| Sl. No | Page | Field name / Line item | Max Chars | Field Format |
| 1 | N/A | FormID | 5 | Numeric; Format Ex: (222XX: 222 = OUPC, XX=ODT Assigned Vendor Code) |
| 2 | Page 1 | Tax Type | 3 | Numeric; Required, Mandatory field (440=PIT and 441=SDI) |
| 3 | Page 1 | ID Type | 2 | Numeric; Required, Mandatory field (01=SSN) |
| 4 | Page 1 | ID Number | 14 | Numeric; Required, Mandatory field (If less than 14 digits, pad number with leading 0's) |
| 5 | Page 1 | Reporting Period | 4 | Numeric;Required, Mandatory field (MMYY) |
| 6 | Page 1 | Coupon Type | 2 | Numeric; Required, Mandatory field (54=Return payment, 55=Estimated payment) |
| 7 | Page 1 | School District Number | 4 | Numeric; Required, Mandatory field. If tax type=441, must be valid taxing School District (see instructions booklet for complete list.) If tax type=440, send 0000. |
| 8 | Page 1 | Taxpayer Last Name 1st three Chars | 3 | Alpha and Space allowed (Special characters allowed 'apostrophe', '-'); Required, Mandatory field |
| 9 | Page 1 | Amount Paid | 11 | Numeric; Required, Mandatory field; Send amount as dollars and cents without $ sign or decimal point |
| 10 | N/A | Trailer | 5 | Always *EOD* |
| Total Bytes/Characters | 53 | |||
| General Fields | ||||
| Form Fields |