A Separate Form Must Be Filed For Each Quarter Being Corrected.
List Only The Data For Which Corrections Are Required
Examples To Correct Data Previously Reported or Omitted
(2)
(3)
(4)
(1)
Employee’s Name
Total Wages
Employee’s
1st
2nd
Social Security
As Reported
Corrected
Init.
Init.
Last
Account Number
The following example illustrates the proper method to report either omitted Social Security
Account Numbers(s) or Wage Amounts(s). The Total Wages, As Reported, Column (3) will be -0-
as no wages were credited to employee’s earning records due to the omitted Social Security Ac-
count Number or wage amount.
123 45 6789
J. A. Doe
-0-
1,000.00
The following example illustrates the proper method to correct the amount of wages previously
reported for J. A. Doe.
123 45 6789
J. A. Doe
1,000.00
1,200.00
The following example illustrates the proper method to correct wages erroneously reported for J.
B. Doe instead of J. A. Doe.
123 45 6789
J. B. Doe
1,000.00
-0-
123 45 6789
J. A. Doe
-0-
1,000.00
The following example illustrates the proper method to correct the reporting of an erroneous
Social Security Account Number.
123 54 6789
J. A. Doe
1,000.00
-0-
123 45 6789
J. A. Doe
-0-
1,000.00
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