Instructions For Form W-3c Pr - Transmittal Of Corrected Wage And Tax Statements

Form W-3c PR can be filed alone (without Forms 499 R-2c/

Medicare Employees only. Mark this checkbox if you are a

W-2c PR) to correct your EIN on a previously filed Form

government agency correcting Forms 499 R-2/W-2 PR for

W-3PR. If the EIN is the only change you need to make,

employees subject only to Medicare taxes.

complete only boxes a, b, d, e, and g, and sign the form.

Section 218. Mark this checkbox if you are a state or local

government employer correcting 1986 or earlier Forms 499 R-2/

In the Changes section of Form W-3c PR, total the amounts

from each box and column on the Forms 499 R-2c/W-2c PR

W-2 PR for employees covered under section 218 of the Social

Security Act. You must also enter your employer’s SSA number

you are sending. However, if you are sending Form W-3c PR

or Payroll Record Unit (PRU) number in box j.

without Forms 499 R-2c/W-2c PR to correct a previously filed

Form W-3PR, enter the amounts from the previous Form

Box g — Employer’s SSA number and PRU. If you are

W-3PR and any necessary corrections.

correcting a 1986 or earlier year, show the number assigned to

Box a — Tax year/Form being corrected. Enter all four digits

you by the SSA. This number always starts with 69. Also add

the ‘‘L’’ indicator, coverage group, and/or PRU numbers if these

of the year of the original Form 499 R-2/W-2 PR you are

correcting. For the type of form, enter “499 R-2/W-2 PR” or

have been assigned to you by SSA.

“W-3PR.” For example, entering “2001” and “499 R-2/W-2 PR”

Boxes h through j. Make entries here only if the number on

indicates that all forms being corrected are 2001 Forms 499

the original form is incorrect. Your correct numbers should

R-2/W-2 PR.

appear in boxes d, e, and g, respectively.

Box b — Employer’s name, address, and ZIP code. This

Boxes 1 through 7 — Changes. Enter the totals from the

should be the same as what is shown on your Form 941-PR.

same boxes on the related Forms 499 R-2c/W-2c PR. The box

Include the suite, room, or other unit number after the street

numbers on this form do not match Form 499 R-2c/

address. If the Post Office does not deliver mail to the street

W-2cPR. Complete only those items that are being corrected.

address and you use a P.O. box, show the P.O. box instead of

Otherwise, leave blank.

the street address.

On any line that shows a dollar change, if one of the

Change of address. The IRS will not use Form W-3c PR to

amounts is zero, enter ‘‘zero’’ or ‘‘-0-’’. Do not leave blank.

update your address of record. To change your address,

Explain any decreases here. Explain any decreases that

complete Form 8822, Change of Address. To get Form 8822,

appear in the third column. Enclose (but do not attach)

or any other IRS form, call 1-800-TAX-FORM (1-800-829-3676)

additional sheets, if necessary.

or visit the IRS Web Site at

Signature. Sign and date the form. Also, enter your title, phone

Box c — Total number of Forms 499 R-2c/W-2c PR. Enter

number, and the name of a person to contact. If you have a fax

the number of individual Forms 499 R-2c/W-2c PR filed with

number and/or e-mail address, also enter them. If you are not

this Form W-3c PR (not including “Void” forms); enter “-0-” if

the employer, see Who may sign Form W-3c PR, on page 3.

you are correcting only a previously filed Form W-3PR.

Privacy Act and Paperwork Reduction Act Notice. We ask

Box d — Establishment number. You may use this box to

for the information on Form W-3c PR to carry out the Internal

identify separate establishments in your business. You may file

Revenue laws of the United States. We need it to figure and

a separate Form W-3c PR, with Forms 499 R-2c/w-2c PR, for

collect the right amount of tax. Section 6051 of the Internal

each establishment, or you may use a single Form W-3c PR for

Revenue Code and its regulations require you to furnish wage

all Forms 499 R-2c/W-2c PR. You do not have to complete this

and tax statements to employees and to the Social Security

item; it is optional.

Administration. Section 6109 of the Code requires you to

Box e — Employer’s Federal EIN. Enter the correct number

provide your employer identification number.

assigned to you by the IRS in the format: 00-0000000. If you

Routine uses of this information include giving it to the

are correcting the EIN reported on Form W-3PR, enter the

Department of Justice for civil and criminal litigation, and with

incorrect EIN you used on Form W-3PR in box h.

cities, states, territories and possessions, and the District of

Box f — Kind of payer. Mark the checkbox that applies to you.

Columbia for use in administering their tax laws. If you fail to

Third-party sick pay. Mark this checkbox if you are a

provide this information in a timely manner or you provide false

third-party sick pay payer (or an employer reporting sick pay

or fraudulent information, you may be subject to penalties.

payments made by a third party) correcting Forms 499 R-2/W-2

You are not required to provide the information requested on

PR by marking this checkbox. (This checkbox and a second

a form that is subject to the Paperwork Reduction Act unless

applicable one (e.g., Form 941-PR) must be marked, if

the form displays a valid OMB control number. Books or

necessary.)

records relating to this form or its instructions must be retained

941-PR. Mark this checkbox if you file Form 941-PR and

as long as their contents may become material in the

none of the other categories apply.

administration of any Internal Revenue law. Generally, tax

returns and return information are confidential, as required by

Household. Mark this checkbox if you are a household

Code section 6103.

employer correcting Forms 499 R-2/W-2 PR for household

employees (Schedule H-PR (Form 1040-PR), or Form 942-PR

The time needed to complete and file this form will vary

for tax years before 1995). If you also have to correct forms of

depending on individual circumstances. The estimated average

employees who are not household employees, complete a

time is 31 minutes. If you have comments concerning the

separate Form W-3c PR.

accuracy of this time estimate or suggestions for making this

form simpler, we would be happy to hear from you. You can

943-PR. Mark this checkbox if you file Form 943-PR and are

write to the Tax Forms Committee, Western Area Distribution

correcting forms for agricultural employees. For nonagricultural

Center, Rancho Cordova, CA 95743-0001. Do not send this tax

employees, send Forms 499 R-2c/W-2c PR with a separate

form to this address. Instead, see Where to file on page 3.

Form W-3c PR, generally with the “941-PR” box checked.

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Instructions For Form W-3c Pr - Transmittal Of Corrected Wage And Tax Statements - 2001 Page 4

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