"Employee SSN"	"Employee First Name"	"Employee Middle Name"	"Employee Last Name"	"Employee Address Line 1"	"Employee Address Line 2"	"Employee Address Line 3"	"Employee City"	"Employee State"	"Employee Zip Code 1"	"Employee Zip Code + 4"	"Employee Foreign Country Code"	"Employee Foreign Country Name"	"Employee Foreign Zip Code"	"Date of Birth"	"Date of Hire"	"State of Hire"	"Employer FEIN"	"Employer SEIN"	"Employer Name"	"Employer Address Line 1"	"Employer Address Line 2"	"Employer Address Line 3"	"Employer City"	"Employer State"	"Employer Zip Code 1"	"Employer Zip +4"	"Employer Foreign Country Code"	"Employer Foreign Country Name"	"Employer Foreign Zip Code"	"Employer Optional Address Line 1"	"Employer Optional Address Line 2"	"Employer Optional Address Line 3"	"Employer Optional City"	"Employer Optional State"	"Employer Optional Zip Code 1"	"Employer Optional Zip +4"	"Employer Optional Foreign Country Code"	"Employer Optional Foreign Country Name"	"Employer Optional Foreign Zip Code"	"Medical Insurance Available?"	"Employer Phone"	"Multi-State?"	"Insurance Company Name"