Form W-3 - Transmittal Of Wage And Tax Statements - 2011 Page 2
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1
2DO NOT STAPLE
a Control number
For Official Use Only
▶
33333
OMB No. 1545-0008
b
941
Military
943
944
None apply
501c non-govt.
Third-party
sick pay
Kind
Kind
of
of
(Check if
Hshld.
Medicare
State/local
Payer
Employer
applicable)
CT-1
emp.
govt. emp.
non-501c
State/local 501c
Federal govt.
(Check one)
(Check one)
c Total number of Forms W-2
d Establishment number
1 Wages, tips, other compensation
2 Federal income tax withheld
e Employer identification number (EIN)
3 Social security wages
4 Social security tax withheld
6 Medicare tax withheld
f Employer’s name
5 Medicare wages and tips
7 Social security tips
8 Allocated tips
10 Dependent care benefits
9
11 Nonqualified plans
12a Deferred compensation
g Employer’s address and ZIP code
h Other EIN used this year
13 For third-party sick pay use only
12b
15 State
Employer’s state ID number
14 Income tax withheld by payer of third-party sick pay
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
Contact person
Telephone number
For Official Use Only
Email address
Fax number
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and
complete.
Signature
Date
Title
▶
▶
▶
W-3
2011
Transmittal of Wage and Tax Statements
Department of the Treasury
Form
Internal Revenue Service
Send this entire page with the entire Copy A page of Form(s) W-2 to the Social Security Administration.
Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3.
Reminder
Separate instructions. See the 2011 Instructions for Forms W-2 and
W-3 for information on completing this form.
Purpose of Form
A Form W-3 Transmittal is completed only when paper Copy A of
Form(s) W-2, Wage and Tax Statement, is being filed. Do not file Form
W-3 alone. Do not file Form W-3 for Form(s) W-2 that were submitted
electronically to the Social Security Administration (see below). All paper
forms must comply with IRS standards and be machine readable.
Photocopies are not acceptable. Use a Form W-3 even if only one
paper Form W-2 is being filed. Make sure both the Form W-3 and
When To File
Form(s) W-2 show the correct tax year and Employer Identification
Number (EIN). Make a copy of this form and keep it with Copy D (For
Mail any paper Forms W-2 under cover of this Form W-3 Transmittal by
Employer) of Form(s) W-2 for your records.
February 29, 2012. Electronic fill-in forms or uploads are filed through
SSA’s Business Services Online (BSO) Internet site and will be on time if
Electronic Filing
submitted by April 2, 2012.
Where To File Paper Forms
The Social Security Administration (SSA) strongly suggests employers
report Form W-3 and W-2 Copy A electronically instead of on paper.
Send this entire page with the entire Copy A page of Form(s) W-2 to:
SSA provides two free options on its Business Services Online (BSO)
website:
Social Security Administration
Data Operations Center
• W-2 Online. Use fill-in forms to create, save, print, and submit up to
20 Forms W-2 at a time to SSA.
Wilkes-Barre, PA 18769-0001
• File Upload. Upload wage files to SSA that you have created using
Note. If you use “Certified Mail” to file, change the ZIP code to
payroll or tax software that formats the files according to SSA’s
“18769-0002.” If you use an IRS-approved private delivery service, add
Specifications for Filing Forms W-2 Electronically (EFW2).
“ATTN: W-2 Process, 1150 E. Mountain Dr.” to the address and change
For more information, go to and
the ZIP code to “18702-7997.” See Publication 15 (Circular E),
select “First Time Filers” or “Returning Filers” under “BEFORE YOU
Employer’s Tax Guide, for a list of IRS-approved private delivery
FILE.”
services.
For Privacy Act and Paperwork Reduction Act Notice, see the back of Copy D of Form W-2.
Cat. No. 10159Y
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