Form W-3ss - Transmittal Of Wage And Tax Statements - 2006 Page 6

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Code Z—Income under section 409A on a nonqualified deferred
Code E—Elective deferrals under a section 403(b) salary
compensation plan. Show any income under section 409A on a
reduction agreement.
nonqualified deferred compensation plan that was included in
Code F—Elective deferrals under a section 408(k)(6) salary
box 1. This income is subject to an additional tax reported on the
reduction SEP.
employee’s tax return.
Code G—Elective deferrals and employer contributions
Code AA—Designated Roth contributions to a section 401(k)
(including nonelective deferrals) to any governmental or
plan. Use this code to report designated Roth contributions to a
nongovernmental section 457(b) deferred compensation plan. Do
section 401(k) plan. Do not use this code to report elective deferrals
not report either section 457(b) or section 457(f) amounts that are
under code D.
subject to a substantial risk of forfeiture.
Code BB—Designated Roth contributions under a section 403(b)
Code H—Elective deferrals to a section 501(c)(18)(D) tax-exempt
salary reduction agreement. Use this code to report designated Roth
organization plan. Be sure to include this amount in box 1 as wages.
contributions under a section 403(b) salary reduction agreement. Do
The employee will deduct the amount on his or her income tax return.
not use this code to report elective deferrals under code E.
Code J—Nontaxable sick pay. Show any sick pay that was paid by
Box 13—Checkboxes. Check all boxes that apply.
a third-party and was not includible in income (and not shown in boxes
● Statutory employee. Check this box for statutory employees whose
1, 3, and 5) because the employee contributed to the sick pay plan.
earnings are subject to social security and Medicare taxes but not
Code M—Uncollected social security tax on taxable cost of
subject to income tax withholding. Do not check this box for common
group-term life insurance over $50,000 (for former employees). If
law employees. See Pub. 80 (Circular SS) for more information on
you provided your former employees (including retirees) more than
statutory employees.
$50,000 of group-term life insurance coverage for periods during which
● Retirement plan. Check this box if the employee was an “active
an employment relationship no longer exists, enter the amount of
uncollected social security tax on the coverage in box 12. See
participant” (for any part of the year) in any of the following:
Group-term life insurance on page 4.
1. A qualified pension, profit-sharing, or stock bonus plan described
Code N—Uncollected Medicare tax on taxable cost of
in section 401(a) (including a 401(k) plan).
group-term life insurance over $50,000 (for former employees).
2. An annuity plan described in section 403(a).
Enter any uncollected Medicare tax on the cost of group-term life
3. An annuity contract or custodial account described in section
insurance coverage over $50,000 for your former employees. See Code
403(b).
M above.
4. A simplified employee pension (SEP) plan described in section
Code P—Excludable moving expense reimbursements paid
408(k).
directly to employee. Show the total moving expense reimbursements
5. A SIMPLE retirement account described in section 408(p).
that you paid directly to your employee for qualified (deductible)
6. A trust described in section 501(c)(18).
moving expenses. See Moving expenses on page 4.
7. A plan for federal, state, or local government employees or by an
Code R—Employer contributions to an Archer MSA. Show any
agency or instrumentality thereof (other than a section 457(b) plan).
employer contributions to an Archer MSA.
Generally, an employee is an active participant if covered by (a) a
Code S—Employee salary reduction contributions under a
section 408(p) SIMPLE. Show deferrals under a section 408(p) salary
defined benefit plan for any tax year that he or she is eligible to
participate or (b) a defined contribution plan (for example, a section
reduction SIMPLE retirement account. However, if the SIMPLE is part
of a section 401(k) arrangement, use code D.
401(k) plan) for any tax year that employer or employee contributions
(or forfeitures) are added to his or her account. For additional
Code T—Adoption benefits. Show the total that you paid or
information on employees who are eligible to participate in a plan,
reimbursed for qualified adoption expenses furnished to your employee
contact your plan administrator.
under an adoption assistance program. Also include adoption benefits
For details on the active participant rules, see Notice 87-16, 1987-1
paid or reimbursed from the pre-tax contributions made by the
C.B. 446, Notice 98-49, 1998-2 C.B. 365, section 219(g)(5), and Pub.
employee to a section 125 (cafeteria) plan. However, do not include
590, Individual Retirement Arrangements (IRAs). You can find Notice
adoption benefits forfeited from a section 125 (cafeteria) plan. Report
98-49 on page 5 of Internal Revenue Bulletin 1998-38 at
all amounts including those in excess of the $10,960 exclusion.
Code V—Income from the exercise of nonstatutory stock
option(s). Show the spread (that is, fair market value of stock over the
Do not check this box for contributions made to a nonqualified
or section 457(b) plan.
exercise price of option(s) granted to your employee with respect to
● Third-party sick pay. Check this box only if you are a third-party
that stock) from your employee’s (or former employee’s) exercise of
nonstatutory stock option(s). Include this amount in boxes 1, 3 (up to
sick pay payer filing a Form W-2AS, W-2GU, or W-2VI for an insured’s
social security wage base), and 5.
employee or are an employer reporting sick pay payments made by a
third party. See Sick Pay Reporting in section 6 of Pub. 15-A.
This reporting requirement does not apply to the exercise of a
statutory stock option, or the sale or disposition of stock acquired
Box 14—Other. The lease value of a vehicle provided to your
pursuant to the exercise of a statutory stock option. For more
employee and reported in box 1 must be reported here or on a
information concerning stock options, see Pub. 15-B, Employer’s Tax
separate statement to your employee. You may use this box for any
Guide to Fringe Benefits.
other information that you want to give to your employee, such as
health insurance premiums deducted, union dues, voluntary after-tax
Code W—Employer contributions to an employee’s Health
contributions (but not designated Roth contributions) to a pension plan,
Savings Account (HSA). Show any employer contributions (including
or nontaxable income. Clearly label each entry.
amounts the employee elected to pay under a section 125 (cafeteria)
plan) to your employee’s Health Savings Account (HSA).
Specific Instructions for Form W-3SS
See Notice 2004-2 and Notice 2004-50 for more information about
How to complete Form W-3SS. Please type or print entries. Make all
HSAs. You can find Notice 2004-2 on page 269 of Internal Revenue
entries without the dollar sign and comma but with the decimal point
Bulletin 2004-2 at You can find
(00000.00). If a box does not apply, leave it blank.
Notice 2004-50 on page 196 of Internal Revenue Bulletin 2004-33 at
Box a—Control number. This is an optional box that you may use for
See also Form 8889, Health
numbering the whole transmittal. Make certain that entries do not
Savings Accounts (HSAs), and Pub. 969, Health Savings Accounts and
crossover into the form identification box (33333).
Other Tax-Favored Health Plans.
Box b—Kind of Payer. Check only one box unless the second,
Code Y—Deferrals under a section 409A, nonqualified deferred
marked checkbox is “Third-party sick pay.” If you have more than one
compensation plan. Include current year deferrals under a section
type of Form W-2AS, W-2GU, W-2CM, or W-2VI, send each type with
409A deferred compensation plan. Any earnings during the year on
a separate Form W-3SS.
current year and prior year deferrals must also be reported here.
Page 6

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