| Box | Description |
|---|---|
| 1 | Wages - ORP, TSA, TRS & Parking Amounts Deducted From Taxable Wages |
| 2 | Federal Income Tax Withheld (020 & 022) |
| 3 | Social Security Wages |
| 4 | Social Security Tax Withheld (010) |
| 5 | Medicare Wages |
| 6 | Medicare Tax Withheld (011) |
| 9 | Advance EIC Payment - Earned Income (040) |
| 10 | Dependent Care Benefits - Tex Flex Dependent Care (TFD) |
| 12C | Cost of Group Term Life Insurance - (LIT) |
| 12CC | FICA Hire Act - Applicable Gross (012) |
| 12DD | Health Plan Costs HGP, HOF, HOP, HSF, HSP (TPS, TPM, TPC, RO4, ROL, ROS) |
| 12E | Section 403 (b) Contributions - (ORP and TSA) - Amount Already Deducted From Wages |
| 12EE | Designated Roth Contributions Under 457(b) Effective 2012 |
| 12G | Section 457 Contributions - TexaSaver 457 (TXS) |
| 12P | Nontaxable Relocation Reimbursements (116) |
| 13R | Retirement Contributions Not In Boxes 12D, E, F, H (TRS, T90) - Amount Already Deducted From Wages |
| 14A | Housing - Taxable (126) |
| 14B | Car Allowance - Taxable (122) |
| 14C | Tuition - Taxable (112) |