| Company name, address, EIN, phone and logo | Title and three-column header card: employer, employee, pay details |
| Employee name, address and ID | Title and three-column header card: employer, employee, pay details |
| Last four digits of the SSN | Title and three-column header card: employer, employee, pay details |
| Pay period, pay date and pay frequency | Title and three-column header card: employer, employee, pay details |
| Filing status and how the pay was made | Title and three-column header card: employer, employee, pay details |
| Hours and rate, or the salary for the period | Earnings table with gross taxable pay |
| Overtime, bonus, commission and tips lines | Earnings table with gross taxable pay |
| Federal, state, Social Security and Medicare (estimated) | Earnings table with gross taxable pay |
| Your own deductions (health plan, retirement, garnishment) | Deductions table with total deductions |
| Year-to-date totals | Net pay box with YTD net pay |
| Memo or notes | Memo note, when you add one |