Example: St Joseph County, 15-141-0000, is a county and also the tax jurisdiction that the employee is being paid for.
Therefore the user must set up IDTX with 15-141-0000 that points to the County with ‘St Joseph Cnty’.
‘W2 STATE MEDIA FILING’ | Must be set to ‘02’ to generate the County tax information in the Indiana State File |
‘W2 TAX TYPE CODE’ | Must be set to ‘D’ for County Tax |
‘W2 TAXING ENTITY’ | Enter the County Code assigned by Indiana State (2 characters only) |
Media Format | Federal File Format (set IDGV state media filing to ‘01’). |
Select State | Indiana, USA |
Column | Description | Source |
---|---|---|
1-2 | Record Identifier | Constant "RA" |
3-11 | Submitter’s Employer ID Number (EIN) | Required. Derived from the ‘SUB-ER-EIN’ IDFDV Field Identifier (seq 1000). Numeric only. |
12-19 | User Identification (User ID) | Required. Enter the eight-character BSO User ID assigned to the employee who is attesting to the accuracy of this file. |
20-23 | Software Vendor Code | Enter the numeric four-digit Software Vendor Identification Code assigned by the National Association of Computerized Tax Processors (NACTP). If "99 (Off-the-Shelf Software)" is entered in the Software Code field (positions 36-37) enter the Software Vendor Code. Otherwise, fill with blanks. |
24-28 | Blank | Fill with blanks. Reserved for SSA use. |
29 | Resub Indicator | Enter "1" if this file is being resubmitted. Otherwise, enter "0" (zero). |
30-35 | Resub Wage File Identifier (WFID) | If "1" was entered in Resub Indicator field (position 29), enter the WFID displayed on the notice SSA sent. Otherwise, fill with blanks. |
36-37 | Software Code | Enter "99" to indicate 'Off-the-Shelf Software' |
38-94 | Company Name | Enter the Company Name. Left justify and fill with blanks. |
95-116 | Location Address | Enter the company's location address (Attention, Suite, Room Number, etc). Left justify and fill with blanks |
117-138 | Delivery Address | Enter the company's delivery address (Street or Post Office Box). Example: 123 Main Street. Left justify and fill with blanks |
139-160 | City | Enter the company's city. Left justify and fill with blanks |
161-162 | State Abbreviation | Enter the company's State or commonwealth/territory. Use a postal abbreviation. For a foreign address, fill with blanks |
163-167 | ZIP Code | Enter the company's ZIP code. For a foreign address, fill with blanks |
168-171 | ZIP Code Extension | Enter the company's four-digit extension of the ZIP code. If not applicable, fill with blanks |
172-176 | Blank | Fill with blanks. Reserved for SSA use. |
177-199 | Foreign State/Province | If applicable, enter the company's foreign State/Province. Left justify and fill with blanks. Otherwise, fill with blanks. |
200-214 | Foreign Postal Code | If applicable, enter the company's foreign postal code. Left justify and fill with blanks. Otherwise, fill with blanks. |
215-216 | Country Code | If one of the following applies, fill with blanks: * One of the 50 States of the U.S.A. * District of Columbia * Military Post Office (MPO) * American Samoa * Guam * Northern Mariana Islands * Puerto Rico * Virgin Islands Otherwise, enter the applicable Country Code. |
217-273 | Submitter Name | Required. Enter the name of the organization's submitter to receive error notification if this file cannot be processed. Left Justify and fill with blanks. Derived from the ‘SUB-SUBM-NAME’ IDFDV Field Identifier (seq 1150). |
274-295 | Submitter Location Address | Enter the submitter's location address (Attention, Suite, Room Number, etc.) Left justify and fill with blanks. Derived from the ‘SUB-SUBM-LOCN’ IDFDV Field Identifier (seq 1160). |
296-317 | Submitter Delivery Address | Required. Enter the submitter's delivery address (Street or Post Office Box). Left justify and fill with blanks. Derived from the ‘SUB-SUBM-DELIV’ IDFDV Field Identifier (seq 1170). |
318-339 | Submitter City | Required. Enter the submitter's city. Left justify and fill with blanks. Derived from the ‘SUB-SUBM-CITY’ IDFDV Field Identifier (seq 1180). |
340-341 | Submitter State Abbreviation | Required. Enter the submitter's State or commonwealth/territory. Use a postal abbreviation. For a foreign address, fill with blanks. Derived from the ‘SUB-SUBM-STATE’ IDFDV Field Identifier (seq 1190). |
342-346 | Submitter ZIP Code | Required. Enter the submitter's ZIP Code. For a foreign address, fill with blanks. Derived from the ‘SUB-SUBM-ZIP’ IDFDV Field Identifier (seq 1200). |
347-350 | Submitter ZIP Code extension | Enter the submitter's four-digit extension of the ZIP code. If not applicable, fill with blanks. Derived from the ‘SUB-SUBM-ZIP-EXT’ IDFDV Field Identifier (seq 1210). |
351-355 | Blank | Fill with blanks. Reserved for SSA use |
356-378 | Foreign State/Province | If applicable, enter the submitter's foreign State/Province. Left justify and fill with blanks. Otherwise, fill with blanks. |
379-393 | Foreign Postal Code | If applicable, enter the submitter's foreign Postal Code. Left justify and fill with blanks. Otherwise, fill with blanks. |
394-395 | Country Code | If one of the following applies, fill with blanks * One of the 50 States of the U.S.A. * District of Columbia * Military Post Office (MPO) * American Samoa * Guam * Northern Mariana Islands * Puerto Rico * Virgin Islands Otherwise, enter the applicable Country Code. |
396-422 | Contact Name | Required. Enter the name of the person to be contacted by SSA concerning processing problems. Left justify and fill with blanks. Derived from the ‘SUB-CONT-NAME’ IDFDV Field Identifier (seq 1250). |
423-437 | Contact Phone Number | Required. Enter the contact's phone number with numeric valies only (including area code). Do not use any special characters. Left justify and fill with blanks. NOTE: It is imperative that the contact's telephone number be entered in the appropriate positions. Failure to include correct and complete submitter contact information may, in some cases, delay the timely processing of your file. Derived from the ‘SUB-CONT-TEL’ IDFDV Field Identifier (seq 1260). |
438-442 | Contact Phone Extension | Enter the contact's telephone extension. Left justify and fill with blanks. Derived from the ‘SUB-CONT-TEL-EXT’ IDFDV Field Identifier (seq 1270). |
443-445 | Blank | Fill with blanks. Reserved for SSA use. |
446-485 | Contact E-mail/Internet | Enter the contact's e-mail/internet address. Derived from the ‘SUB-CONT-EMAIL’ IDFDV Field Identifier (seq 1280). |
486-488 | Blank | Fill with blanks. Reserved for SSA use. |
489-498 | Contact Fax | If applicable, enter the contact's fax number (including area code). Otherwise, fill with blanks. Derived from the ‘SUB-CONT-FAX’ IDFDV Field Identifier (seq 1290). |
499 | Blank | Fill with blanks. Reserved for SSA use. |
500 | Preparer Code | Enter one of the following codes to indicate who prepared this file: * A = Accounting Firm * L = Self Prepared * S = Service Bureau * P = Parent Company * O = Other If more than one code applies, use the code that best describes who prepared this file. |
501-512 | Blank | Fill with blanks. Reserved for SSA use. |
Column | Description | Source |
---|---|---|
1-2 | Record Identifier | Constant "RE" |
3-6 | Tax year | Required. Enter the tax year for this report (YYYY). Derived from the user defined FROM-TO period, converted to YYYY. |
7 | Agent Indicator Code | If applicable, enter one of the following codes: * 1 = 2678 Agent * 2 = Common Paymaster * 3 = 3504 Agent If more than one code applies, use the one that best describes your status as an agent. Otherwise, fill with a blank. |
8-16 | Employer/Agent EIN | Required. Derived from the applicable Federal reporting EIN, from IDGV or IDGR. |
17-25 | Agent for EIN | If "1" was entered in the Agent Indicator Code field (position 7), enter the client-employer's EIN for which you are an Agent. Otherwise, fill with blanks. |
26 | Terminating Business Indicator | If this is the last tax year that W-2s will be filed under this EIN, enter "1". Otherwise, enter 0 (zero). |
27-30 | Establishment Number | For multiple RE (Employer) Records with the same EIN, you can use this field to assign a unique identifier for each RE (Employer) Record. Otherwise, fill with blanks. |
31-39 | Other EIN | For this tax year, if you submitted tax payments to the IRS under Form 941, 943, 944, CT-1 or Schedule H or W2 data to SSA, and a different EIN was used from the EIN in positions 8-16, enter the other EIN. Otherwise, fill with blanks. |
40-96 | Employer Name | Required. Enter the name associated with the EIN entered in positions 8 - 16. Left justify and fill with blanks. Derived from the 'W2-ER-NAME' IDFDV Field Identifier (seq 2010). |
97-118 | Employer Location Address | Enter the employer's location address (Attention, Suite, Room Number, etc.) Left justify and fill with blanks. Derived from the 'W2-ER-LOCN-ADDR' IDFDV Field Identifier (seq 2020). |
119-140 | Employer Delivery Address | Enter the employer's delivery address (Street or Post Office Box). Left justify and fill with blanks. Derived from the 'W2-ER-DELIV-ADDR' IDFDV Field Identifier (seq 2030). |
141-162 | Employer City | Enter the employer's city. Left justify and fill with blanks. Derived from the 'W2-ER-CITY' IDFDV Field Identifier (seq 2040). |
163-164 | Employer State Abbreviation | Enter the employer's State or commonwealth/territory. Use a postal abbreviation. For a foreign address, fill with blanks. Derived from the 'W2-ER-STATE' IDFDV Field Identifier (seq 2050). |
165-169 | Employer ZIP Code | Enter the employer's ZIP Code. For a foreign address, fill with blanks. Derived from the 'W2-ER-ZIP' IDFDV Field Identifier (seq 2060). |
170-173 | Employer ZIP Code Extension | Enter the employer's four-digit extension of the ZIP code. If not applicable, fill with blanks. Derived from the 'W2-ER-ZIP-EXT' IDFDV Field Identifier (seq 2070). |
174 | Kind of Employer | Required. Enter the appropriate kind of employer: * F = Federal Government * State/local non-501c * T = 501c non-government * Y = State/local 501c * N = None apply NOTE: Leave blank if the tax jurisdiction Code in position 220 of the RE (Employer) Records is "P" (Puerto Rico). |
175-178 | Blank | Fill with blanks. Reserved for SSA use. |
179-201 | Foreign State/Province | If applicable, enter the employer's foreign State/Province. Left justify and fill with blanks. Otherwise, fill with blanks. |
202-216 | Foreign Postal Code | If applicable, enter the company's foreign postal code. Left justify and fill with blanks. Otherwise, fill with blanks. |
217-218 | Country Code | If one of the following applies, fill with blanks: * One of the 50 States of the U.S.A. * District of Columbia * Military Post Office (MPO) * American Samoa * Guam * Northern Mariana Islands * Puerto Rico * Virgin Islands Otherwise, enter the applicable Country Code. |
219 | Employment Code | Required. Enter the appropriate employment code: * A = Agriculture (Form 943) * H = Household (Schedule H) * M = Military (Form 941) * Q = Medicare Qualified Government Employment (Form 941) * X = Railroad (CT-1) * F = Regular (Form 944) * R = Regular (all others) (Form 941). NOTE: Railroad reporting is not applicable for Puerto Rico and territorial employers. |
220 | Tax Jurisdiction Code | Required. Enter the code that identifies the type of income tax withheld from the employee's earnings: * Blank (W-2) * V = Virgin Islands (W-2VI) * G = Guam (W-2GU) * S = American Samoa (W-2AS) * N = Northern Mariana Islands (W-2CM) * P = Puerto Rico (W-2PR/499R-2) |
221 | Third Party Sick Pay Indicator | Enter "1" for a sick pay indicator. Otherwise, enter "0" (zero). |
222-248 | Employer Contact Name | Enter the name of the employer's contact. Left justify and fill with blanks. |
249-263 | Employer Contact Phone Number | Enter the employer's contact telephone number with numeric values only (including area code). Do not use any special characters. Left justify and fill with blanks. |
264-268 | Employer Contact Phone Extension | Enter the employer's contact telephone extension with numeric values only. Do not use any special characters. Left justify and fill with blanks. |
269-278 | Employer Contact Fax Number | If applicable, enter the employer's contact fax number with numeric values only (including area code). Do not use any special characters. Otherwise, fill with blanks. For US and US Territories only |
279-318 | Employer Contact E-Mail/Internet | Enter the employer's contact e-mail/internet address. |
319-512 | Blank | Fill with blanks. Reserved for SSA use. |
Column | Description | Source |
---|---|---|
1-2 | Record Identifier | Constant "RW" |
3-11 | Social Security Number | Required. Enter the employee's SSN. If an invalid SSN is encountered, this field is filled with zeros. Derived from the ‘W2-EE-SSN’ (seq 2500) IDFDV Field Identifier. |
12-26 | Employee First Name | Required. Enter the employee's first name. Left justify and fill with blanks. Derived from the ‘W2-EE-FIRST-NAME’ (seq 2510) IDFDV Field Identifier. |
27-41 | Employee Middle Name or Initial | If applicable, enter the employee's middle name or initial. Left Justify and fill with blanks. Otherwise, fill with blanks. Derived from the ‘W2-EE-MIDDLE’ (seq 2520) IDFDV Field Identifier. |
42-61 | Employee Last Name | Required. Enter the employee's last name. Left justify and fill with blanks. Derived from the ‘W2-EE-LAST-NAME’ (seq 2530) IDFDV Field Identifier. |
62-65 | Employee Suffix | If applicable, enter the employee's alphabetic suffix. Left justify and fill with blanks. Otherwise, fill with blanks. Derived from the ‘W2-EE-SUFFIX’ (seq 2540) IDFDV Field Identifier. |
66-87 | Employee Location Address | Enter the employee's location address (Attention, Suite, Room Number, etc.) Left justify and fill with blanks. Derived from the ‘W2-EE-LOCN-ADDR’ (seq 2600) IDFDV Field Identifier. |
88-109 | Employee Delivery Address | Enter the employee's delivery address (Street or Post Office Box). Left justify and fill with blanks. Derived from the ‘W2-EE-DELIV-ADDR’ (seq 2610) IDFDV Field Identifier. |
110-131 | Employee City | Enter the employee's City. Left justify and fill with blanks. Derived from the ‘W2-EE-CITY’ (seq 2620) IDFDV Field Identifier. |
132-133 | Employee State Abbreviation | Enter the employee's State or commonwealth/territory. For a foreign address, fill with blanks. Derived from the ‘W2-EE-STATE’ (seq 2630) IDFDV Field Identifier. |
134-138 | Employee ZIP Code | Enter the employee's ZIP code. For a foreign address, fill with blanks. Derived from the ‘W2-EE-ZIP’ (seq 2640) IDFDV Field Identifier. |
139-142 | Employee ZIP Code Extension | Enter the employee's four-digit ZIP code extension. If not applicable, fill with blanks. Derived from the ‘W2-EE-ZIP-EXT’ (seq 2650) IDFDV Field Identifier. |
143-147 | Blank | Fill with blanks. Reserved for SSA use. |
148-170 | Employee Foreign State/Province | If applicable, enter the employee's foreign State/Province. Left justify and fill with blanks. Otherwise, fill with blanks. Derived from the ‘W2-EE-F-STATE’ (seq 2660) IDFDV Field Identifier. |
171-185 | Employee Foreign Postal Code | If applicable, enter the employee's foreign postal code. Left justify and fill with blanks. Otherwise, fill with blanks. Derived from the ‘W2-EE-F-POSTAL’ (seq 2670) IDFDV Field Identifier. |
186-187 | Employee Country Code | If one of the following applies, fill with blanks: * One of the 50 States of the U.S.A. * District of Columbia * Military Post Office (MPO) * American Samoa * Guam * Northern Mariana Islands * Puerto Rico * Virgin Islands Otherwise, enter the applicable Country Code. Derived from the ‘W2-EE-COUNTRY’ (seq 2680) IDFDV Field Identifier. |
188-198 | Wages, Tips and Other Compensation | No negative amounts. Right justify and zero fill. Derived from the ‘W2-FIT-WAGE’ (seq 3000) IDFDV Field Identifier. Does not apply to Puerto Rico, Virgin Islands, American Samoa, Guam or Northern Mariana Islands employees. |
199-209 | Federal Income Tax Withheld | No negative amounts. Right justify and zero fill. Derived from the ‘W2-FIT-TAX’ (seq 3010) IDFDV Field Identifier. Does not apply to Puerto Rico, Virgin Islands, American Samoa, Guam or Northern Mariana Islands employees. |
210-220 | Social Security Wages | Zero fill if the Employment Code reported in position 219 of the preceding RE (Employer) Record is 'Q-MGQE' or 'X-Railroad'. If Employment Code is 'H-Household' and the tax year is 1994 or later, the sum of this field and the Social Security Tips field must be equal to or greater than the annual Household minimum for the tax year being reported. Otherwise, reports zeros. The sum of this field and the Social Security Tips field should not exceed the annual maximum Social Security wage base for the tax year being reported. No negative amounts. Right justify and zero fill. Derived from the ‘W2-SSN-WAGE’ (seq 3020) IDFDV Field Identifier. |
221-231 | Social Security Tax Withheld | Zero fill if the Employment Code reported in position 219 of the preceeding RE (Employer_ Record is 'Q-MGQE' or 'X-Railroad'. If the Employement Code is not 'Q-MGQE' or 'X-Railroad' and the amount in this field is greater than zero, then the Social Security Wages field and/or the Social Security Tips field must be greater than zero. No negative amounts. Right justify and zero fill. Derived from the ‘W2-SSN-TAX’ (seq 3030) IDFDV Field Identifier. |
232-242 | Medicare Wages and Tips | Zero fill if the Employment Code reported in position 219 of the preceding RE (Employer) Record is 'X-Railroad'. If Employment Code is 'H-Household' and the tax year is 1994 or later, this field must be equal to or greater than the annual Household minimum for the tax year being reported. Otherwise, fill with zeros. No negative amounts. Right justify and zero fill. Derived from the ‘W2-MEDI-WAGE’ (seq 3040) IDFDV Field Identifier. |
243-253 | Medicare Tax Withheld | Zero fill if the Employment Code reported in position 219 of the preceding RE (Employer) Record is 'X-Railroad'. No negative amounts. Right justify and zero fill. Derived from the ‘W2-MEDI-TAX’ (seq 3050) IDFDV Field Identifier. |
254-264 | Social Security Tips | Zero fill if the Employment Code reported in position 219 of the preceding RE (Employer) Record is 'Q-MGQE' or 'X-Railroad'. The sum of this field and the Social Security Wages field should not exceed the annual maximum Social Security wage base for the tax year being reported. Otherwise, reports zeros. If Employment Code is 'H-Household' and the tax year is 1994 or later, the sum of this field and the Social Security Wages field must be equal to or greater than the annual Household minimum for the tax year being reported. Otherwise, report zeros. No negative amounts. Right justify and zero fill. Derived from the ‘W2-SSN-TIP’ (seq 3060) IDFDV Field Identifier. |
265-275 | Blank | Fill with blanks. Reserved for SSA use. |
276-286 | Dependent Care Benefits | No negative amounts. Right justify and zero fill. Derived from the ‘W2-DEP-CARE’ (seq 3090) IDFDV Field Identifier. Does not apply to Puerto Rico, Virgin Islands, American Samoa, Guam or Northern Mariana Islands employees. |
287-297 | Deferred Compensation Contributions to Section 401(k) (Code D) | No negative amounts. Right justify and zero fill. Derived from the ‘W2-CODE-D’ (seq 4030) IDFDV Field Identifier. Does not apply to Puerto Rico employees. |
298-308 | Deferred Compensation Contributions to Section 403(b) (Code E) | No negative amounts. Right justify and zero fill. Derived from the ‘W2-CODE-E’ (seq 4040) IDFDV Field Identifier. Does not apply to Puerto Rico employees. |
309-319 | Deferred Compensation Contributions to Section 408(k)(6) (Code F) | No negative amounts. Right justify and zero fill. Derived from the ‘W2-CODE-F’ (seq 4050) IDFDV Field Identifier. Does not apply to Puerto Rico employees. |
320-330 | Deferred Compensation Contributions to Section 457(b) (Code G) | No negative amounts. Right justify and zero fill. Derived from the ‘W2-CODE-G’ (seq 4060) IDFDV Field Identifier. Does not apply to Puerto Rico employees. |
331-341 | Deferred Compensation Contributions to Section 501(c)(18)(D) (Code H) | No negative amounts. Right justify and zero fill. Derived from the ‘W2-CODE-H’ (seq 4070) IDFDV Field Identifier. Does not apply to Puerto Rico employees. |
342-352 | Blank | Fill with blanks. Reserved for SSA use. |
353-363 | Nonqualified Plan Section 457 Distributions or Contributions | No negative amounts. Right justify and zero fill. Derived from the ‘W2-NQUAL-457’ (seq 3102) IDFDV Field Identifier. Does not apply to Puerto Rico employees. |
364-374 | Employer Contributions to a Health Savings Account (Code W) | No negative amounts. Right justify and zero fill. Derived from the ‘W2-CODE-W’ (seq 4190) IDFDV Field Identifier. Does not apply to Puerto Rico or Northern Mariana Islands employees. |
375-385 | Nonqualified Plan Not Section 457 Distributions or Contributions | No negative amounts. Right justify and zero fill. Derived from the ‘W2-NQUAL-N457’ (seq 3104) IDFDV Field Identifier. Does not apply to Puerto Rico employees. |
386-396 | Nontaxable Combat Pay (Code Q) | No negative amounts. Right justify and zero fill. Does not apply to Puerto Rico or Northern Mariana Islands employees. |
397-407 | Blank | Fill with blanks. Reserved for SSA use. |
408-418 | Employer Cost of Premiums for Group Term Life Insurance Over $50,000 (Code C) | No negative amounts. Right justify and zero fill. Derived from the ‘W2-CODE-C’ (seq 4020) IDFDV Field Identifier. Does not apply to Puerto Rico employees. |
419-429 | Income from the Exercise of Non-Statutory Stock Options (Code V) | No negative amounts. Right justify and zero fill. Derived from the ‘W2-CODE-V’ (seq 4180) IDFDV Field Identifier. Does not apply to Puerto Rico employees. |
430-440 | Deferrals Under a Section 409A Non-Qualified Deferred Compensation Plan (Code Y) | No negative amounts. Right justify and zero fill. Does not apply to Puerto Rico or Northern Mariana Islands employees. |
441-451 | Designated Roth Contributions to a Section 401 (k) Plan (Code AA) | No negative amounts. Right justify and zero fill. Does not apply to Puerto Rico employees. |
452-462 | Designated Roth Contributions to a Section 403 (b) Salary Reduction Agreement (Code BB) | No negative amounts. Right justify and zero fill. Does not apply to Puerto Rico employees. |
463-473 | Cost of Employer-Sponsored Health Coverage (Code DD) | No negative amounts. Right justify and zero fill. Does not apply to Puerto Rico or Northern Mariana Islands employees. |
474-484 | Permitted Benefits Under a Qualified Small Employer Health Reimbursement Arrangement (Code FF) | No negative amounts. Right justify and zero fill. |
485 | Blank | Fill with blanks. Reserved for SSA use. |
486 | Statutory Employee Indicator | Enter "1" for statutory employee. Otherwise, enter "0" (zero). Derived from the ‘W2-STAT-EE’ (seq 6000) IDFDV Field Identifier. |
487 | Blank | Fill with blanks. Reserved for SSA use. |
488 | Retirement Plan Indicator | Enter "1" for a retirement plan. Otherwise, enter "0" (zero). Derived from the ‘W2-RETIRE-PLAN’ (seq 6020) IDFDV Field Identifier. |
489 | Third-Party Sick Pay Indicator | Enter "1" for a sick pay indicator. Otherwise, enter "0" (zero). Derived from the ‘W2-3PARTY-SICK’ (seq 6060) IDFDV Field Identifier. |
490-512 | Blank | Fill with blanks. Reserved for SSA use. |
Column | Description | Source |
---|---|---|
1-2 | Record Identifier | Constant ‘RO’ |
3-11 | Blank | Fill with blanks. Reserved for SSA use. |
12-22 | Allocated Tips | No negative amounts. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-ALLOC-TIP’ (seq 3070) |
23-33 | Uncollected Employee Tax on Tips (Codes A and B) | Combine the uncollected Social Security tax and the uncollected Medicare tax. No negative amounts. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-CODE-A’ + Field Identifier: ‘W2-CODE-B’ (seq 4010) |
34-44 | Medical Savings Account (Code R) | No negative amounts. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-CODE-R’ (seq 4150). Does not apply to Puerto Rico or Northern Mariana Islands employees. |
45-55 | Simple Retirement Account (Code S) | No negative amounts. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-CODE-S’ (seq 4160). Does not apply to Puerto Rico employees. |
56-66 | Qualified Adoption Expenses (Code T) | No negative amounts. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-CODE-T’ (seq 4170). Does not apply to Puerto Rico or Northern Mariana Islands employees. |
67-77 | Uncollected Social Security or RRTA Tax on Cost of Group Term Life Insurance over $50,000 (Code M) | No negative amounts. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-CODE-M’ (seq 4110). Does not apply to Puerto Rico employees. |
78-88 | Uncollected Medicare Tax on Cost of Group Term Life Insurance over $50,000 (Code N) | No negative amounts. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-CODE-N’ (seq 4120). Does not apply to Puerto Rico employees. |
89-99 | Income Under a Nonqualified Deferred Compensation Plan That Fails to Satisfy Section 409A (Code Z) | No negative amounts. Right justify and zero fill. Does not apply to Puerto Rico or Northern Mariana Islands employees. |
100-110 | Blank | Fill with blanks. Reserved for SSA use. |
111-121 | Designated Roth Contributions Under a Governmental Section 457(b) Plan )(Code EE) | No negative amounts. Right justify and zero fill. Does not apply to Puerto Rico or Northern Mariana Islands employees. |
122-132 | Income from Qualified Grants Under Section 83(i) (Code GG) | No negative amounts. Right justify and zero fill. |
133-143 | Aggregate Deferrals Under Section 83(i) Elections as of the Close of the Calendar Year (Code HH) | No negative amounts. Right justify and zero fill. |
144-274 | Blank | Fill with blanks. Reserved for SSA use. |
275-285 | Wages Subject to Puerto Rico Tax | No negative amounts. Right justify and zero fill. For Puerto Rico employees only. |
286-296 | Commissions Subject to Puerto Rico Tax | No negative amounts. Right justify and zero fill. For Puerto Rico employees only. |
297-307 | Allowances Subject to Puerto Rico Tax | No negative amounts. Right justify and zero fill. For Puerto Rico employees only. |
308-318 | Tips Subject to Puerto Rico Tax | SNo negative amounts. Right justify and zero fill. For Puerto Rico employees only. |
319-329 | Total Wages, Commissions, Tips, and Allowances Subject to Puerto Rico Tax | No negative amounts. Right justify and zero fill. For Puerto Rico employees only. |
330-340 | Puerto Rico Tax Withheld | No negative amounts. Right justify and zero fill. For Puerto Rico employees only. |
341-351 | Retirement Fund Annual Contributions | No negative amounts. Right justify and zero fill. For Puerto Rico employees only. |
352-362 | Blank | Fill with blanks. Reserved for SSA use. |
363-373 | Total Wages, Tips and Other Compensation Subject to Virgin Islands, Guam, American Samoa or Northern Mariana Islands Income Tax | No negative amounts. Right justify and zero fill. For Virgin Islands, American Samoa, Guam, or Northern Mariana Islands employees only. |
374-384 | Virgin Islands, American Samoa, Guam, or Northern Mariana Islands Income Tax Withheld | No negative amounts. Right justify and zero fill. For Virgin Islands, American Samoa, Guam, or Northern Mariana Islands employees only. |
385-512 | Blank | Fill with blanks. Reserved for SSA use. |
Column | Description | Source | |
---|---|---|---|
1-2 | Record Identifier | Constant "RS" | |
3-4 | State Code | Constant 18 | |
5-9 | Taxing Entity Code | Fill with blanks | |
10-18 | Social Security Number | Enter the employee's social security number. If an invalid SSN is encountered, this field is entered with zeroes. Derived from IDFDV Field Identifier: ‘W2-EE-SSN’ | |
19-33 | Employee First Name | Enter the employee's first name Derived from IDFDV Field Identifier: ‘W2-EE-FIRST-NAME’ | |
34-48 | Employee Middle Name or Initial | Enter the employee's middle name or initial, if applicable Derived from IDFDV Field Identifier: ‘W2-EE-MIDDLE’ | |
49-68 | Employee Last Name | Enter the employee's last name Derived from IDFDV Field Identifier: ‘W2-EE-LAST-NAME’ | |
69-72 | Employee Suffix | Enter the employee's suffix Derived from IDFDV Field Identifier: ‘W2-EE-SUFFIX’ | |
73-94 | Employee Location Address | Enter the employee's location address Derived from IDFDV Field Identifier: ‘W2-EE-LOCN-ADDR’ | |
95-116 | Employee Delivery Address | Enter the employee's delivery address Derived from IDFDV Field Identifier: ‘W2-EE-DELIV-ADDR’ | |
117-138 | Employee City | Enter the employee's city Derived from IDFDV Field Identifier: ‘W2-EE-CITY’ | |
139-140 | Employee State Abbreviation | Enter the employee's State Derived from IDFDV Field Identifier: ‘W2-EE-STATE’ | |
141-145 | Employee ZIP Code | Enter the employee's Zip Code Derived from IDFDV Field Identifier: ‘W2-EE-ZIP’ | |
146-149 | Employee ZIP Code Extension | Enter the employee's Zip Code extension, if applicable Derived from IDFDV Field Identifier: ‘W2-EE-ZIP-EXT’ | |
150-154 | Blank | Fill with blanks | |
155-177 | Employee Foreign State/Province | Enter the employee's foreign State/Province, if applicable Derived from IDFDV Field Identifier: ‘W2-EE-F-STATE’ | |
178-192 | Employee Foreign Postal Code | Enter the employee's foreign postal code, if applicable Derived from IDFDV Field Identifier: ‘W2-EE-F-POSTAL’ | |
193-194 | Country Code | Enter the appropriate country code. If one of the following applies, fill with blanks: * One of the 50 States of the U.S.A. * District of Columbia * Military Post Office (MPO) * American Samoa * Guam * Northern Mariana Islands * Puerto Rico * Virgin Islands Otherwise, enter the applicable Country Code. | |
195-196 | Optional Code | Defined by State/Local Agency. Applies to unemployment reporting. | |
197-202 | Reporting Period | Enter the last month and four-digit year for the calendar quarter this report applies to. Applies to unemployment reporting. | |
203-213 | State Quarterly Unemployment Insurance Total Wages | Enter the total quarterly UI wages Right justify and zero fill. Applies to unemployment reporting. | |
214-224 | State Quarterly Unemployment Insurance Total Taxable Wages | Enter the total quarterly UI taxable wages Right justify and zero fill. Applies to unemployment reporting. | |
225-226 | Number of Weeks Worked | Defined by State/Local Agency. Applies to unemployment reporting. | |
227-234 | Date First Employed | Enter the month, day and four-digit year the employee was first employed. Applies to unemployment reporting. | |
235-242 | Date of Separation | Enter the month, day and four-digit year the employee separated from your organization Applies to unemployment reporting. | |
243-247 | Blank | Fill with blanks | |
248-267 | State Employer Account Number | Enter the State employer account number. Applies to unemployment reporting. | |
268-273 | Blank | Fill with blanks. Reserved for SSA. | |
274-275 | State Code | Constant 18 | |
276-286 | State Taxable Wages | Enter the total State taxable wages Right justify and zero fill. If State IDGV ‘W2 STATE MEDIA FILING’ = ‘02’, then State Taxable Wages are reported. Derived from IDFDV Field Identifier: ‘W2-ST-WAGE-HOME’ and ‘W2-ST-WAGE-WORK’ | |
287-297 | State Income Tax Withheld | Enter the total State income tax withheld Right justify and zero fill. If State IDGV ‘W2 STATE MEDIA FILING’ = ‘02’, then State Taxable Wages are reported. Derived from IDFDV Field Identifier: ‘W2-ST-TAX-HOME’ and ‘W2-ST-TAX-WORK’ | |
298-305 | Blank | Fill with blanks | |
306-307 | County Code | Enter the appropriate County code, such as ‘49’ for Marion Derived from IDFDV Field Identifier: 'W2 TAXING ENTITY' for the county | |
308 | Tax Type Code | Enter the appropriate code for entries in fields 309-330: C=City Income Tax D=County Income Tax E=School District Income Tax F=Other Income Tax. Applies to income tax reporting. | |
309-319 | County Taxable Wages | Enter the total County taxable wages Derived from IDFDV Field Identifier: ‘W2-CN-WAGE-HOME’ and ‘W2-CN-WAGE-WORK’ | |
320-330 | County Income Tax Withheld | Enter the total County income tax withheld Derived from IDFDV Field Identifier: ‘W2-CN-TAX-HOME’ and ‘W2-CN-TAX-WORK’ | |
331-340 | Employer Taxpayer ID (TID) | Enter the Indiana Employer Taxpayer ID number. Does not include the 3-digit location. Derived from IDFDV Field Identifier: ‘Local Registration’ Regist# posn 1-10 for the County being reported | |
341-343 | Employer TID Location | Enter the 3-digit Indiana Employer TID location number. Derived from IDFDV Field Identifier: ‘Local Registration’ Regist# posn 11-13 for the County being reported | |
344-512 | Blank | Fill with blanks |
Column | Description | Source |
---|---|---|
1-2 | Record Identifier | Constant "RT" |
3-9 | Number of RW Records | Total number of "RW" records reported since last "RE" record. Right justify and zero fill. |
10-24 | Wages, Tips and Other Compensation | Total of all "RW" records since last "RE" record. Right justify and zero fill. Does not apply to Puerto Rico, Virgin Islands, American Samoa, Guam or Northern Mariana Islands emplyees. Derived from IDFDV Field Identifier: ‘W2-FIT-WAGE’ |
25-39 | Federal Income Tax Withheld | Total of all "RW" records since last "RE" record. Right justify and zero fill. Does not apply to Puerto Rico, Virgin Islands, American Samoa, Guam or Northern Mariana Islands emplyees. Derived from IDFDV Field Identifier: ‘W2-FIT-TAX’ |
40-54 | Social Security Wages | Total of all "RW" records since last "RE" record. Zero fill if the Employment Code is position 219 of the preceeding RE Employer Record is "Q-MQGE" or "X-Railroad". Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-SSN-WAGE’ |
55-69 | Social Security Tax Withheld | Total of all "RW" records since last "RE" record. Zero fill if the Employment Code is position 219 of the preceeding RE Employer Record is "Q-MQGE" or "X-Railroad". Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-SSN-TAX’ |
70-84 | Medicare Wages and Tips | Total of all "RW" records since last "RE" record. Zero fill if the Employment Code is position 219 of the preceeding RE Employer Record is "X-Railroad". Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-MEDI-WAGE’ |
85-99 | Medicare Tax Withheld | Total of all "RW" records since last "RE" record. Zero fill if the Employment Code is position 219 of the preceeding RE Employer Record is "X-Railroad". Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-MEDI-TAX’ |
100-114 | Social Security Tips | Total of all "RW" records since last "RE" record. Zero fill if the Employment Code is position 219 of the preceeding RE Employer Record is "Q-MQGE" or "X-Railroad". Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-SSN-TIP’ |
115-129 | Blank | Fill with blanks. Reserved for SSA use. |
130-144 | Dependent Care Benefits | Total of all "RW" records since last "RE" record. Does not apply to Puerto Rico, Virgin Islands, American Samoa, Guam or Northern Mariana Islands employees. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-DEP-CARE’ |
145-159 | Deferred Compensation Contributions to Section 401(k) (Code D) | Total of all "RW" records since last "RE" record. Does not apply to Puerto Rico employees. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-CODE-D’ |
160-174 | Deferred Compensation Contributions to Section 403(b)(Code E) | Total of all "RW" records since last "RE" record. Does not apply to Puerto Rico employees. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-CODE-E’ |
175-189 | Deferred Compensation Contributions to Section 408(k)(6) (Code F) | Total of all "RW" records since last "RE" record. Does not apply to Puerto Rico employees. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-CODE-F’ |
190-204 | Deferred Compensation Contributions to Section 457(b) (Code G) | Total of all "RW" records since last "RE" record. Does not apply to Puerto Rico employees. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-CODE-G’ |
205-219 | Deferred Compensation Contributions to Section 501(c)(18)(D) (Code H) | Total of all "RW" records since last "RE" record. Does not apply to Puerto Rico employees. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-CODE-H’ |
220-234 | Blank | Fill with blanks. Reserved for SSA use. |
235-249 | Nonqualified Plan Section 457 Distributions or Contributions | Total of all "RW" records since last "RE" record. Does not apply to Puerto Rico employees. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-NQUAL-457’ |
250-264 | Employer Contribution to a Health Savings Account (Code W) | Total of all "RW" records since last "RE" record. No negative amounts. Does not apply to Puerto Rico or Northern Mariana Islands employees. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-CODE-W’ |
265-279 | Nonqualified Plan Not Section 457 Distributions or Contributions | Total of all "RW" records since last "RE" record. Does not apply to Puerto Rico employees. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-NQUAL-N457’ |
280-294 | Nontaxable Combat Pay (Code Q) | Total of all "RW" records since last "RE" record. Does not apply to Puerto Rico or Northern Mariana Islands employees. Right justify and zero fill. |
295-309 | Cost of Employer-Sponsored Health Coverage (Code DD) | Total of all "RW" records since last "RE" record. Does not apply to Puerto Rico or Northern Mariana Islands employees. Right justify and zero fill. |
310-324 | Employer Cost of Premiums for Group Term Life Insurance over $50,000 (Code C) | Total of all "RW" records since last "RE" record. Does not apply to Puerto Rico employees. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-CODE-C’ |
325-339 | Income Tax Withheld by Payer of Third-Party Sick Pay | Total of all "RW" records since last "RE" record. Total Federal Income Tax withheld by third-parties (generally insurance companies) from sick or disability payments made to your employees. Does not apply to Puerto Rico employees. Derived from IDFDV Field Identifier: ‘SUB-3RD-PARTY-TAX’ |
340-354 | Income from the Exercise of Non-statutory Stock Options (Code V) | Total of all "RW" records since last "RE" record. Does not apply to Puerto Rico employees. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-CODE-V’ |
355-369 | Deferrals Under a Section 409A Nonqualified Deferred Compensation Plan (Code Y) | Total of all "RW" records since last "RE" record. Does not apply to Puerto Rico or Northern Mariana Islands employees. Right justify and zero fill. |
370-384 | Designated Roth Contributions to a Section 401(k) Plan (Code AA) | Total of all "RW" records since last "RE" record. Does not apply to Puerto Rico employees. Right justify and zero fill. |
385-399 | Designated Roth Contributions to a Section 403(b) Salary Reduction Agreement (Code BB) | Total of all "RW" records since last "RE" record. Does not apply to Puerto Rico employees. Right justify and zero fill. |
400-414 | Permitted Benefits Under a Qualified Small Employer Health Reimbursement Arrangement (Code FF) | Total of all "RW" records since last "RE" record. Right justify and zero fill. |
415-512 | Blank | Fill with blanks. Reserved for SSA use. |
Column | Description | Source |
---|---|---|
1-2 | Record Identifier | Constant "RU" |
3-9 | Number of RO Records | Total number of "RO" records reported since last "RE" record. Right justify and zero fill. |
10-24 | Allocated Tips | Total of all "RO" records since last "RE" record. Right justify and zero fill. Does not apply to Puerto Rico, Virgin Islands, American Samoa, Guam or Northern Maraina Islands employees. Derived from IDFDV Field Identifier: ‘W2-ALLOC-TIP’ |
25-39 | Uncollected Employee Tax on Tips (Code A and B) | Total of all "RO" records since last "RE" record. Right justify and zero fill. Derived from IDFDV Field Identifier: ‘W2-CODE-A’ and ‘W2-CODE-B’ |
40-54 | Medical Savings Account (Code R) | Total of all "RO" records since last "RE" record. Right justify and zero fill. Does not apply to Puerto Rico or Northern Maraina Islands employees. Derived from IDFDV Field Identifier: ‘W2-CODE-R’ |
55-69 | Simple Retirement Account (Code S) | Total of all "RO" records since last "RE" record. Right justify and zero fill. Does not apply to Puerto Rico employees. Derived from IDFDV Field Identifier: ‘W2-CODE-S’ |
70-84 | Qualified Adoption Expenses (Code T) | Total of all "RO" records since last "RE" record. Right justify and zero fill. Does not apply to Puerto Rico or Northern Maraina Islands employees. Derived from IDFDV Field Identifier: ‘W2-CODE-T’ |
85-99 | Uncollected SSA tax or RRTA Tax on Cost of Group Term Life Insurance over $50,000 (Code M) | Total of all "RO" records since last "RE" record. Right justify and zero fill. Does not apply to Puerto Rico employees. Derived from IDFDV Field Identifier: ‘W2-CODE-M’ |
100-114 | Uncollected Medicare Tax on Cost of Group Term Life Insurance over $50,000 (Code N) | Total of all "RO" records since last "RE" record. Right justify and zero fill. Does not apply to Puerto Rico employees. Derived from IDFDV Field Identifier: ‘W2-CODE-N’ |
115-129 | Income Under a Nonqualified Deferred Compensation Plan That Fails to Satisfy Section 409A (Code Z) | Total of all "RO" records since last "RE" record. Right justify and zero fill. Does not apply to Puerto Rico or Northern Maraina Islands employees. |
130-144 | Blank | Fill with blanks. Reserved for SSA use. |
145-159 | Designated Roth Contributions Under a Governmental Section 457(b) Plan (Code EE) | Total of all "RO" records since last "RE" record. Right justify and zero fill. Does not apply to Puerto Rico or Northern Maraina Islands employees. |
160-174 | Income from Qualified Equity Grants Under Section 83(i) (Code GG) | Total of all "RO" records since last "RE" record. Right justify and zero fill. |
175-189 | Aggregate Deferrals Under Section 83(i) Elections as of the Close of the Calendar Year (Code HH) | Total of all "RO" records since last "RE" record. Right justify and zero fill. |
190-354 | Blank | Fill with blanks. Reserved for SSA use. |
355-369 | Wages Subject to Puerto Rico Tax | Total of all "RO" records since last "RE" record. Right justify and zero fill. For Puerto Rico employees only. |
370-384 | Commissions Subject to Puerto Rico Tax | Total of all "RO" records since last "RE" record. Right justify and zero fill. For Puerto Rico employees only. |
385-399 | Allowances Subject to Puerto Rico Tax | Total of all "RO" records since last "RE" record. Right justify and zero fill. For Puerto Rico employees only. |
400-414 | Tips Subject to Puerto Rico Tax | Total of all "RO" records since last "RE" record. Right justify and zero fill. For Puerto Rico employees only. |
415-429 | Total Wages, Commissions, Tips and Allowances Subject to Puerto Rico Tax | Total of all "RO" records since last "RE" record. Right justify and zero fill. For Puerto Rico employees only. |
430-444 | Puerto Rico Tax Withheld | Total of all "RO" records since last "RE" record. Right justify and zero fill. For Puerto Rico employees only. |
445-459 | Retirement Fund Annual Contributions | Total of all "RO" records since last "RE" record. Right justify and zero fill. For Puerto Rico employees only. |
460-474 | Total Wages, Tips and Other Compensation Subject to Virgin Islands, Guam, American Samoa or Northern Mariana Islands Income Tax | Total of all "RO" records since last "RE" record. Right justify and zero fill. For Virgin Islands, Guam, American Samoa or Northern Mariana Islands employees only. |
475-489 | Virgin Islands, Guam, American Samoa, or Northern Mariana Islands Income Tax Withheld | Total of all "RO" records since last "RE" record. Right justify and zero fill. For Virgin Islands, Guam, American Samoa or Northern Mariana Islands employees only. |
490-512 | Blank | Fill with blanks. Reserved for SSA use. |
Column | Description | Source |
---|---|---|
1-2 | Record Identifier | Constant "RV" |
3-4 | State Code | Constant ‘18’ |
5-17 | Total of RS Record | Enter the total number of Code RS Record in entire file. System derived number of all Code RS records for this Employer |
18-30 | Total State Tax Withheld | Enter the total state tax withheld |
31-43 | Total County Tax Withheld | Enter the total county tax withheld |
44-512 | Blank | Fill with blanks |
Column | Description | Source |
---|---|---|
1-2 | Record Indentifier | Constant "RF" |
3-7 | Blank | Fill with blanks. Reserved for SSA use |
8-16 | Number of RW Records | Total number of RW (Employee) Records reported on the entire file. Right justify and zero fill |
17-512 | Blank | Fill with blanks. Reserved for SSA use |
Media Format | State SUI File Format |
Select State | Indiana, USA |
Column | Description | Source |
---|---|---|
1-1 | Record Identifier | Constant ‘E’ |
2-5 | Payment Year | Enter the year the report is being prepared for, in YYYY format |
6-14 IN | Federal EIN | Federal EIN. Enter only numeric characters |
15-23 IN | Not Required | |
24-73 | Employer Name | Enter the first 50 positions of the employer’s name exactly as registered with the State UI agency. Derived from the Entity |
74-113 IN | Employer Street Address | Enter the employer's street address |
114-138 IN | Employer City | Enter the employer's city |
139-140 IN | Employer State | Enter the employer's State |
141-148 IN | Blank | Fill with blanks |
149-153 | Zip Code Extension | Enter the employer's zip code extension, if applicable |
154-158 IN | Zip Code | Enter the employer's zip code |
159-172 IN | Blank | Fill with blanks |
173-187 | State Unemployment Insurance Account Number | Enter the Indiana SUTA Number Derived from the IDGV State SUI Registration |
188-189 | Reporting Period | Enter the last month of the reporting period. Options are: 03, 06, 09, or 12 |
190-275 IN | Blank | Fill with blanks |
Column | Description | Source |
---|---|---|
1-1 | Record Identifier | Constant ‘S’ |
2-10 | Social Security Number | Employee’s social security number. If not known, enter ‘I’ in position 2 and blanks in position 3-10 |
11-30 | Employee Last Name | Enter the employee's last name |
31-42 | Employee First Name | Enter the employee's first name |
43-43 | Employee Middle Initial | Enter the employee's middle initial name. If no middle initial, fill with blanks |
44-45 | State Code | Enter the state FIPS postal numeric code for the State wages are being reported for Indiana's numeric code is ‘18’ |
46-53 IN | Employee Start Date | Enter the first date the employee worked, in MMDDYYYY format |
54-58 IN | Zip Code of Primary Work Location | Enter the zip code of the employee's primary work location |
59-63 IN | Blank | Fill with blanks |
64-77 | State QTR Unemployment Insurance Total Gross Wages | Enter the total quarterly gross wages subject to unemployment taxes. Derived from IDFDV Field Identifier: sequence 7200 |
78-105 IN | Blank | Fill with blanks |
106-111 IN | Standard Occupation Classification Code | Enter the Standard Occupation Classification Code. Numeric values only |
112-146 IN | Blank | Fill with blanks |
147-152 IN | State Unemployment Insurance Account Number | Enter the SUTA number Derived from the SUI Registration Number on IDGV |
153-204 IN | Blank | Fill with blanks |
205-206 IN | Full Time/Part Time/Seasonal | Enter FT for Full Time, PT for Part Time and a two digit numeric code for Seasonal Derived from IDFDV screen, Field sequence 3270 |
207-211 IN | Blank | Fill with blanks |
212 IN | Month 1 Employment | Enter “Y” if the employee worked during or received pay for pay period including the 12th day of the first month. Enter “N” if the employee did not work and received no pay for pay period including the 12th day of the first month. |
213 IN | Month 2 Employment | Enter “Y” if the employee worked during or received pay for pay period including the 12th day of the second month. Enter “N” if the employee did not work and received no pay for pay period including the 12th day of the second month. |
214 IN | Month 3 Employment | Enter “Y” if the employee worked during or received pay for pay period including the 12th day of the third month. Enter “N” if the employee did not work and received no pay for pay period including the 12th day of the third month. |
215-220 | Reporting Quarter and Year | Enter the last month and year for the reporting period. Example: MMYYYY |
221-275 | Blank | Fill with blanks |
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