| Field | Type | Length | Start Position | End Position | Status | Comments |
|---|---|---|---|---|---|---|
| Worker's First Name | Char | 11 | 1 | 11 | Required | At least two characters, no special characters. |
| Worker's Middle Initial | Char | 1 | 12 | 12 | Optional | |
| Worker's Last Name | Char | 15 | 13 | 27 | Required | At least two characters, no special characters except hyphen. |
| Worker's Address Line 1 | Char | 30 | 28 | 57 | Required | |
| Worker's Address Line 2 | Char | 30 | 58 | 87 | Optional | |
| Worker's City | Char | 18 | 88 | 105 | Required | |
| Worker's State | Char | 2 | 106 | 107 | Required | Valid 2 letter state code (e.g. MS) |
| Worker's Zip Code | Numeric | 5 | 108 | 112 | Required | |
| Worker's Zip +4 | Numeric | 4 | 113 | 116 | Required | |
| Worker's SSN | Number | 9 | 117 | 125 | Required | All zeroes will be rejected |
| Worker's Date of Hire | Numeric | 8 | 126 | 133 | Required | YYYYMMDD |
| Worker's Date of Birth | Numeric | 8 | 134 | 141 | Required | YYYYMMDD, if unknown -00000000 |
| Worker's Gender | Char | 1 | 142 | 142 | Required | M/F/U |
| Worker's Work State | Char | 2 | 143 | 144 | Required | Valid 2 letter state code (default to MS) |
| Employer's Name | Char | 30 | 145 | 174 | Required | |
| Employer's Payroll Address Line 1 | Character | 30 | 175 | 204 | Required | |
| Employer's Payroll Address Line 2 | Char | 30 | 205 | 234 | Optional | |
| Employer's Payroll City | Char | 18 | 235 | 252 | Required | |
| Employer's Payroll State | Char | 2 | 253 | 254 | Required | Valid 2 letter state code (default to MS) |
| Employer's Payroll Zip Code | Numeric | 5 | 255 | 259 | Required | |
| Employer's Payroll Zip +4 | Numeric | 4 | 260 | 263 | Required | |
| Employer's Payroll Country Code | Char | 2 | 264 | 265 | Optional | |
| Employer's Federal EIN | Numeric | 9 | 266 | 274 | Required | |
| Employer's State EIN | Numeric | 10 | 275 | 284 | Required | If unknown default to 0000000000 |
| Employee Salary | Numeric | 8 | 285 | 292 | Required | No decimal, last two digits for cents. Right-justify with leading zeroes |
| Payment Frequency | Char | 1 | 293 | 293 | Required | Effective December 1, 2010 use W (weekly), B (bi-weekly), M (monthly), and A (annual). If unavailable, default to a space or blank |
| Employee eligible for an insurance benefit | Char | 1 | 294 | 294 | Required | Y or N |
| Filler | Char | 6 | 295 | 300 | Required | blank spaces |