| Field Name | Size | Type | Description | Notes |
|---|---|---|---|---|
| See Form Filer Common Fields | Filer fields common to all form types. | |||
| See Recipient Common Fields | Recipient fields common to all form types. | |||
Box 1 Amount | 12 | Amount | Wages, tips, other compen. | |
| Box 2 Amount | 12 | Amount | Federal income tax withheld | |
| Box 3 Amount | 12 | Amount | Social security wages | |
| Box 4 Amount | 12 | Amount | Social security tax withheld | |
| Box 5 Amount | 12 | Amount | Medicare wages and tips | |
| Box 6 Amount | 12 | Amount | Medicare tax withheld | |
| Box 7 Amount | 12 | Amount | Social security tips | |
| Box 8 Amount | 12 | Amount | Allocated tips | |
| Box 10 Amount | 12 | Amount | Dependent care benefits | |
| Box 11 Amount | 12 | Amount | Nonqualified plans | |
| Box 11 is Sect 457 | 1 | Checkbox | Sec 457 checkbox | |
| Box 12a Amount | 12 | Amount | See instructions. | |
| Box 12a Code | 2 | Text | See instructions. | |
| Box 12b Amount | 12 | Amount | See instructions. | |
| Box 12b Code | 2 | Text | See instructions. | |
| Box 12c Amount | 12 | Amount | See instructions. | |
| Box 12c Code | 2 | Text | See instructions. | |
| Box 12d Amount | 12 | Amount | See instructions. | |
| Box 12d Code | 2 | Text | See instructions. | |
| Box 13 Checkbox 1 | 1 | Checkbox | Statutory employee checkbox | |
| Box 13 Checkbox 2 | 1 | Checkbox | Retire plan checkbox | |
| Box 13 Checkbox 3 | 1 | Checkbox | Third-party sick pay checkbox | |
| Box 14 All lines | 60 | Text | Other | |
| Box 14 Line 1 | 20 | Text | Other | |
| Box 14 Line 2 | 20 | Text | Other | |
| Box 14 Line 3 | 20 | Text | Other | |
| Box 15 SUTA State | 2 | Text | Withholding State | |
| Box 15(1) State ID number | 20 | Text | Employer's state ID number | |
| Box 16(1) Amount | 12 | Amount | State wages, tips, etc | |
| Box 17(1) Amount | 12 | Amount | State income tax | |
| Box 18(1) Amount | 12 | Amount | Local wages, tips, etc | |
| Box 19(1) Amount | 12 | Amount | Local income tax | |
| Box 20(1) Locality | 20 | Text | Locality name | |
| See Form Common Fields | Form fields common to all form types | |||