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DocuSign Envelope ID: EA6C45CD-7691-43D8-B939-A4300A7DD233 <br /> IIF" IIFiii VIII III <br /> Field Pic Length <br /> Employee ID (possibly SSN/EIN etc.) 999999999 9 <br /> Last Name X(25) 25 <br /> First Name X(15) 15 <br /> Address Line 1 X(30) 30 <br /> Address Line 2 X(30) 30 <br /> City X(20) 20 <br /> State X(2) 2 <br /> Zip X(9) 9 <br /> * Pay Frequency X(1) 1 <br /> ** MRA Per Pay Period Amount 9999V99 6 <br /> MRA Annual Amount 99999V99 7 <br /> ** DCRA Per Pay Period Amount 9999V99 6 <br /> DCRA Annual Amount 99999V99 7 <br /> ** QTE Per Pay Period Amount 9999V99 6 <br /> QTE Annual Amount 99999V99 7 <br /> Date Entered MRA YYYYMMDD 8 <br /> Date Left MRA YYYYMMDD 8 <br /> Date Entered DCRA YYYYMMDD 8 <br /> Date Left DCRA YYYYMMDD 8 <br /> Date Entered QTE YYYYMMDD 8 <br /> Date Left QTE YYYYMMDD 8 <br /> ***MRA Actual Deduction 9999V99 6 <br /> ***DCRA Actual Deduction 9999V99 6 <br /> ***QTE Actual Deduction 9999V99 6 <br /> HSA Enrollment (U/N) X(1) 1 <br /> Debit Card Useage (U/N) X(1) 1 <br /> Record Length 248 <br /> * Pay Frequency Values: <br /> B—Bi-Weekly,W—Weekly,S—Semi-Monthly, M—Monthly <br /> If you have more than one pay group of the same frequency (e.g. you have two different bi-weekly runs so <br /> that you are paying employees on alternate weeks) please contact us to setup a code for each pay group. <br /> ** The amount to be taken out each paycheck <br /> (This is the amount enrolled, not necessarily the actual deduction) <br /> ***The amount that was actually taken out of the participant's pay check for this payroll run <br /> The filename should be the group's prefix,followed by.Yxx. The xx should be replaced with a serial number <br /> from 01 to 99 which indicates which file this I for the current plan year. <br /> ORANGE COUNTY 8 Flores <br />