ERISA Form 8955-SSA 2-D Barcode Standards Version 2.15 January 06, 2023 Plan Years: 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
| ERISA Form 8955-SSA 2-D Barcode Standards Version 2.15 January 06, 2023 Plan Years: 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 |
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History Log
Version Date Summary of Changes Editor
1.0 01/14/2011 Version 1.0 WBAPSO
Domenic Irace
1.1 6/27/2011 - Update Barcode Specs: Page 2 Barcode 1, #6 WBAPSO
“Software Version” should be a 2 position Domenic Irace
numeric field specifying vendor software
version (0, 1, 2, 3, etc.)
- Add details about font for page data under the
Approval Procedures section
- Update Plan Name on Page 2 Barcode 1, #9 –
Field Notes should make reference to
repeating Plan Name from Section 1a, not
Section 1b
- Field Types: Amounts no longer show
decimals in print format
1.2 11/01/2011 - Adding 2010 Form 8955-SSA WBAPSO
- Barcode is Mandatory for SSA Approval Domenic Irace
- New Section 7: Form Printing/Notes
o Printing Data – Fonts/Sizes
o Vendor ID to print in top left corner
o Address field updates
- Update Approval Procedures – vendor
information
1.3 6/7/2012 - Added a note about carriage returns in the WBAPSO
barcode to the General Standards section Domenic Irace
- Update Links to State and Country Codes at
the end of the Barcode Layout section
- Update Title Page and Overview section to
reflect plan years for which this document is
valid (2009-2011)
1.4 4/15/2013 - Document applicable to plan year 2012 WBAPSO
Domenic Irace
1.5 1/30/2014 - Document applicable to plan year 2013 WBAPSO
Domenic Irace
1.6 6/25/2014 - Change requirements for SSN to allow 8 as WBAPSO
starting digit Domenic Irace
- Corrected invalid EIN prefixes – add 49
where missing
1.7 6/9/2015 - Document applicable to plan year 2014 WBAPSO
- Updated room number on approval address Domenic Irace
1.8 2/3/2016 - Document applicable for plan year 2015 WBAPSO
- Removed reference to Play Years 2009 – Domenic Irace
2011 on Page #1 (Overview).
- Change approval submission room to 341.
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Version Date Summary of Changes Editor
1.9 1/13/2017 - Document applicable for plan year 2016 WBAPSO
Domenic Irace
2.0 2/15/2018 - Document applicable for plan year 2017 WBAPSO
Domenic Irace
2.1 4/5/2018 - Update language in 7. Form Versions and WBAPSO
Printing Notes (also updated to current plan Domenic Irace
year line in this section)
2.11 1/2/2019 - Document applicable for plan year 2018. WBAPSO
- Correct version numbering Domenic Irace
- Update language in (7) to current plan year
2.12 1/2/2020 - Document applicable for plan year 2019 WBAPSO)
- Update language in (7) to current plan year Domenic Irace
- Moved the sample image for vendor code to
proper location
- Fixed footnote in section 3 (was not enough
room and half of footnote was on next page
- Updated Table of Contents
2.13 12/23/2020 - Document applicable for plan year 2020 WBAPSO
- Update language in (7) to current plan year Domenic Irace
- Updated Table of Contents
2.14 12/15/2021 - Document applicable for plan year 2021 WBAPSO
- Update language in (7) to current plan year Domenic Irace
- Updated Table of Contents
2.15 01/06/2023 - Document applicable for plan year 2021 WBAPSO
- Update language in (7) to current plan year Domenic Irace
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SSA’s ERISA Form 8955-SSA Barcode Standards
ERISA Form 8955-SSA - 2D Barcode Standards
Contents
1. Overview _______________________________________________________________ 1
2. General Standards ______________________________________________________ 2
3. Approval Procedures ___________________________________________________ 2
4. Duration of Approvals __________________________________________________ 3
5. Barcode Specifications _________________________________________________ 3
6. Rules __________________________________________________________________ 4
7. Form Versions and Printing Notes _______________________________________ 5
8. Field Types_____________________________________________________________ 7
9. Form 8955-SSA Barcode Layout _________________________________________ 8
a. Page 1 - Barcode 1 (bottom left side) ______________________________________________ 8
b. Page 1 - Barcode 2 (bottom right side) ____________________________________________ 12
c. Page 2 - Barcode 1 (bottom left side) _____________________________________________ 16
d. Page 2 - Barcode 2 (bottom right side) ____________________________________________ 27
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SSA’s ERISA Form 8955-SSA Barcode Standards
1. Overview
This document covers only the 2D barcode on ERISA Form 8955-SSA. The 2D barcode
is intended to represent the information on the paper form. Barcodes for this form are
generated from two sources:
1. The IRS Form 8955-SSA Fillable PDF produces a barcode after printing the form
in Adobe.
2. The approved software vendors for Form 8955-SSA produce a barcode when
printing their forms from their software packages.
The first page of the form contains information about the Plan Administrator and Plan
Sponsor, as well as annual statement identification data and signatures. This page must
have two barcodes, and the content for each barcode is defined in the barcode layout
section (see Section 8 - Form 8955-SSA Barcode Layout). The signature and signed
dates are the only data fields not included in the barcodes; all other fields are included
in the barcode data.
When generating your output file, on the bottom of page 1, you will provide a page
number, which will indicate this is page 1 of X. Where X is equal to the total number of
pages in this submission. (You can reference the official IRS PDF file for correct
placement of this information.)
The second page of the form contains participant information, such as the name, social
security number, and information about the participant’s benefits. The form will allow ten
participants on each page 2, and multiple page 2’s can be submitted for more
participants. Each page 2 must have two barcodes as defined in the layout (see Section
8 - Form 8955-SSA Barcode Layout). All data on this page should be included in the
barcode.
On page 2, you will display a number in the upper right corner of the page, identifying
the correct page number (i.e., the first page 2 in your submission will have printed on
the page, in this location, page 2.1. If you have additional page 2’s, you must number
them to indicate that they are additional. The next page 2 for this submission would be
numbered 2.2, and so on.) You must also indicate on the page, the correct (whole
number) page number (i.e., page 3 of 4, page 5 of 6.) (You can reference the official
IRS PDF file for correct placement of this information.)
Refer to the form samples provided by the IRS (PDF Form 8955-SSA) for proper layout
(labels, graphics, content, lines, scale, margins, etc.). If a software developer doesn’t
support 2-D barcodes, the area reserved for the barcode must be left blank. A general
rule used to determine if a printer can produce a 2-D barcode is if the printer can
produce a graphic such as an agency seal or business logo, then the printer should be
capable of producing a 2-D barcode that can be scanned.
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SSA’s ERISA Form 8955-SSA Barcode Standards
2. General Standards
• The barcode will be a 2-D barcode in the PDF-417 format. The PDF 417 has error
detection and correction capabilities. The error correction level should be set to level
5.
• All fields within the barcode are followed by a carriage return delimiter - <CR>.
o NOTE – Please don’t insert a carriage return within the Plan Name field. It
may appear as two lines on the form to fit all 140 characters, but don’t use
any delimiter in the barcode between the two lines of text. Doing so will
make the barcode invalid.
• All fields are required, although a field can be left empty (leaving just the field
terminating <CR>).
• Don’t zero fill or fill with spaces if a field is to be left blank, unless otherwise
specified. If there is no data, a field should be left empty followed by a terminating
<CR>. It is up to the decoder to determine how to handle empty fields.
• Stretching or scaling the barcode changes its integrity and reduces the readability of
the barcode; please don’t stretch or scale the barcode.
”
• The barcode must be surrounded by at least 1/4 of whitespace.
• Barcodes are required on vendor forms to obtain SSA Form Approval for Form
8955-SSA.
3. Approval Procedures
• Software vendors should provide up-to-date contact information including accurate
email addresses when submitting forms for approval.
• Test scenarios for 2-D barcode testing are via PDF.
• The format of the Form and the 2-D barcode data will be approved separately and
simultaneously, if possible, to expedite the approval process. SSA will indicate
exactly what is being approved.
• SSA requests 2 sheets of forms with test data for approval. If submitting a 2-D
barcode for approval, at least one sheet with 2-D barcode sample must be a ‘max-
fill’ sample. Samples with data fields that are maximum filled must have data in all
fields. The data in the remaining 2-D barcode samples should reflect the data on the
sheets, including field inclusion or exclusion requirements based on certain data
specified. Example: Entry Code ‘C’ on Page 2 requires data in the “Previous
Sponsor’s EIN” and “Previous Plan Number” fields but require no data in the
“Defined benefit Plan Periodic Payment” and “Total Value of Account” fields.
• SSA requests one printout of a blank form (without data and without a barcode).
• The vendor number must be included in the barcode per barcode layout in Section 8
of this document. It must also be printed at the top of the form per specifications.
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SSA’s ERISA Form 8955-SSA Barcode Standards
1
• The SSA can provide vendor codes for non-NACTP submissions.
• Please use a fixed pitch font for the printed data on Form 8955-SSA, preferably
Courier New. Please ensure that the data in each field fits in the appropriate box on
the form when printed. Please see Section 7 of this document for font size details.
Any questions or submissions for the Form 8955-SSA barcode specifications should be
emailed to: erisa.forms@ssa.gov, or sent to:
Social Security Administration
Data Operations Center
Attn: Erisa Forms Approval, Room 341
1150 E. Mountain Drive
Wilkes-Barre, PA 18702-7997
The following information should be included with the test sheets, either on a cover
page or in the body of the email:
- Date of Request
- Company Name
- Address
- Contact Name / Title / Phone
- Email
- Software Product
- Software Product Website
- Software Product Sales Phone
- Vendor ID
- Form Type for approval
4. Duration of Approvals
• Approvals are valid for only one tax year (January through December)
• In general, each new filing season requires new approval, even if the official form
does not change.
5. Barcode Specifications
• The barcode should be a 2-D barcode in the PDF-417 format. The PDF-417 has
error detection and correction capabilities. The error correction level should be set to
level 5.
1 The National Association of Computerized Tax Processors (NACTP) is a nonprofit association that represents
tax processing software and hardware developers, electronic filing processors, tax form publishers, and tax
processing service bureaus. The association encourages standardization of tax forms and the electronic filing
process.
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SSA’s ERISA Form 8955-SSA Barcode Standards
• All fields within the barcode will use <CR> as a field delimiter (carriage returns after
each field, including the final *EOD* field).
• All fields are required, except where not applicable for specific entry codes (see
Section 8 - Form 8955-SSA Barcode Layout). If no data is provided, the barcode
data for that field will be blank followed by the <CR> delimiter. Exception:
Mandatory data fields may not be left empty.
• If there is no data for a field entry, the field should be left empty. Don’t zero fill or pad
with spaces if a field is to be left blank. Exception: Plan Numbers should be left zero
filled.
• Stretching or scaling the barcode changes its integrity and reduces the readability of
the barcode; it shouldn’t be done.
”
• The barcode must be surrounded by at least 1/4 of whitespace.
• Provide an End of Data field at the end of each barcode (“*EOD*” followed by a
<CR>).
• Provide appropriate header information for each page in the first barcode per page
(as defined in Section 8).
o Header, Developer Code, Jurisdiction, and Form Number
Please note the printed Developer Code should appear at the top
left of the form. (see barcode specs for this field).
o Specification Version must be updated as revisions are made
o Software Version must be maintained accurately
6. Rules
• Money fields must:
o Contain only numbers
o No punctuation
o No signed amounts (high order signed or low order signed)
o No negative amounts
o Round to the nearest dollar (example: $5,500.99 = 5501)
• Address Fields
o Must conform to U.S. Postal Service rules since address fields are used by
SSA to prepare mail correspondence if necessary. For more information:
See U.S. Postal Service Publication 28; or
View the U.S. Postal Service website at:
pe.usps.com/businessmail101/addressing/deliveryAddress.htm
Call the U.S. Postal Service at 1-800-275-8777
o For state, use only the two-letter abbreviations
o “FOREIGN” addresses aren’t validated in SSA processing, but should
conform to regional standards as appropriate.
• Employer EIN
o Only numeric characters
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SSA’s ERISA Form 8955-SSA Barcode Standards
o Omit hyphens
o Don’t begin with 00, 07, 08, 09, 17, 18, 19, 28, 29, 49, 69, 70, 78, 79, or 89.
o The employer EIN should normally match the EIN under which tax payments
were submitted to the IRS under Form 941, 943, 944, CT-1 or Schedule H.
• Employee Name
o Enter the name exactly as shown on the individual’s Social Security Card
Employee First Name
Employee Middle Initial
Employee Last Name
• Suffix (if shown on Social Security Card)
o Don’t include any titles
• Social Security Number (SSN)
o Use the number shown on the original /replacement SSN card
o Only numeric characters
o Omit hyphens
o May not begin with a 9
o Don’t enter a fictitious SSN (for example, 111111111, 333333333 or
123456789).
o For valid range numbers, check the latest list of newly issued Social Security
number ranges on the Internet at
www.socialsecurity.gov/employer/ssnvhighgroup.htm.
7. Form Versions and Printing Notes
• Font for data on the form:
o The Social Security Administration recommends a fixed pitch font, preferably
Courier or OCR A Extended.
o 8-Point for all text fields and 9-Point for all numeric fields will allow all
displayed data to remain within its respective box on the form.
o If using a different font, please be sure that the size of the font doesn’t cause
the displayed data to exceed the space provided on the form.
• The 2010 version of the form has a few minor changes from the original 2009
version:
o Some address fields on the first page are resized to accommodate the
Courier New font on the IRS’ downloadable PDF version of the form.
o The Foreign Country field now prints the complete country name followed by
a dash and the country code (ex. Andorra – AN).
o The vendor ID should print at the top left of the form, about .5” from the left
edge and .5” from the top edge (sample vendor code 1807 is in the image
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SSA’s ERISA Form 8955-SSA Barcode Standards
below). Print a sample form (IRS version) with data to see an example of the
vendor ID printed.
• Subsequent versions of the form through plan year 2022 remain structurally identical
to the 2010 version.
• Vendor facsimile forms are required to have a conforming barcode when printed to
obtain SSA Form Approval for Form 8955-SSA.
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SSA’s ERISA Form 8955-SSA Barcode Standards
8. Field Types
Field Type Data Limitations Print Format 2-D Barcode Format
Text • All printable characters
allowed
• No leading or trailing
blanks
Amount • Money fields 999,999,999 999999999
• Only characters 0-9
allowed
• Right justified, no
leading zeros unless
specified
Date • Must be a valid date 09/30/2010 09302010
with four positions for Format: Format: mmddyyyy
the year mm/dd/yyyy
Numeric • Only characters 0-9 999999999 999999999
allowed
Checkbox • Must be capital “X” or X or leave 0=Not checked
empty blank 1=Checked
• Barcode is 0 or 1 (Question 8 is unique.
(Question 8 is an 0 = unchecked, 1 =
exception) Yes, 2 = No
SSN • Only characters 0-9 999-99-9999 999999999
allowed Or
• Must contain exactly Or
nine characters “FOREIGN”
• Exception: Can use “FOREIGN”
characters –
““FOREIGN””
• May not be left blank.
Federal ID • Only characters 0-9 99-9999999 999999999
allowed
• Must contain exactly
nine characters
• May not be left blank.
• May not begin with a 9
End of Data • Text characters *EOD* NA *EOD*
followed by <CR> at
the end of each
barcode to verify it was
read completely
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SSA’s ERISA Form 8955-SSA Barcode Standards
9. Form 8955-SSA Barcode Layout
a. Page 1 - Barcode 1 (bottom left side)
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
1 Header Text 2 T1 NA
Print on the 9999
top-left of the
form, about .5”
from the left
edge and .5”
from the top
Vendor’s NACTP ID or
edge (use
2 Developer Code Numeric 4 SSA provided ID. This
approx 6-8
field cannot be blank.
point font).
See IRS
printed version
for correct
positioning and
size)
3 Jurisdiction Numeric 2 US NA
4 Form Number Numeric 7 Must be “8955SSA” NA
Version of this NA
Specification specification used to
5 Text 4
Version create this barcode.
Currently “1.0”
Software product used to NA
create this barcode.
6 Software Version Numeric 2
Begin with “0” and
increment.
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Current Page NA 1
7 Text 6 Value must be 1
Number
• Valid date formatted 09/30/2010 09302010
mm/dd/yyyy Format: Format:
Part I • Not past current date mm/dd/yyyy mmddyyyy
Plan Year Begin
8 Date 8 Barcode
Date
• Omit slashes/dashes
• Only numeric
• Format mmddyyyy
• Valid date formatted 09/30/2010 09302010
mm/dd/yyyy Format: Format:
• Not past current date mm/dd/yyyy mmddyyyy
9 Plan Year End Date Part I Date 8 Barcode
• Omit slashes/dashes
• Only numeric
• Format mmddyyyy
Voluntary Filing Part I, Check X or leave 0=Not checked
10 1 • 0 or 1 in barcode
Indicator A Box blank 1=Checked
Part I, Check X or leave 0=Not checked
11 Amended Indicator 1 • 0 or 1 in barcode
B Box blank 1=Checked
F5558 Application Part I, Check X or leave 0=Not checked
12 1 • 0 or 1 in barcode
Filed Indicator C(a) Box blank 1=Checked
Extension Part I, Check X or leave 0=Not checked
13 1 • 0 or 1 in barcode
Automatic Indicator C(b) Box blank 1=Checked
Extension Special Part I, Check X or leave 0=Not checked
14 1 • 0 or 1 in barcode
Indicator C(c) Box blank 1=Checked
Extension Special Part I,
15 Text 36
Text C(d)
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Part II,
16 Plan Name Text 140
1a
• Only numeric:001-999 999 999
Part II,
17 Plan Number Numeric 3 • Left fill with zeros
1b
Part II,
18 Sponsor Name Text 70
2a
• Must NOT begin with 99-9999999 999999999
00, 07, 08, 09, 17, 18,
19, 28, 29, 49, 69, 70,
Sponsor Employer
Part II, 78, 79, or 89
19 Identification Federal ID 9
2b Barcode
Number (EIN)
• Only numeric
• Omit hyphens
• Left fill with zeros
Sponsor Trade Part II,
20 Text 70
Name 2c
Barcode (999)999-9999 999999999
Part II,
21 Sponsor Phone Numeric 10 • Only numeric 999-999-9999
2d
• Omit dashes & parens
Sponsor Care Of Part II,
22 Text 35
name 2e
Sponsor Street Part II, • Used for U.S. AND
23 Text 35
Address 2f foreign addresses
Part II, • Used for U.S. AND
24 Sponsor City Name Text 22
2g foreign addresses
Part II, • U.S. addresses only
25 Sponsor State Text 2 2
2h • Must be a valid state
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
• U.S. addresses only 99999-9999 999999999
Barcode
Part II,
26 Sponsor Zip Code Numeric 9 • Only numeric
2i
• Omit dashes
• Left fill with zeros
Part II,
Sponsor Foreign • For use with foreign
27 2j Text 22
Province/State addresses
Full Country Country Code
• For use with foreign Name followed only
Sponsor Foreign Part II, addresses by a dash and
28 Text 2
Country Code 2k • Must be a valid the country
3
country code code (ex.
Andorra – AN)
Sponsor Foreign Part II, • For use with foreign
29 Text 22
Routing Code 2l addresses
NA *EOD*
30 End of Data Text 5 “*EOD*”
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SSA’s ERISA Form 8955-SSA Barcode Standards
b. Page 1 - Barcode 2 (bottom right side)
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Current Page NA 1
1 Text 6 Value must be 1
Number
• Only numeric:001-999 999 999
Part II,
2 Plan Number Numeric 3 • Left fill with zeros
1b
• Must NOT begin with 99-9999999 999999999
00, 07, 08, 09, 17, 18,
19, 28, 29, 49, 69, 70,
Sponsor Employer
Part II, 78, 79, or 89
3 Identification Federal ID 9
2b Barcode
Number (EIN)
• Only numeric
• Omit hyphens
Left fill with zeros
Part II,
4 Administrator Name Text 70
3a
• Must NOT begin with 99-9999999 999999999
00, 07, 08, 09, 17, 18,
Administrator 19, 28, 29, 49, 69, 70,
Employer Part II, 78, 79, or 89
5 Federal ID 9
Identification 3b Barcode
Number (EIN) • Only numeric
• Omit hyphens
• Left fill with zeros
Administrator Care Part II,
6 Text 35
Of Name 3c
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Barcode (999)999-9999 999999999
Administrator Part II,
7 Numeric 10 • Only numeric 999-999-9999
Phone 3d
• Omit dashes & parens
Administrator Street Part II, • Used for U.S. AND
8 Text 35
Address 3e foreign addresses
Administrator City Part II, • Used for U.S. AND
9 Text 22
Name 3f foreign addresses
Part II, • U.S. addresses only
10 Administrator State Text 2 2
3g • Must be a valid state
• U.S. addresses only 99999-9999 999999999
Barcode
Administrator Zip Part II,
11 Numeric 9 • Only numeric
Code 3h
• Omit dashes
• Left fill with zeros
Administrator Part II,
• For use with foreign
12 Foreign 3i Text 22
addresses
Province/State
Full Country Country Code
• For use with foreign Name followed Only
Administrator
Part II, addresses by a dash and
13 Foreign Country Text 2
3j • Must be a valid the country
Code 3 code (ex.
country code
Andorra – AN)
Administrator
Part II, • For use with foreign
14 Foreign Routing Text 22
3k addresses
Code
Last Report Admin Part II,
15 Text 70
Name 4
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
• Must NOT begin with 99-9999999 999999999
00, 07, 08, 09, 17, 18,
19, 28, 29, 49, 69, 70,
Last Report Admin Part II, 78, 79, or 89
16 Numeric 9
EIN 4 Barcode
• Only numeric
• Omit hyphens
• Left fill with zeros
Last Report Part II,
17 Text 70
Sponsor Name 5
• Must NOT begin with 99-9999999 999999999
00, 07, 08, 09, 17, 18,
19, 28, 29, 49, 69, 70,
Last Report Part II, 78, 79, or 89
18 Numeric 9
Sponsor EIN 5 Barcode
• Only numeric
• Omit hyphens
• Left fill with zeros
Last Report 999 999
Part II, • Only numeric
19 Sponsor Plan Numeric 3
5 • Left fill with zeros
number
Barcode 99999999 99999999
Separated • Only numeric
Part II,
20 Participants Numeric 8 • Omit commas, dollar
6a
Required on SSA signs, etc.
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Barcode 99999999 99999999
Voluntary
Part II, • Only numeric
21 Separated Numeric 8
6b • Omit commas, dollar
Participants on SSA
signs, etc.
Barcode 99999999 99999999
Total Participants Part II, • Only numeric
22 Numeric 8
Reported on SSA 7 • Omit commas, dollar
signs, etc.
• 0,1, or 2 in barcode X or leave 0=Neither
• Only allow blank, Yes, blank block checked
Individual Part II, Check or No. Do’not allow 1=Yes checked
23 1
Statement Indicator 8 Box Yes and No to be 2=No checked
filled in at the same
time.
24 End of Data Text 5 “*EOD*” NA *EOD*
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SSA’s ERISA Form 8955-SSA Barcode Standards
c. Page 2 - Barcode 1 (bottom left side)
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
1 Header Text 2 T1 NA
Print on the 9999
top-left of the
form, about .5”
from the left
edge and .5”
from the top
Vendor’s NACTP ID or
edge (use
2 Developer Code Numeric 4 SSA provided ID. This
approx 6-8
field cannot be blank.
point font).
See IRS
printed version
for correct
positioning and
size)
3 Jurisdiction Numeric 2 US NA
4 Form Number Numeric 7 8955SSA NA
Version of this NA
Specification specification used to
5 Text 5
Version create this barcode.
Currently, the text “1.0”
Software product used to NA
create this barcode.
6 Software Version Numeric 2
Begin with “0” and
increment.
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
2, 3, 4, etc. (the first page NA 9
2 will be identified as 2. If
Current Page additional pages are
7 Text 6
Number required, increment the
page number accordingly
(i.e. 3, 4, 5, 6, etc.)
Repeat Name of Plan from
8 Name of Plan i Text 140
Page 1 (section 1a)
Repeat Plan Number from 999 999
9 Plan Number ii Numeric 3
Page 1 (section 1b)
Repeat Sponsor EIN from 99-9999999 999999999
10 EIN iii Numeric 9
Page 1 (section 2b)
Must be 1 character
Part III,
11 Entry Code 1 Text 1 • Only A, B, C, or D is
a
valid
Required for all Entry 999-99-9999 999999999
Codes
Only numeric characters* Or Or
• Omit dashes
• Must be 9 positions “FOREIGN” “FOREIGN”
Social Security Part III, • All zeroes for any
12 Numeric 9
Number (SSN) 1 b segment isn’t valid
• Cannot start with 9
• First 3 positions cannot
be 666
*Exception – may contain
the word ““FOREIGN””
Part III, Required for all Entry
13 First Name 1 Text 11
c Codes
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Part III,
14 Middle initial 1 Text 1
c
Part III, Required for all Entry
15 Last name 1 Text 35
c Codes
Required for Entry Codes
A & B – Blank for Code C
Type of Annuity Part III, or D
16 Text 1
Code 1 d Must be 1 character
• Only A, B, C, D, E, F,
G, or M is valid
Required for Entry Codes
A & B – Blank for Code C
Payment Frequency Part III, or D
17 Text 1
Code 1 e Must be 1 character
• Only A, B, C, D, E, or
M is valid
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DB Periodic Part III,
18 Amount 10 Only numeric characters
Payment Amount 1 f
• Omit Decimals
• Round to nearest
whole dollar amount
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DC Total Value of Part III,
19 Amount 10 Only numeric characters
Account Amount 1 g
• Omit Decimals
• Round to nearest
whole dollar amount
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for Entry Code C 99-9999999 999999999
Blank for Code A, B, or D
• Must NOT begin with
00, 07, 08, 09, 17, 18,
Previous Sponsor Part III, 19, 28, 29, 49, 69, 70,
20 Numeric 9
EIN 1 h 78, 79, or 89
Barcode
• Only numeric
• Omit hyphens
• Left fill with zeros
Required for Entry Code C 999 999
Previous Sponsor Part III, Blank for Code A, B, or D
21 Numeric 3
Plan Number 1 i • Only numeric:001-999
• Left fill with zeros
Must be 1 character
Part III,
22 Entry Code 2 Text 1 • Only A, B, C, or D is
a
valid
Required for all Entry 999-99-9999 999999999
Codes
Only numeric characters* Or Or
• Omit dashes
• Must be 9 positions “FOREIGN” “FOREIGN”
Social Security Part III, • All zeroes for any
23 Numeric 9
Number (SSN) 2 b segment is not valid
• Cannot start with 9
• First 3 positions cannot
be 666
*Exception – may contain
the word ““FOREIGN””
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Part III, Required for all Entry
24 First Name 2 Text 11
c Codes
Part III,
25 Middle initial 2 Text 1
c
Part III, Required for all Entry
26 Last name 2 Text 35
c Codes
Required for Entry Codes
A & B – Blank for Code C
Type of Annuity Part III, or D
27 Text 1
Code 2 d Must be 1 character
• Only A, B, C, D, E, F,
G, or M is valid
Required for Entry Codes
A & B – Blank for Code C
Payment Frequency Part III, or D
28 Text 1
Code 2 e Must be 1 character
• Only A, B, C, D, E, or
M is valid
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DB Periodic Part III,
29 Amount 10 Only numeric characters
Payment Amount 2 f
• Omit Decimals
• Round to nearest
whole dollar amount
20 of 41
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DC Total Value of Part III,
30 Amount 10 Only numeric characters
Account Amount 2 g
• Omit Decimals
• Round to nearest
whole dollar amount
Required for Entry Code C 99-9999999 999999999
Blank for Code A, B, or D
• Must NOT begin with
00, 07, 08, 09, 17, 18,
Previous Sponsor Part III, 19, 28, 29, 49, 69, 70,
31 Numeric 9
EIN 2 h 78, 79, or 89
Barcode
• Only numeric
• Omit hyphens
• Left fill with zeros
Required for Entry Code C 999 999
Previous Sponsor Part III, Blank for Code A, B, or D
32 Numeric 3
Plan Number 2 i • Only numeric:001-999
• Left fill with zeros
Must be 1 character
Part III,
33 Entry Code 3 Text 1 • Only A, B, C, or D is
a
valid
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for all Entry 999-99-9999 999999999
Codes
Only numeric characters* Or Or
• Omit dashes
• Must be 9 positions “FOREIGN” “FOREIGN”
Social Security Part III, • All zeroes for any
34 Numeric 9
Number (SSN) 3 b segment is not valid
• Cannot start with 9
• First 3 positions cannot
be 666
*Exception – may contain
the word ““FOREIGN””
Part III, Required for all Entry
35 First Name 3 Text 11
c Codes
Part III,
36 Middle initial 3 Text 1
c
Part III, Required for all Entry
37 Last name 3 Text 35
c Codes
Required for Entry Codes
A & B – Blank for Code C
Type of Annuity Part III, or D
38 Text 1
Code 3 d Must be 1 character
• Only A, B, C, D, E, F,
G, or M is valid
Required for Entry Codes
A & B – Blank for Code C
Payment Frequency Part III, or D
39 Text 1
Code 3 e Must be 1 character
• Only A, B, C, D, E, or
M is valid
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DB Periodic Part III,
40 Amount 10 Only numeric characters
Payment Amount 3 f
• Omit Decimals
• Round to nearest
whole dollar amount
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DC Total Value of Part III,
41 Amount 10 Only numeric characters
Account Amount 3 g
• Omit Decimals
• Round to nearest
whole dollar amount
Required for Entry Code C 99-9999999 999999999
Blank for Code A, B, or D
• Must NOT begin with
00, 07, 08, 09, 17, 18,
Previous Sponsor Part III, 19, 28, 29, 49, 69, 70,
42 Numeric 9
EIN 3 h 78, 79, or 89
Barcode
• Only numeric
• Omit hyphens
• Left fill with zeros
Required for Entry Code C 999 999
Previous Sponsor Part III, Blank for Code A, B, or D
43 Numeric 3
Plan Number 3 i • Only numeric:001-999
• Left fill with zeros
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Must be 1 character
Part III,
44 Entry Code 4 Text 1 • Only A, B, C, or D is
a
valid
Required for all Entry 999-99-9999 999999999
Codes Or
Only numeric characters* Or
• Omit dashes “FOREIGN”
• Must be 9 positions “FOREIGN”
Social Security Part III, • All zeroes for any
45 Numeric 9
Number (SSN) 4 b segment isn’t valid
• Can’t start with 9
• First 3 positions cannot
be 666
*Exception – may contain
the word ““FOREIGN””
Part III, Required for all Entry
46 First Name 4 Text 11
c Codes
Part III,
47 Middle initial 4 Text 1
c
Part III, Required for all Entry
48 Last name 4 Text 35
c Codes
Required for Entry Codes
A & B – Blank for Code C
Type of Annuity Part III, or D
49 Text 1
Code 4 d Must be 1 character
• Only A, B, C, D, E, F,
G, or M is valid
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for Entry Codes
A & B – Blank for Code C
Payment Frequency Part III, or D
50 Text 1
Code 4 e Must be 1 character
• Only A, B, C, D, E, or
M is valid
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DB Periodic Part III,
51 Amount 10 Only numeric characters
Payment Amount 4 f
• Omit Decimals
• Round to nearest
whole dollar amount
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DC Total Value of Part III,
52 Amount 10 Only numeric characters
Account Amount 4 g
• Omit Decimals
• Round to nearest
whole dollar amount
Required for Entry Code C 99-9999999 999999999
Blank for Code A, B, or D
• Must NOT begin with
00, 07, 08, 09, 17, 18,
Previous Sponsor Part III, 19, 28, 29, 49, 69, 70,
53 Numeric 9
EIN 4 h 78, 79, or 89
Barcode
• Only numeric
• Omit hyphens
• Left fill with zeros
25 of 41
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for Entry Code C 999 999
Previous Sponsor Part III, Blank for Code A, B, or D
54 Numeric 3
Plan Number 4 i • Only numeric:001-999
• Left fill with zeros
55 End of Data Text 5 “*EOD*” NA *EOD*
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SSA’s ERISA Form 8955-SSA Barcode Standards
d. Page 2 - Barcode 2 (bottom right side)
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
2, 3, 4, etc. (the first page 2 NA 9
will be identified as 2. If
Current Page additional pages are
1 Text 6
Number required, increment the
page number accordingly
(i.e. 3, 4, 5, 6, etc.)
• Only numeric: 001-999 999 999
2 Plan Number ii Numeric 3
Left fill with zeros
• Must NOT begin with 99-9999999 999999999
00, 07, 08, 09, 17, 18,
19, 28, 29, 49, 69, 70,
78, 79, or 89
3 EIN iii Numeric 9
Barcode
• Only numeric
• Omit hyphens
Left fill with zeros
Part III, Must be 1 character
4 Entry Code 5 Text 1
a Only A, B, C, or D is valid
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for all Entry 999-99-9999 999999999
Codes Or
Only numeric characters* Or
• Omit dashes “FOREIGN”
• Must be 9 positions “FOREIGN”
Social Security Part III, • All zeroes for any
5 Numeric 9
Number (SSN) 5 b segment isn’t valid
• Can’t start with 9
• First 3 positions cannot
be 666
*Exception – may contain
the word ““FOREIGN””
Part III, Required for all Entry
6 First Name 5 Text 11
c Codes
Part III,
7 Middle initial 5 Text 1
c
Part III, Required for all Entry
8 Last name 5 Text 35
c Codes
Required for Entry Codes
A & B – Blank for Code C
Type of Annuity Part III, or D
9 Text 1
Code 5 d Must be 1 character
Only A, B, C, D, E, F, G, or
M is valid
Required for Entry Codes
A & B – Blank for Code C
Payment Frequency Part III, or D
10 Text 1
Code 5 e Must be 1 character
Only A, B, C, D, E, or M is
valid
28 of 41
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DB Periodic Part III,
11 Amount 10 Only numeric characters
Payment Amount 5 f
• Omit Decimals
Round to nearest whole
dollar amount
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DC Total Value of Part III,
12 Amount 10 Only numeric characters
Account Amount 5 g
• Omit Decimals
Round to nearest whole
dollar amount
Required for Entry Code C 99-9999999 999999999
Blank for Code A, B, or D
• Must NOT begin with
00, 07, 08, 09, 17, 18,
Previous Sponsor Part III, 19, 28, 29, 49, 69, 70,
13 Numeric 9
EIN 5 h 78, 79, or 89
Barcode
• Only numeric
• Omit hyphens
Left fill with zeros
Required for Entry Code C 999 999
Previous Sponsor Part III, Blank for Code A, B, or D
14 Numeric 3
Plan Number 5 i • Only numeric:001-999
Left fill with zeros
29 of 41
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Must be 1 character
Part III,
15 Entry Code 6 Text 1 • Only A, B, C, or D is
a
valid
Required for all Entry 999-99-9999 999999999
Codes Or
Only numeric characters* Or
• Omit dashes “FOREIGN”
• Must be 9 positions “FOREIGN”
Social Security Part III, • All zeroes for any
16 Numeric 9
Number (SSN) 6 b segment isn’t valid
• Cannot start with 9
• First 3 positions can’t
be 666
*Exception – may contain
the word ““FOREIGN””
Part III, Required for all Entry
17 First Name 6 Text 11
c Codes
Part III,
18 Middle initial 6 Text 1
c
Part III, Required for all Entry
19 Last name 6 Text 35
c Codes
Required for Entry Codes
A & B – Blank for Code C
Type of Annuity Part III, or D
20 Text 1
Code 6 d Must be 1 character
• Only A, B, C, D, E, F,
G, or M is valid
30 of 41
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for Entry Codes
A & B – Blank for Code C
Payment Frequency Part III, or D
21 Text 1
Code 6 e Must be 1 character
• Only A, B, C, D, E, or M
is valid
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DB Periodic Part III,
22 Amount 10 Only numeric characters
Payment Amount 6 f
• Omit Decimals
• Round to nearest whole
dollar amount
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DC Total Value of Part III,
23 Amount 10 Only numeric characters
Account Amount 6 g
• Omit Decimals
• Round to nearest whole
dollar amount
Required for Entry Code C 99-9999999 999999999
Blank for Code A, B, or D
• Must NOT begin with
00, 07, 08, 09, 17, 18,
Previous Sponsor Part III, 19, 28, 29, 49, 69, 70,
24 Numeric 9
EIN 6 h 78, 79, or 89
Barcode
• Only numeric
• Omit hyphens
• Left fill with zeros
31 of 41
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for Entry Code C 999 999
Previous Sponsor Part III, Blank for Code A, B, or D
25 Numeric 3
Plan Number 6 i • Only numeric:001-999
• Left fill with zeros
Must be 1 character
Part III,
26 Entry Code 7 Text 1 • Only A, B, C, or D is
a
valid
Required for all Entry 999-99-9999 999999999
Codes Or
Only numeric characters* Or
• Omit dashes “FOREIGN”
• Must be 9 positions “FOREIGN”
Social Security Part III, • All zeroes for any
27 Numeric 9
Number (SSN) 7 b segment isn’t valid
• Cannot start with 9
• First 3 positions can’t
be 666
*Exception – may contain
the word ““FOREIGN””
Part III, Required for all Entry
28 First Name 7 Text 11
c Codes
Part III,
29 Middle initial 7 Text 1
c
Part III, Required for all Entry
30 Last name 7 Text 35
c Codes
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for Entry Codes
A & B – Blank for Code C
Type of Annuity Part III, or D
31 Text 1
Code 7 d Must be 1 character
• Only A, B, C, D, E, F,
G, or M is valid
Required for Entry Codes
A & B – Blank for Code C
Payment Frequency Part III, or D
32 Text 1
Code 7 e Must be 1 character
• Only A, B, C, D, E, or M
is valid
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DB Periodic Part III,
33 Amount 10 Only numeric characters
Payment Amount 7 f
• Omit Decimals
• Round to nearest whole
dollar amount
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DC Total Value of Part III,
34 Amount 10 Only numeric characters
Account Amount 7 g
• Omit Decimals
• Round to nearest whole
dollar amount
33 of 41
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for Entry Code C 99-9999999 999999999
Blank for Code A, B, or D
• Must NOT begin with
00, 07, 08, 09, 17, 18,
Previous Sponsor Part III, 19, 28, 29, 49, 69, 70,
35 Numeric 9
EIN 7 h 78, 79, or 89
Barcode
• Only numeric
• Omit hyphens
• Left fill with zeros
Required for Entry Code C 999 999
Previous Sponsor Part III, Blank for Code A, B, or D
36 Numeric 3
Plan Number 7 i • Only numeric:001-999
• Left fill with zeros
Must be 1 character
Part III,
37 Entry Code 8 Text 1 • Only A, B, C, or D is
a
valid
Required for all Entry 999-99-9999 999999999
Codes
Only numeric characters* Or Or
• Omit dashes
• Must be 9 positions “FOREIGN” “FOREIGN”
Social Security Part III, • All zeroes for any
38 Numeric 9
Number (SSN) 8 b segment isn’t valid
• Cannot start with 9
• First 3 positions can’t
be 666
*Exception – may contain
the word ““FOREIGN””
34 of 41
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Part III, Required for all Entry
39 First Name 8 Text 11
c Codes
Part III,
40 Middle initial 8 Text 1
c
Part III, Required for all Entry
41 Last name 8 Text 35
c Codes
Required for Entry Codes
A & B – Blank for Code C
Type of Annuity Part III, or D
42 Text 1
Code 8 d Must be 1 character
• Only A, B, C, D, E, F,
G, or M is valid
Required for Entry Codes
A & B – Blank for Code C
Payment Frequency Part III, or D
43 Text 1
Code 8 e Must be 1 character
• Only A, B, C, D, E, or M
is valid
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DB Periodic Part III,
44 Amount 10 Only numeric characters
Payment Amount 8 f
• Omit Decimals
• Round to nearest whole
dollar amount
35 of 41
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DC Total Value of Part III,
45 Amount 10 Only numeric characters
Account Amount 8 g
• Omit Decimals
• Round to nearest whole
dollar amount
Required for Entry Code C 99-9999999 999999999
Blank for Code A, B, or D
• Must NOT begin with
00, 07, 08, 09, 17, 18,
Previous Sponsor Part III, 19, 28, 29, 49, 69, 70,
46 Numeric 9
EIN 8 h 78, 79, or 89
Barcode
• Only numeric
• Omit hyphens
• Left fill with zeros
Required for Entry Code C 999 999
Previous Sponsor Part III, Blank for Code A, B, or D
47 Numeric 3
Plan Number 8 i • Only numeric:001-999
• Left fill with zeros
Must be 1 character
Part III,
48 Entry Code 9 Text 1 • Only A, B, C, or D is
a
valid
36 of 41
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for all Entry 999-99-9999 999999999
Codes
Only numeric characters* Or Or
• Omit dashes
• Must be 9 positions “FOREIGN” “FOREIGN”
Social Security Part III, • All zeroes for any
49 Numeric 9
Number (SSN) 9 b segment isn’t valid
• Cannot start with 9
• First 3 positions can’t
be 666
*Exception – may contain
the word ““FOREIGN””
Part III, Required for all Entry
50 First Name 9 Text 11
c Codes
Part III,
51 Middle initial 9 Text 1
c
Part III, Required for all Entry
52 Last name 9 Text 35
c Codes
Required for Entry Codes
A & B – Blank for Code C
Type of Annuity Part III, or D
53 Text 1
Code 9 d Must be 1 character
• Only A, B, C, D, E, F,
G, or M is valid
Required for Entry Codes
A & B – Blank for Code C
Payment Frequency Part III, or D
54 Text 1
Code 9 e Must be 1 character
• Only A, B, C, D, E, or M
is valid
37 of 41
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DB Periodic Part III,
55 Amount 10 Only numeric characters
Payment Amount 9 f
• Omit Decimals
• Round to nearest whole
dollar amount
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DC Total Value of Part III,
56 Amount 10 Only numeric characters
Account Amount 9 g
• Omit Decimals
• Round to nearest whole
dollar amount
Required for Entry Code C 99-9999999 999999999
Blank for Code A, B, or D
• Must NOT begin with
00, 07, 08, 09, 17, 18,
Previous Sponsor Part III, 19, 28, 29, 49, 69, 70,
57 Numeric 9
EIN 9 h 78, 79, or 89
Barcode
• Only numeric
• Omit hyphens
• Left fill with zeros
Required for Entry Code C 999 999
Previous Sponsor Part III, Blank for Code A, B, or D
58 Numeric 3
Plan Number 9 i • Only numeric:001-999
• Left fill with zeros
38 of 41
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Must be 1 character
Part III,
59 Entry Code 10 Text 1 • Only A, B, C, or D is
a
valid
Required for all Entry 999-99-9999 999999999
Codes
Only numeric characters* Or Or
• Omit dashes
• Must be 9 positions “FOREIGN” “FOREIGN”
Social Security Part III, • All zeroes for any
60 Numeric 9
Number (SSN) 10 b segment isn’t valid
• Can’t start with 9
• First 3 positions cannot
be 666
*Exception – may contain
the word ““FOREIGN””
Part III, Required for all Entry
61 First Name 10 Text 11
c Codes
Part III,
62 Middle initial 10 Text 1
c
Part III, Required for all Entry
63 Last name 10 Text 35
c Codes
Required for Entry Codes
A & B – Blank for Code C
Type of Annuity Part III, or D
64 Text 1
Code 10 d Must be 1 character
• Only A, B, C, D, E, F,
G, or M is valid
39 of 41
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for Entry Codes
A & B – Blank for Code C
Payment Frequency Part III, or D
65 Text 1
Code 10 e Must be 1 character
• Only A, B, C, D, E, or M
is valid
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
DB Periodic or D
Part III,
66 Payment Amount Amount 10 Only numeric characters
f
10 • Omit Decimals
• Round to nearest whole
dollar amount
Required for Entry Codes 9,999,999,999 9999999999
A & B – Blank for Code C
or D
DC Total Value of Part III,
67 Amount 10 Only numeric characters
Account Amount 10 g
• Omit Decimals
• Round to nearest whole
dollar amount
Required for Entry Code C 99-9999999 999999999
Blank for Code A, B, or D
• Must NOT begin with
00, 07, 08, 09, 17, 18,
Previous Sponsor Part III, 19, 28, 29, 49, 69, 70,
68 Numeric 9
EIN 10 h 78, 79, or 89
Barcode
• Only numeric
• Omit hyphens
• Left fill with zeros
40 of 41
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SSA’s ERISA Form 8955-SSA Barcode Standards
Pos Description Box # Field Max Field Notes Print Format 2-D Barcode
on Type Field Format
Form Length
Required for Entry Code C 999 999
Previous Sponsor Part III, Blank for Code A, B, or D
69 Numeric 3
Plan Number 10 i • Only numeric:001-999
• Left fill with zeros
70 End of Data Text 5 “*EOD*” NA *EOD*
2
Valid 2-character State Codes can be found at: http://www.irs.gov/irb/2011-22_IRB/ar06.html#d0e2463
• See Part A. Section 7. State Abbreviations
• Do not use Military state addresses
3
Valid 2-character Country Codes can be found at: http://www.irs.gov/irb/2011-22_IRB/ar06.html#d0e2463
• See Part A. Section 8. Foreign Country Codes
• These are the FIPS country codes
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