| Company name, address, EIN, phone and logo | Issued by: company address, phone, EIN |
| Last four digits of the SSN | Issued to: name, ID, masked SSN, address |
| Pay period, pay date and pay frequency | Pay details under a rounded header row |
| Filing status and how the pay was made | Pay details under a rounded header row |
| Hours and rate, or the salary for the period | Earnings table with rate, hours, current and YTD |
| Overtime, bonus, commission and tips lines | Earnings table with rate, hours, current and YTD |
| Federal, state, Social Security and Medicare (estimated) | Taxes and deductions table with the total |
| Your own deductions (health plan, retirement, garnishment) | Taxes and deductions table with the total |
| Year-to-date totals | Earnings table with rate, hours, current and YTD |
| Memo or notes | Net pay with YTD, and a memo note |