"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 State"	"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 Payroll Zip +4"	"Employer's Payroll Country Code"	"Employer's Federal EIN"	"Employer's State EIN"	"Employee's Salary"	"Employee eligible for an insurance benefit"