This form contains 272 fields organized into 39 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Additional Information
9 Text
Enter any additional information or codes provided by your employer.
Suff. cd9b Text
Enter the sufficiency code provided by your employer.
00 Text
Enter the code for box 12d, if applicable.
Max length: 2 characters
00 48 Text
Enter the code for box 12d, if applicable.
topmostSubform[0].CopyA[0].Col_Right[0].Line12_ReadOrder[0].f1_22[0 Text
Enter the code for box 12d, if applicable.
Max length: 2 characters
topmostSubform[0].CopyA[0].Col_Right[0].Line12_ReadOrder[0].f1_23[0 Text
Enter the code for box 12d, if applicable.
topmostSubform[0].CopyA[0].Col_Right[0].Line12_ReadOrder[0].f1_24[0 Text
Enter the code for box 12d, if applicable.
Max length: 2 characters
topmostSubform[0].CopyA[0].Col_Right[0].Line12_ReadOrder[0].f1_25[0 Text
Enter the code for box 12d, if applicable.
12d B Text
Enter the code for box 12d, if applicable.
Max length: 2 characters
topmostSubform[0].CopyA[0].Col_Right[0].Line12_ReadOrder[0].f1_27[0 Text
Enter the code for box 12d, if applicable.
14 Other Text
Enter any other compensation or information that does not fit into the other categories on the form.
C 00 Text
Enter the appropriate code for Box 12, which indicates specific types of compensation or benefits.
Max length: 2 characters
C 00 f2 Text
Enter the appropriate code for Box 12, which indicates specific types of compensation or benefits.
topmostSubform[0].CopyB[0].Col_Right[0].Box12_ReadOrder[0].f2_22[0 Text
Enter the appropriate code for Box 12, which indicates specific types of compensation or benefits.
Max length: 2 characters
topmostSubform[0].CopyB[0].Col_Right[0].Box12_ReadOrder[0].f2_23[0 Text
Enter the appropriate code for Box 12, which indicates specific types of compensation or benefits.
topmostSubform[0].CopyB[0].Col_Right[0].Box12_ReadOrder[0].f2_24[0 Text
Enter the appropriate code for Box 12, which indicates specific types of compensation or benefits.
Max length: 2 characters
C 974 Text
Enter the appropriate code for Box 12, which indicates specific types of compensation or benefits.
14 Other Text
Enter any other compensation or information not covered by other boxes.
C 6 Text
Enter the appropriate code for box 12, which may include various types of compensation or benefits. The maximum length is 2 characters.
Max length: 2 characters
C 6 bd Text
Enter the appropriate code for box 12, which may include various types of compensation or benefits.
topmostSubform[0].CopyC[0].Col_Right[0].Box12_ReadOrder[0].f2_22[0 Text
Enter the appropriate code for box 12, which may include various types of compensation or benefits. The maximum length is 2 characters.
Max length: 2 characters
topmostSubform[0].CopyC[0].Col_Right[0].Box12_ReadOrder[0].f2_23[0 Text
Enter the appropriate code for box 12, which may include various types of compensation or benefits.
C Text
Enter the code for box 12, which identifies the type of compensation or benefits (e.g., C for cost of group-term life insurance over $50,000).
Max length: 2 characters
C 7b Text
Enter the amount corresponding to the code entered in the previous field (box 12).
topmostSubform[0].Copy2[0].Col_Right[0].Box12_ReadOrder[0].f2_22[0 Text
Enter the code for box 12, which identifies the type of compensation or benefits (e.g., C for cost of group-term life insurance over $50,000).
Max length: 2 characters
topmostSubform[0].CopyD[0].Col_Right[0].Box9_ReadOrder[0].f2_17[0 Text
Enter any additional information or special codes as required.
10 Dependent care benefits Text
Enter the total dependent care benefits provided to the employee.
Benefits
10 Dependent care benefits Text
Enter the total amount of dependent care benefits received.
10 Dependent care benefits Text
Enter the total amount of dependent care benefits you received during the year.
10 Dependent care benefits Text
Enter the total amount of dependent care benefits provided to the employee.
11 Nonqualified plans Text
Enter the total amount of nonqualified plans provided to the employee.
Benefits Information
10 Dependent care benefits Text
Enter the total dependent care benefits provided to the employee.
11 Nonqualified plans Text
Enter the total amount of nonqualified deferred compensation plans.
Box 12
topmostSubform[0].Copy2[0].Col_Right[0].Box12_ReadOrder[0].f2_23[0 Text
Enter the specific code for Box 12. This box is used to report various types of compensation or benefits.
topmostSubform[0].Copy2[0].Col_Right[0].Box12_ReadOrder[0].f2_24[0 Text
Enter the two-character code for Box 12. This code identifies the type of compensation or benefit being reported.
Max length: 2 characters
topmostSubform[0].Copy2[0].Col_Right[0].Box12_ReadOrder[0].f2_25[0 Text
Enter the specific code for Box 12. This box is used to report various types of compensation or benefits.
topmostSubform[0].Copy2[0].Col_Right[0].Box12_ReadOrder[0].f2_26[0 Text
Enter the two-character code for Box 12. This code identifies the type of compensation or benefit being reported.
Max length: 2 characters
topmostSubform[0].Copy2[0].Col_Right[0].Box12_ReadOrder[0].f2_27[0 Text
Enter the specific code for Box 12. This box is used to report various types of compensation or benefits.
Box 12 Amounts
00 03 Text
Enter the amount corresponding to the code in Box 12. This is the value associated with the specific type of compensation or benefit.
topmostSubform[0].CopyD[0].Col_Right[0].Box12_ReadOrder[0].f2_23[0 Text
Enter the amount corresponding to the code in Box 12. This is the value associated with the specific type of compensation or benefit.
topmostSubform[0].CopyD[0].Col_Right[0].Box12_ReadOrder[0].f2_25[0 Text
Enter the amount corresponding to the code in Box 12. This is the value associated with the specific type of compensation or benefit.
59 Text
Enter the amount corresponding to the code in Box 12. This is the value associated with the specific type of compensation or benefit.
Box 12 Codes
00 Text
Enter the code for Box 12. This is a two-character code that identifies the type of compensation or benefit.
Max length: 2 characters
topmostSubform[0].CopyD[0].Col_Right[0].Box12_ReadOrder[0].f2_22[0 Text
Enter the code for Box 12. This is a two-character code that identifies the type of compensation or benefit.
Max length: 2 characters
topmostSubform[0].CopyD[0].Col_Right[0].Box12_ReadOrder[0].f2_24[0 Text
Enter the code for Box 12. This is a two-character code that identifies the type of compensation or benefit.
Max length: 2 characters
12d Text
Enter the code for Box 12. This is a two-character code that identifies the type of compensation or benefit.
Max length: 2 characters
Codes
topmostSubform[0].Copy1[0].Col_Right[0].Box12_ReadOrder[0].f2_20[0 Text
Enter the appropriate code for Box 12. This field has a maximum length of 2 characters.
Max length: 2 characters
topmostSubform[0].Copy1[0].Col_Right[0].Box12_ReadOrder[0].f2_21[0 Text
Enter the appropriate code for Box 12.
topmostSubform[0].Copy1[0].Col_Right[0].Box12_ReadOrder[0].f2_22[0 Text
Enter the appropriate code for Box 12. This field has a maximum length of 2 characters.
Max length: 2 characters
topmostSubform[0].Copy1[0].Col_Right[0].Box12_ReadOrder[0].f2_23[0 Text
Enter the appropriate code for Box 12.
topmostSubform[0].Copy1[0].Col_Right[0].Box12_ReadOrder[0].f2_24[0 Text
Enter the appropriate code for Box 12. This field has a maximum length of 2 characters.
Max length: 2 characters
topmostSubform[0].Copy1[0].Col_Right[0].Box12_ReadOrder[0].f2_25[0 Text
Enter the appropriate code for Box 12.
topmostSubform[0].Copy1[0].Col_Right[0].Box12_ReadOrder[0].f2_26[0 Text
Enter the appropriate code for Box 12. This field has a maximum length of 2 characters.
Max length: 2 characters
Compensation and Benefits
topmostSubform[0].Copy1[0].Col_Right[0].Box12_ReadOrder[0].f2_27[0 Text
Enter the code and amount for Box 12. This box is used to report various types of compensation or benefits.
topmostSubform[0].CopyB[0].Col_Right[0].Box12_ReadOrder[0].f2_26[0 Text
Enter the code for Box 12, which indicates specific types of compensation or benefits.
Max length: 2 characters
c Od Text
Enter the amount corresponding to the code in Box 12.
topmostSubform[0].CopyC[0].Col_Right[0].Box12_ReadOrder[0].f2_24[0 Text
Enter the code for Box 12, which indicates the type of compensation or benefits provided.
Max length: 2 characters
topmostSubform[0].CopyC[0].Col_Right[0].Box12_ReadOrder[0].f2_25[0 Text
Enter the amount corresponding to the code in Box 12.
12d Text
Enter the code for Box 12d, which indicates the type of compensation or benefits provided.
Max length: 2 characters
23 Text
Enter the amount corresponding to the code in Box 12d.
14 Other Text
Enter any other compensation or benefits not covered in other boxes.
11 Nonqualified plans Text
Enter the total amount of nonqualified plans. This includes any deferred compensation that does not meet the requirements of qualified plans.
Compensation and Taxes
1 Wages, tips, other compensation Text
Enter the total wages, tips, and other compensation paid to the employee.
2 Federal income tax withheld Text
Enter the total federal income tax withheld from the employee's wages.
3 Social security wages Text
Enter the total social security wages paid to the employee.
4 Social security tax withheld Text
Enter the total social security tax withheld from the employee's wages.
5 Medicare wages and tips Text
Enter the total Medicare wages and tips paid to the employee.
6 Medicare tax withheld Text
Enter the total Medicare tax withheld from the employee's wages.
7 Social security tips Text
Enter the total social security tips received by the employee.
Employee Benefits
topmostSubform[0].CopyB[0].Col_Right[0].Retirement_ReadOrder[0].c2_3[0]_1 CheckBox
Check this box if the employee participated in an employer's retirement plan.
topmostSubform[0].CopyB[0].Col_Right[0].c2_4[0]_1 CheckBox
Check this box if the employee received third-party sick pay.
10 Dependent care benefits Text
Enter the total amount of dependent care benefits provided to the employee.
11 Nonqualified plans Text
Enter the total amount of nonqualified deferred compensation plans.
topmostSubform[0].CopyD[0].Col_Right[0].Retirement_ReadOrder[0].c2_3[0]_1 CheckBox
Check this box if the employee participated in an employer's retirement plan during the year.
topmostSubform[0].CopyD[0].Col_Right[0].c2_4[0]_1 CheckBox
Check this box if the employee received third-party sick pay.
Employee Earnings
1 Wages, tips, other compensation Text
Enter the total amount of wages, tips, and other compensation paid to the employee during the year.
3 Social security wages Text
Enter the total amount of wages subject to social security tax.
5 Medicare wages and tips Text
Enter the total amount of wages and tips subject to Medicare tax.
7 Social security tips Text
Enter the total amount of tips reported to the employer that are subject to social security tax.
8 Allocated tips Text
Enter the total amount of tips allocated to the employee by the employer.
Employee Information
a Employee's social security number Text
Enter the employee's social security number. This should be a 9-digit number.
Max length: 11 characters
topmostSubform[0].CopyA[0].Col_Left[0].f1_02[0 Text
Enter the employee's identification number or other relevant identifier.
Max length: 10 characters
e Employee's first name and initial Text
Enter the employee's first name and initial.
Last name Text
Enter the employee's last name.
Suff Text
Enter the employee's suffix, if applicable (e.g., Jr., Sr., III).
topmostSubform[0].CopyA[0].Col_Left[0].f1_08[0 Text
Enter any additional employee information as required.
a Employee's social security number Text
Enter the employee's social security number. This should be a 9-digit number.
Max length: 11 characters
e Employee's first name and initial Text
Enter the employee's first name and initial.
Last name Text
Enter the employee's last name.
Suff Text
Enter the employee's suffix, if applicable (e.g., Jr., Sr., III).
topmostSubform[0].Copy1[0].Col_Left[0].f2_08[0 Text
Enter the employee's address, including street address, city, state, and ZIP code.
a Employee's social security number Text
Enter the employee's social security number. This should be a 9-digit number formatted as XXX-XX-XXXX.
Max length: 11 characters
e Employee's first name and initial Text
Enter the employee's first name and initial.
Last name Text
Enter the employee's last name.
Suff Text
Enter the employee's suffix, if applicable (e.g., Jr., Sr., III).
topmostSubform[0].CopyB[0].Col_Left[0].f2_08[0 Text
Enter any additional information related to the employee's name.
a Employee's social security number Text
Enter the employee's social security number. This should be a 9-digit number.
Max length: 11 characters
e Employee's first name and initial Text
Enter the employee's first name and initial.
Last name Text
Enter the employee's last name.
Suff Text
Enter the employee's suffix, if applicable (e.g., Jr., Sr., III).
599f Text
Enter the employee's first name and initial.
a Employee's social security number Text
Enter the employee's social security number. This should be a 9-digit number.
Max length: 11 characters
e Employee's first name and initial Text
Enter the employee's first name and initial.
Last name Text
Enter the employee's last name.
Suff Text
Enter the suffix of the employee's name, if applicable (e.g., Jr., Sr., III).
0644 Text
Enter the employee's control number, if applicable. This is an internal number used by the employer to identify individual W-2 forms.
a Employee's social security number Text
Enter the employee's social security number. This should be a 9-digit number formatted as XXX-XX-XXXX.
Max length: 11 characters
e Employee's first name and initial Text
Enter the employee's first name and initial.
Last name Text
Enter the employee's last name.
Suff Text
Enter the employee's suffix, if applicable (e.g., Jr., Sr., III).
368e Text
Enter the employee's social security number.
Employee Status
topmostSubform[0].CopyA[0].Col_Right[0].Statutory_ReadOrder[0].c1_2[0]_1 CheckBox
Check this box if you are a statutory employee.
topmostSubform[0].Copy1[0].Col_Right[0].Statutory_ReadOrder[0].c2_2[0]_1 CheckBox
Check this box if the employee is a statutory employee. Statutory employees are independent contractors treated as employees for tax purposes.
topmostSubform[0].CopyB[0].Col_Right[0].Statutory_ReadOrder[0].c2_2[0]_1 CheckBox
Check this box if the employee is a statutory employee.
topmostSubform[0].CopyC[0].Col_Right[0].Statutory_ReadOrder[0].c2_2[0]_1 CheckBox
Check this box if the employee is a statutory employee.
topmostSubform[0].CopyC[0].Col_Right[0].Retirement_ReadOrder[0].c2_3[0]_1 CheckBox
Check this box if the employee participated in an employer-sponsored retirement plan.
topmostSubform[0].CopyC[0].Col_Right[0].c2_4[0]_1 CheckBox
Check this box if the employee received third-party sick pay.
topmostSubform[0].Copy2[0].Col_Right[0].Statutory_ReadOrder[0].c2_2[0]_1 CheckBox
Check this box if the employee is a statutory employee. Statutory employees are independent contractors treated as employees for tax purposes.
topmostSubform[0].Copy2[0].Col_Right[0].Retirement_ReadOrder[0].c2_3[0]_1 CheckBox
Check this box if the employee participated in an employer-sponsored retirement plan during the year.
topmostSubform[0].Copy2[0].Col_Right[0].c2_4[0]_1 CheckBox
Check this box if the employee received third-party sick pay.
topmostSubform[0].CopyD[0].Col_Right[0].Statutory_ReadOrder[0].c2_2[0]_1 CheckBox
Check this box if the employee is a statutory employee. Statutory employees are independent contractors treated as employees for tax purposes.
Employer Information
C Employer's name, address, and ZIP code Text
Enter the employer's name, address, and ZIP code.
d Control number Text
Enter the control number assigned by the employer.
b Employer identification number (EIN) Text
Enter the employer's identification number (EIN). This should be a 9-digit number.
Max length: 10 characters
C Employer's name, address, and ZIP code Text
Enter the employer's name, address, and ZIP code.
d Control number Text
Enter the control number, if applicable. This is an optional field used by some employers to identify individual W-2 forms.
b Employer identification number (EIN) Text
Enter the employer's identification number (EIN). This should be a 9-digit number formatted as XX-XXXXXXX.
Max length: 10 characters
C Employer's name, address, and ZIP code Text
Enter the employer's name, address, and ZIP code.
d Control number Text
Enter the control number, if applicable. This is an optional field used by some employers for internal purposes.
Employer's state ID number Text
Enter the employer's state ID number.
b Employer identification number (EIN) Text
Enter the employer's identification number (EIN). This should be a 9-digit number.
Max length: 10 characters
C Employer's name, address, and ZIP code Text
Enter the employer's name, address, and ZIP code.
topmostSubform[0].CopyC[0].Col_Left[0].f2_04[0 Text
Enter the employer's address and ZIP code.
b Employer identification number (EIN) Text
Enter the employer's identification number (EIN). This should be a 9-digit number.
Max length: 10 characters
C Employer's name, address, and ZIP code Text
Enter the employer's name, address, and ZIP code.
d Control number Text
Enter the control number, if applicable. This is used by the employer for internal purposes.
b Employer identification number (EIN) Text
Enter the employer's identification number (EIN). This should be a 9-digit number formatted as XX-XXXXXXX.
Max length: 10 characters
c Employer's name, address, and ZIP code Text
Enter the employer's name, address, and ZIP code.
topmostSubform[0].CopyD[0].Col_Left[0].f2_04[0 Text
Enter the employer's identification number (EIN).
Federal Wages and Taxes
topmostSubform[0].CopyB[0].Col_Right[0].Box1_ReadOrder[0].f2_09[0 Text
Enter the total amount of wages, tips, and other compensation.
2 Federal income tax withheld Text
Enter the total amount of federal income tax withheld.
Form Status
topmostSubform[0].CopyA[0].Void_ReadOrder[0].c1_1[0]_1 CheckBox
Check this box if the form is void.
General Information
topmostSubform[0].CopyD[0].Void_ReadOrder[0].c2_1[0]_1 CheckBox
Check this box if the form is void. This is typically used by employers to indicate that the form should not be processed.
Income
8 Allocated tips Text
Enter the total amount of tips allocated to you by your employer.
7 Social security tips Text
Enter the total amount of tips you received that are subject to Social Security tax.
8 Allocated tips Text
Enter the total amount of tips that were allocated to you by your employer.
11 Nonqualified plans Text
Enter the total amount of income from nonqualified deferred compensation plans.
Income Information
1 Wages, tips, other compensation Text
Enter the total wages, tips, and other compensation paid to the employee during the year.
3 Social security wages Text
Enter the total wages subject to social security tax.
5 Medicare wages and tips Text
Enter the total wages and tips subject to Medicare tax.
7 Social security tips Text
Enter the total tips reported to the employer that are subject to social security tax.
8 Allocated tips Text
Enter the total tips allocated to the employee by the employer.
Local Information
18 Local wages, tips, etc Text
Enter the total local wages, tips, etc. for the employee.
topmostSubform[0].CopyA[0].Box18_ReadOrder[0].f1_38[0 Text
Enter the total local wages, tips, etc. for the employee.
19 Local income tax Text
Enter the total local income tax withheld from the employee's wages.
topmostSubform[0].Copy1[0].Box16_ReadOrder[0].f2_33[0 Text
Enter the local wages, tips, etc. This is Box 18.
topmostSubform[0].Copy1[0].Box16_ReadOrder[0].f2_34[0 Text
Enter the local income tax withheld. This is Box 18.
17 Text
Enter the name of the locality. This is Box 20.
topmostSubform[0].Copy1[0].Box17_ReadOrder[0].f2_36[0 Text
Enter the locality name. This is Box 20.
tax Text
Enter the local income tax withheld. This is Box 19.
topmostSubform[0].CopyB[0].Box16_ReadOrder[0].f2_33[0 Text
Enter the local wages, tips, etc.
topmostSubform[0].CopyB[0].Box16_ReadOrder[0].f2_34[0 Text
Enter the local income tax withheld.
topmostSubform[0].CopyB[0].Box17_ReadOrder[0].f2_35[0 Text
Enter the name of the locality.
topmostSubform[0].CopyC[0].Box16_ReadOrder[0].f2_33[0 Text
Enter the local wages, tips, etc.
18 Local wages, tips, etc Text
Enter the local wages, tips, etc. for the employee.
topmostSubform[0].CopyC[0].Box18_ReadOrder[0].f2_38[0 Text
Enter any additional local wages, tips, etc. for the employee.
topmostSubform[0].CopyC[0].Box19_ReadOrder[0].f2_39[0 Text
Enter the local income tax withheld for the employee.
topmostSubform[0].CopyC[0].Box19_ReadOrder[0].f2_40[0 Text
Enter any additional local income tax withheld for the employee.
20 Locality name Text
Enter the name of the locality for which the local wages and taxes are being reported.
topmostSubform[0].CopyC[0].f2_42[0 Text
Enter any additional locality information if applicable.
17 Text
Enter the local wages, tips, and other compensation.
topmostSubform[0].CopyD[0].Box16_ReadOrder[0].f2_34[0 Text
Enter the local income tax withheld.
topmostSubform[0].CopyD[0].Box17_ReadOrder[0].f2_36[0 Text
Enter the local wages, tips, and other compensation.
18 Local wages, tips, etc Text
Enter the local wages, tips, and other compensation.
topmostSubform[0].CopyD[0].Box18_ReadOrder[0].f2_38[0 Text
Enter the local income tax withheld.
topmostSubform[0].CopyD[0].Box19_ReadOrder[0].f2_39[0 Text
Enter the local income tax withheld.
topmostSubform[0].CopyD[0].Box19_ReadOrder[0].f2_40[0 Text
Enter the local income tax withheld.
20 Locality name Text
Enter the name of the locality where the wages were earned.
topmostSubform[0].CopyD[0].f2_42[0 Text
Enter the name of the locality where the wages were earned.
Local Tax Information
topmostSubform[0].CopyA[0].Box19_ReadOrder[0].f1_40[0 Text
Enter the amount of local income tax withheld from the employee's wages.
20 Locality name Text
Enter the name of the locality for which the local income tax is being reported.
topmostSubform[0].CopyA[0].f1_42[0 Text
Enter the amount of local wages, tips, and other compensation.
topmostSubform[0].CopyB[0].Box18_ReadOrder[0].f2_37[0 Text
Enter the local wages, tips, and other compensation for the employee.
topmostSubform[0].CopyB[0].Box18_ReadOrder[0].f2_38[0 Text
Enter the local income tax amount withheld from the employee's wages.
topmostSubform[0].CopyB[0].Box19_ReadOrder[0].f2_39[0 Text
Enter any additional local income tax amount withheld from the employee's wages.
topmostSubform[0].CopyB[0].Box19_ReadOrder[0].f2_40[0 Text
Enter any additional local wages, tips, and other compensation for the employee.
20 Locality name Text
Enter the name of the locality for which the local taxes are being reported.
1beb Text
Enter the locality name for the local taxes being reported.
Local Wages and Taxes
topmostSubform[0].Copy1[0].Box18_ReadOrder[0].f2_38[0 Text
Enter the total amount of local wages, tips, and other compensation.
topmostSubform[0].Copy1[0].Box19_ReadOrder[0].f2_39[0 Text
Enter the total amount of local income tax withheld.
topmostSubform[0].Copy1[0].Box19_ReadOrder[0].f2_40[0 Text
Enter any additional local income tax withheld.
20 Locality name Text
Enter the name of the locality (city, town, etc.) for which the local taxes are being reported.
topmostSubform[0].Copy1[0].f2_42[0 Text
Enter any additional information related to local wages and taxes.
Miscellaneous
topmostSubform[0].CopyC[0].Col_Right[0].Box9_ReadOrder[0].f2_17[0 Text
This field appears to be a placeholder or an unrecognized field. Please refer to the form instructions for more details.
Other Compensation
14 Other Text
Enter any other compensation or information that does not fit into the other boxes. This is Box 14.
14 Other Text
Enter any other compensation or benefits not covered by other boxes. This can include items such as moving expenses, union dues, etc.
Other Information
14 Other Text
Enter any other compensation or information that does not fit into the other boxes. This is Box 14 on the form.
Reserved
9 Text
This box is reserved for future use. Leave it blank.
Retirement Information
topmostSubform[0].CopyA[0].Col_Right[0].Retirement_ReadOrder[0].c1_3[0]_1 CheckBox
Check this box if the employee participated in an employer-sponsored retirement plan during the year.
Retirement Plan
topmostSubform[0].Copy1[0].Col_Right[0].Retirement_ReadOrder[0].c2_3[0]_1 CheckBox
Check this box if the employee participated in an employer's retirement plan during the year.
Sick Pay
topmostSubform[0].Copy1[0].Col_Right[0].c2_4[0]_1 CheckBox
Check this box if the employee received third-party sick pay.
Sick Pay Information
topmostSubform[0].CopyA[0].Col_Right[0].c1_4[0]_1 CheckBox
Check this box if the employee's third-party sick pay is being reported.
State Information
15 State Text
Enter the abbreviation for the state in which the employee's wages were earned.
Employer's state ID number Text
Enter the employer's state identification number assigned by the state.
topmostSubform[0].CopyA[0].Boxes15_ReadOrder[0].f1_31[0 Text
Enter the total state wages, tips, etc. for the employee.
topmostSubform[0].CopyA[0].Boxes15_ReadOrder[0].f1_32[0 Text
Enter the total state income tax withheld from the employee's wages.
topmostSubform[0].CopyA[0].Box16_ReadOrder[0].f1_33[0 Text
Enter the total state wages, tips, etc. for the employee.
topmostSubform[0].CopyA[0].Box16_ReadOrder[0].f1_34[0 Text
Enter the total state income tax withheld from the employee's wages.
17 State income tax Text
Enter the total state income tax withheld from the employee's wages.
topmostSubform[0].CopyA[0].Box17_ReadOrder[0].f1_36[0 Text
Enter the total state income tax withheld from the employee's wages.
15 State Text
Enter the state abbreviation for the state in which the employee's wages were earned. This is Box 15.
Employer's state ID number Text
Enter the employer's state ID number. This is Box 15.
topmostSubform[0].Copy1[0].Boxes15_ReadOrder[0].f2_31[0 Text
Enter the state wages, tips, etc. This is Box 16.
topmostSubform[0].Copy1[0].Boxes15_ReadOrder[0].f2_32[0 Text
Enter the state income tax withheld. This is Box 16.
15 State Text
Enter the state abbreviation for state tax purposes.
topmostSubform[0].CopyB[0].Boxes15_ReadOrder[0].f2_31[0 Text
Enter the state wages, tips, etc.
bffd Text
Enter the state income tax withheld.
15 State Text
Enter the state abbreviation for state tax purposes.
topmostSubform[0].CopyC[0].Boxes15_ReadOrder[0].f2_30[0 Text
Enter the employer's state ID number.
topmostSubform[0].CopyC[0].Boxes15_ReadOrder[0].f2_31[0 Text
Enter the state wages, tips, etc.
topmostSubform[0].CopyC[0].Boxes15_ReadOrder[0].f2_32[0 Text
Enter the state income tax withheld.
topmostSubform[0].CopyC[0].Box16_ReadOrder[0].f2_34[0 Text
Enter the state wages, tips, etc. for the employee.
topmostSubform[0].CopyC[0].Box17_ReadOrder[0].f2_35[0 Text
Enter the state income tax withheld for the employee.
topmostSubform[0].CopyC[0].Box17_ReadOrder[0].f2_36[0 Text
Enter any additional state income tax withheld for the employee.
15 State Text
Enter the state abbreviation for the state where the employee's wages were earned. This is Box 15 on the form.
Employer's state ID number Text
Enter the employer's state ID number. This is used for state tax reporting purposes.
topmostSubform[0].Copy2[0].Boxes15_ReadOrder[0].f2_31[0 Text
Enter the state wages, tips, etc. This is Box 16 on the form.
15 State Text
Enter the state abbreviation where the wages were earned.
topmostSubform[0].CopyD[0].Boxes15_ReadOrder[0].f2_30[0 Text
Enter the employer's state ID number.
topmostSubform[0].CopyD[0].Boxes15_ReadOrder[0].f2_31[0 Text
Enter the state wages, tips, and other compensation.
topmostSubform[0].CopyD[0].Boxes15_ReadOrder[0].f2_32[0 Text
Enter the state income tax withheld.
17 State income tax Text
Enter the state income tax withheld.
State Tax Information
topmostSubform[0].CopyB[0].Box17_ReadOrder[0].f2_36[0 Text
Enter the state income tax amount withheld from the employee's wages.
State/Local Tax Information
topmostSubform[0].Copy2[0].Boxes15_ReadOrder[0].f2_32[0 Text
This field is for entering the state or local tax information. Please refer to your tax documents or employer for the exact value.
16 State wages, tips, etc Text
Enter the total state wages, tips, and other compensation received. This information can be found on your pay stubs or provided by your employer.
topmostSubform[0].Copy2[0].Box16_ReadOrder[0].f2_34[0 Text
This field is for additional state wages, tips, and other compensation. Ensure you have the correct figures from your employer.
topmostSubform[0].Copy2[0].Box17_ReadOrder[0].f2_35[0 Text
Enter the state income tax withheld from your wages. This information is typically found on your pay stubs or provided by your employer.
topmostSubform[0].Copy2[0].Box17_ReadOrder[0].f2_36[0 Text
This field is for additional state income tax withheld. Verify the amount with your employer or pay stubs.
topmostSubform[0].Copy2[0].Box18_ReadOrder[0].f2_37[0 Text
Enter the locality name where the wages were earned. This is usually the city or county name.
topmostSubform[0].Copy2[0].Box18_ReadOrder[0].f2_38[0 Text
This field is for additional locality names if applicable. Ensure you have the correct locality information.
topmostSubform[0].Copy2[0].Box19_ReadOrder[0].f2_39[0 Text
Enter the local income tax withheld from your wages. This information can be found on your pay stubs or provided by your employer.
topmostSubform[0].Copy2[0].Box19_ReadOrder[0].f2_40[0 Text
This field is for additional local income tax withheld. Verify the amount with your employer or pay stubs.
20 Locality name Text
Enter the name of the locality where the wages were earned. This is usually the city or county name.
topmostSubform[0].Copy2[0].f2_42[0 Text
This field is for additional locality names if applicable. Ensure you have the correct locality information.
Tax Information
2 Federal income tax withheld Text
Enter the total federal income tax withheld from the employee's wages during the year.
4 Social security tax withheld Text
Enter the total social security tax withheld from the employee's wages during the year.
6 Medicare tax withheld Text
Enter the total Medicare tax withheld from the employee's wages during the year.
Tax Withheld
2 Federal income tax withheld Text
Enter the total amount of federal income tax withheld from the employee's wages during the year.
4 Social security tax withheld Text
Enter the total amount of social security tax withheld from the employee's wages.
6 Medicare tax withheld Text
Enter the total amount of Medicare tax withheld from the employee's wages.
Tax Withholding
6 Medicare tax withheld Text
Enter the total amount of Medicare tax that was withheld from your wages during the year.
Unused Field
topmostSubform[0].Copy2[0].Col_Right[0].Box9_ReadOrder[0].f2_17[0 Text
This field is not used. Leave it blank.
Wage and Tax Information
1 Wages, tips, other compensation Text
Enter the total amount of wages, tips, and other compensation paid to the employee.
2 Federal income tax withheld Text
Enter the total amount of federal income tax withheld from the employee's wages.
3 Social security wages Text
Enter the total amount of social security wages paid to the employee.
4 Social security tax withheld Text
Enter the total amount of social security tax withheld from the employee's wages.
5 Medicare wages and tips Text
Enter the total amount of Medicare wages and tips paid to the employee.
Wages and Taxes
3 Social security wages Text
Enter the total amount of wages subject to social security tax.
4 Social security tax withheld Text
Enter the total amount of social security tax withheld from the employee's wages.
5 Medicare wages and tips Text
Enter the total amount of wages and tips subject to Medicare tax.
6 Medicare tax withheld Text
Enter the total amount of Medicare tax withheld from the employee's wages.
7 Social security tips Text
Enter the total amount of tips subject to social security tax.
8 Allocated tips Text
Enter the total amount of tips allocated to the employee.
9 Text
This field is reserved for future use and should be left blank.
1 Wages, tips, other compensation Text
Enter the total wages, tips, and other compensation paid to the employee.
2 Federal income tax withheld Text
Enter the total federal income tax withheld from the employee's wages.
3 Social security wages Text
Enter the total social security wages paid to the employee.
4 Social security tax withheld Text
Enter the total social security tax withheld from the employee's wages.
5 Medicare wages and tips Text
Enter the total Medicare wages and tips paid to the employee.
topmostSubform[0].CopyD[0].Col_Right[0].f2_14[0 Text
Enter the total Medicare tax withheld from the employee's wages.
7 Social security tips Text
Enter the total social security tips received by the employee.
8 Allocated tips Text
Enter the total allocated tips received by the employee.