| Company name, address, EIN, phone and logo | Company block, boxed title and employee address |
| Employee name, address and ID | Company block, boxed title and employee address |
| Last four digits of the SSN | Company block, boxed title and employee address |
| Pay period, pay date and pay frequency | Labeled boxes for IDs, dates and pay details |
| Filing status and how the pay was made | Labeled boxes for IDs, dates and pay details |
| Hours and rate, or the salary for the period | Earnings ledger with gross taxable pay |
| Overtime, bonus, commission and tips lines | Earnings ledger with gross taxable pay |
| Federal, state, Social Security and Medicare (estimated) | Earnings ledger with gross taxable pay |
| Your own deductions (health plan, retirement, garnishment) | Taxes and deductions ledger with the total |
| Year-to-date totals | Summary strip: this period and year to date |
| Memo or notes | Net pay column, and a memo note |