Employer Withholding Electronic Filing Waiver Request - Virginia Department Of Taxation

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Employer Withholding Electronic Filing Waiver Request
Complete this form to request a waiver if you are unable to file and/or pay your Withholding Tax and/or file your
Employer W-2/1099s electronically or need more time to do so. Indicate the electronic waiver(s) being requested
and provide all information.
The Waiver is being requested for Tax Year __________
Filing/Paying Withholding Tax
Filing Employer W-2/1099s - Number of Employees ___________
Waivers may be granted for one Tax Year and will expire with the filing of the December Tax Period to include the
VA-6 and W-2s/1099s for that year. If you need additional time once the waiver period ends, you must submit a
new waiver request.
Business Information
Tax Preparers submitting requests for multiple businesses - Provide your contact information below and
attach a list of all businesses represented in this request and provide the Business Name, Sole Proprietor Name
if applicable, and Federal Employer Identification Number (FEIN) of each. The Approval or Denial letter will be
sent to the employer. All others, provide the information requested below.
Business Name: ____________________________________________________________________________
If a Sole Proprietor, First and Last Name of Owner: _________________________________________________
FEIN: _____________________________________________________________________________________
Mailing Address: ____________________________________________________________________________
_____________________________________________________________________________
Contact Name: __________________________________________ Phone Number: _____________________
Reason for Waiver
Check the reason a waiver is being requested and provide all information requested.
No Computer
Need More Time – Provide the specific reason and the date you expect to be ready. ________________
____________________________________________________________________________________
No Internet Access Available in Area
Business Closed / Closing – Provide the date the business closed or is closing._____________________
Other – State the specific reason._________________________________________________________
____________________________________________________________________________________
Fax to: (804) 367-3015
OR
Mail to: Virginia Department of Taxation
Waiver Requests
PO Box 27423
Richmond, VA 23261
Employer Withholding Electronic Filing Waiver Request
Rev. 01/2016

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