee State of Hire
  • Employer FEIN
  • Employer State EIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Foreign Country Name
  • Employer Foreign Zip Code
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code plus Extension
  • Employer Optional Foreign Country Code (use FIPS code if present)
  • Employer Optional Foreign Country Name
  • Employer Optional Foreign Zip Code
  • Blank Fill
  • Employee Salary
  • Employee Pay Frequency (H=Hourly, Q=Quarterly, M=Monthly, A=Annually, S=Semi-Monthly, B=Bi-Weekly, W=Weekly, T=Semi-Annually, O=One-Time)
  • Blank Fill

 

State UT

  • Record Identifier (HD)
  • Employer Name
  • Employer Street1
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Contact Name
  • Employer Phone Number
  • Employer Phone Extension
  • Blank Fill

 

  • Record Identifier (DK)
  • Employee SSN
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Foreign Country Name
  • Employee Foreign Zip Code
  • Employee Date Of Birth
  • Employee Date Of Hire
  • Employee State of Hire
  • Employer FEIN
  • Blank Fill
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Foreign Country Name
  • Employer Foreign Zip Code

 

State VA

  • Record Identifier
  • Format Version Number
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code
  • Employee Zip Code Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Employee has Health Insurance available (Y=Yes, N=No)
  • Blank Fill
  • Employer FEIN
  • Employer State EIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code
  • Employer Zip Code Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Phone Number
  • Employer Phone Extension
  • Employer Contact Name
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code
  • Employer Optional Zip Code Extension
  • Employer Optional Foreign Country Code (use FIPS code if present)
  • Employer Optional Phone Number
  • Employer Optional Phone Extension
  • Employer Optional Contact
  • Blank Fill

 

State VT

  • Record Identifier
  • Employee Last Name
  • Employee First Name
  • Employee Middle Name
  • Employee Street1
  • Employee Street2
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee SSN
  • Employee Date of Hire
  • Blank Fill
  • Employee Date of Birth
  • Blank Fill
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer FEIN
  • Blank Fill

 

State WA

  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Foreign Country Name
  • Employee Foreign Zip Code
  • Employee SSN
  • Employee Date of Birth
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer FEIN
  • Employee Date of Hire
  • Date Stamp
  • Blank Fill
  • Record Identifier

 

State WI

  • Employer FEIN
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer City
  • Employer State
  • Employer Zip Code plus Extension
  • Employer Foreign Country Name
  • Employer Foreign Zip Code
  • Employee SSN
  • Employee Last Name
  • Employee First Name
  • Employee Middle Name
  • Employee Street1
  • Employee Street2
  • Employee City
  • Employee State
  • Employee Zip Code plus Extension
  • Employee Foreign Country Name
  • Employee Foreign Zip Code
  • Employee Date Of Birth
  • Employee Date Of Hire
  • Employee State Of Hire
  • Blank Fill

 

State WV

  • Record Identifier
  • Format Version Number
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code
  • Employee Zip Code Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Blank Fill
  • Employer FEIN
  • Blank Fill
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code
  • Employer Zip Code Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Phone Number
  • Employer Phone Extension
  • Employer Contact Name
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code
  • Employer Optional Zip Code Extension
  • Employer Optional Country Code
  • Employer Optional Phone Number
  • Employer Optional Phone Extension
  • Employer Optional Contact Name
  • Blank Fill

 

State WY

  • Record Identifier
  • Format Version Number
  • Employee First Name
  • Employee Middle Name
  • Employee Last Name
  • Employee SSN
  • Employee Street1
  • Employee Street2
  • Employee Street3
  • Employee City
  • Employee State
  • Employee Zip Code
  • Employee Zip Code Extension
  • Employee Foreign Country Code (use FIPS code if present)
  • Employee Date of Birth
  • Employee Date of Hire
  • Employee State of Hire
  • Blank Fill
  • Employer FEIN
  • Blank Fill
  • Employer Name
  • Employer Street1
  • Employer Street2
  • Employer Street3
  • Employer City
  • Employer State
  • Employer Zip Code
  • Employer Zip Code Extension
  • Employer Foreign Country Code (use FIPS code if present)
  • Employer Phone Number
  • Employer Phone Extension
  • Employer Contact Name
  • Employer Optional Street1
  • Employer Optional Street2
  • Employer Optional Street3
  • Employer Optional City
  • Employer Optional State
  • Employer Optional Zip Code
  • Employer Optional Zip Code Extension
  • Employer Optional Country Code
  • Employer Optional Phone Number
  • Employer Optional Phone Extension
  • Employer Optional Contact Name
  • Blank Fill

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