Magnetic Media Transmitter Report Form printable pdf download

Magnetic Media Transmitter Report Form

(Rev. 8/97)

Massachusetts

Wage Reporting

Department of

Magnetic Media Transmitter Report

Revenue

Please print or type. For each tape or cartridge submitted, complete a separate Magnetic Media Transmitter Report. Mail the complete report and

tape or cartridge to: Massachusetts Department of Revenue, PO Box 7030, Boston, MA 02204.

Your tape cannot be processed without the transmitter FID number.

—

Transmitter Federal ID number:

Transmitter’s name

Street address

Contact person

City/town

State

Zip

Phone number

(

)

1. Check box only if your organization’s name or address has changed since filing its last report.

2. Is the tape submitted a multiple reel file?

Yes

No.

Enter tape numbers of multiple reel files.

3. Please provide the information requested below:

DOR format is used only when 96 bytes is selected.

Tape layout:

SSA Format

DOR Format

ICESA Format

Period filed:

Quarter = 1, 2, 3 or 4

Year

Format:

ASCII

EBCDIC

VMS

Density:

1600 BPI

6250 BPI

37,871 BPI

Blocking factor:

Internal label:

IBM Standard

Unlabeled

Record length:

275 Bytes

276 Bytes

96 Bytes

4. What is the total number of employers reported?

5. What is the total number of employees reported?

I declare that I have examined this report and to the best of my knowledge and belief it is true, correct and complete.

Signature

Title

Date

For internal use only — tape validation number:

Magnetic Media Transmitter Report Form

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