"Employer FEIN"	"Employer Name"	"Employer Address Line 1"	"Employer Address line 2"	"Employer City"	"Employer State"	"Employer Zip Code"	"Employer Zip +4"	"Employer Country"	"Employer International Postal Code"	"Employee SSN#"	"Employee Last Name"	"Employee First Name"	"Employee Middle Name"	"Employee Address Line 1"	"Employee Address Line 2"	"Employee City"	"Employee State"	"Employee Zip Code"	"Employee Zip +4"	"Employee Country"	"Employee International Postal Code"	"Employee Date of Birth"	"Employee Date of Hire"	"Employee State of Hire"	"Filler"