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Transmittal Form For The Reporting Of W-2 Information On Electronic Media - State Of Rhode Island - Division Of Taxation

STATE OF RHODE ISLAND

DIVISION OF TAXATION

W2 ELECTRONIC MEDIA SECTION

ONE CAPITOL HILL

PROVIDENCE, RI 02908

TRANSMITTAL FORM

FOR THE REPORTING OF W-2 INFORMATION ON ELECTRONIC MEDIA

Federal Employer Identification Number: ___________________________________

Employer Name:______________________________________________________

Employer Address: ____________________________________________________

Contact Person:

Name: ________________________________________________

Title: _________________________________________________

Phone Number: _______________________________________________________

SUBMITTED MATERIAL WILL NOT BE RETURNED

Record formats outlined in the SSA EFW2 Magnetic Media Reporting amendments or revisions

thereto and by accessing the SSA website at

, selecting

"forms and publications" and choosing EFW2.

Place an external label on the media which is marked with at least one Federal Employer

Identification Number and “W-2”.

PLEASE NOTE: Answers to questions 1 through 3 are required to process your data.

The following information is REQUIRED:

1. Number of CD-ROMs included:

________

2. Number of individual records:

________________

3. Total amount of state withholding:

________________

NOTE: THIS FORM (or the form included within the remittance booklet) MUST BE SUBMITTED WITH YOUR

CD-ROM. IF MORE THAN ONE CD-ROM IS BEING SENT FOR THIS FILING YEAR, INDICATE IF IT IS A

REPLACEMENT, CORRECTION OR AN ADDITION.

Please note, your submission must follow the required guidelines.

Signature: ________________________________ Title: ______________________

Transmittal Form For The Reporting Of W-2 Information On Electronic Media - State Of Rhode Island - Division Of Taxation