Transmittal Form For The Reporting Of W-2 Information On Magnetic Media
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1STATE 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 ) 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
security.gov/employer
, 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 7 are required to process your data.
The following information is REQUIRED:
1. Reporting media:
Cartridge ________ CD-ROM ________
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, or CARTRIDGE .
IF MORE THAN ONE CD-ROM, or CARTRIDGE IS BEING SENT FOR THIS FILING YEAR, INDICATE IF IT IS A
REPLACEMENT OR AN ADDITION.
Signature: ________________________________ Title: ______________________ Date: ____________
Rhode Island Magnetic Media
Rev 12/13
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