Form Ri-Magnetic Media - Magnetic Media Filing Requirements 2009 (Page 4 of 4) in pdf

Form Ri-Magnetic Media - Magnetic Media Filing Requirements 2009 Page 4

STATE OF RHODE ISLAND

DIVISION OF TAXATION

W2 MAGNETIC MEDIA SECTION

ONE CAPITOL HILL

PROVIDENCE, RI 02908

TRANSMITTAL FORM

FOR THE REPORTING OF W-2 INFORMATION ON MAGNETIC MEDIA

Federal Employer Identification Number: ___________________________________

Employer Name & Address: _______________________________________________________________________

_______________________________________________________________________________________________

______________________________________________________________________________________________

Contact Person:

Name: ________________________________________________Title: ___________________________________

Phone Number: _______________________________________________________

SUBMITTED MATERIAL (INCLUDING CARTRIDGES, CD-ROMS AND DISKETTES) 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

security.gov/employer

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 7 are required to process your data.

The following information is REQUIRED:

1. Reporting media:

Cartridge ________ CD-ROM ________ Diskette ________

2. Number of individual records: ________________

3. Total amount of state withholding: _____________________________________

Complete the following if using cartridge:

4. Recording Mode: EBCDIC ______________________ ASCII _____________________

5. Record Length equals 512: yes_________

no ( if no please provide record length) __________________

6. Blocking Factor: __________________

7. IBM Standard Labels: Yes _______ No ______

NOTE: THIS FORM (or the form included within the remittance booklet) MUST BE SUBMITTED WITH YOUR CD-ROM, CARTRIDGE OR

DISKETTE.

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

REPLACEMENT OR AN ADDITION.

Signature: _________________________________________ Title: ______________________ Date: ____________

Form RI-Magnetic Media

Rev 11/09

Form Ri-Magnetic Media - Magnetic Media Filing Requirements 2009 Page 4