Reporting Year

Medicare Qualified Govt Employee

Department

Last Name

First Name

Middle Name

Sequence Number

Address 1

Address 2

Address 3

City

State

Zip Code

Foreign Address

Foreign State/Province

Foreign Postal Code

Country Code

W2 Control Number

Employee ID

Social Security Number

W2 Box For Statutory Employee

W2 Box For Deceased

W2 Box For Pension Plan

W2 Box For Legal Representative

W2 Box For 942 Employee

W2 Box For Subtotal

W2 Box For Deferred Compensation

Wages, Tips, Other Compensation

Federal Income Tax W/H

Social Security Wages

Social Security Tax Withheld

Medicare Wages and Tips

Medicare Tax Withheld

Social Security Tips

Allocated Tips

Advance EIC Payment

Dependent Care Benefits

Nonqualified Plans

Benefits Included in Wages

W2 Forms Counter

Note Index

String Array[1]

String Array[2]

String Array[3]

String Array[4]

String Array[5]

Long Integer Array[1]

Long Integer Array[2]

Long Integer Array[3]

Long Integer Array[4]

Long Integer Array[5]

Employee Suffix