"Worker's First Name"	"Worker's Middle Initial"	"Worker's Last Name"	"Worker's Address Line 1"	"Worker's Address Line 2"	"Worker's City"	"Worker's State"	"Worker's Zip Code"	"Worker's Zip+4"	"Worker's SSN"	"Worker's Date of Hire"	"Worker's Date of Birth"	"Worker's Gender"	"Worker's Work Name"	"Employer's Name"	"Employer's Payroll Address Line 1"	"Employer's Payroll Address Line 2"	"Employer's Payroll City"	"Employer's Payroll State"	"Employer's Payroll Zip Code"	"Employer's Zip+4"	"Employer's Payroll Country Code"	"Employer's Federal EIN"	"Employer's State EIN"	"Filler"