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a. Employee's SSN
b. Employer Identification Number (EIN)
1. Wages, tips, other compensation
2. Federal income tax withheld
c. Employer's name, address and ZIP code
3. Social security wages
4. Social security tax withheld
5. Medicare wages and tips
6. Medicare tax withheld
7. Social security tips
8. Allocated tips
d. Control number
9. Verification code
10. Dependent care benefits
e. Employee's name, address and ZIP code
11. Nonqualified plans
12a.
13.
Statutory employee
Retirement plan
Third-party sick day
12b.
14. Other
12c.
12d.
15.State
Employer's state ID number
16. State wages, tips, etc
17. State income tax
18. Local wages, tips, etc
19. Local income tax
20. Locality name