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Field NameSizeType DescriptionNotes
See Form Filer Common FieldsFiler fields common to all form types. 
See Recipient Common FieldsRecipient fields common to all form types. 

Box 1 Amount

12Amount

Wages, tips, other compen.

 
Box 2 Amount12AmountFederal income tax withheld 
Box 3 Amount12AmountSocial security wages 
Box 4 Amount12AmountSocial security tax withheld 
Box 5 Amount12AmountMedicare wages and tips 
Box 6 Amount12AmountMedicare tax withheld 
Box 7 Amount12AmountSocial security tips 
Box 8 Amount12AmountAllocated tips 
Box 10 Amount12AmountDependent care benefits 
Box 11 Amount12AmountNonqualified plans 
Box 11 is Sect 4571CheckboxSec 457 checkboxX / Y / T / 1 = Checked
Box 12a Amount12AmountSee instructions. 
Box 12a Code2TextSee instructions. 
Box 12b Amount12AmountSee instructions. 
Box 12b Code2TextSee instructions. 
Box 12c Amount12AmountSee instructions. 
Box 12c Code2TextSee instructions. 
Box 12d Amount12AmountSee instructions. 
Box 12d Code2TextSee instructions. 
Box 13 Checkbox 11CheckboxStatutory employee checkboxX / Y / T / 1 = Checked
Box 13 Checkbox 21CheckboxRetire plan checkboxX / Y / T / 1 = Checked
Box 13 Checkbox 31CheckboxThird-party sick pay checkboxX / Y / T / 1 = Checked
Box 14 All lines60TextOther 
Box 14 Line 120TextOther 
Box 14 Line 220TextOther 
Box 14 Line 320TextOther 
Box 15 SUTA State2TextWithholding StateUse state abbreviation
Box 15(1) State ID number20TextEmployer's state ID numberProvided by State
Box 16(1) Amount12AmountState wages, tips, etc 
Box 17(1) Amount12AmountState income tax 
Box 18(1) Amount12AmountLocal wages, tips, etc 
Box 19(1) Amount12AmountLocal income tax 
Box 20(1) Locality20TextLocality name 
See Form Common FieldsForm fields common to all form types 
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