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Table 1. Format for Report (Under Covering Letter) to Request SSA to Allocate Back Pay Under Statute Wages

Employer’s EIN: xx-xxxxxxx

Tax Year in Which Award Payment Was Paid: 2009

(1)

(2)

(3)

(4)

2,3

SSN and

Award Amount

Other Soc. Sec./Med. Wages

Allocation

Employee

and Period(s)

Paid In Award Year

Name

Soc. Sec.

Med./MQGE

Year

Soc. Sec.

Med./MQGE

xxx-xx-xxxx

$100,000

$40,000

2006

$20,000

HELEN T.

1/2006 - 12/2009

2007

25,000

SMITH

2008

27,000

2009

28,000

xxx-xx-xxxx

30,000

-0-

1989

6,000

SAM W.

7/89-12/91

1990

12,000

EVANS

1991

12,000

xxx-xx-xxxx

15,000

-0-

9/80

3,500

ROLAND S.

7/80-12/81

12/80

3,500

ADAMS

1981

8,000

Exclude amounts specifically designated as damages, penalties, etc.

Exclude the amount of back pay, if any, included in that amount.

For periods before January 1, 1978 (and for state and local government (Section 218) employers before January 1, 1981), show

the wage amounts by calendar quarters. The social security and/or Medicare Qualified Government Employment (MQGE) wages

(where applicable) must be shown separately FOR ALL YEARS. (Wages subject ONLY to MQGE would be shown in the

Medicare/MQGE column; no wages would be shown in the Soc. Sec. column.) For tax years 1991 and later, the social security

and Medicare wages must be listed separately.

Explanation of examples.

Helen T. Smith–The back pay award, excluding interest, was $100,000 for the periods 1/2006-12/2009. In 2009, this

employee was also paid $40,000 in other wages. (Her Form W-2 for 2009 reported $106,800 for social security and

$140,000 for Medicare. The SSA allocation will result in adjusted posted wages of $68,000 for social security and

$68,000 for Medicare for 2009.)

Sam W. Evans–The back pay award was $30,000 for the periods 7/89-12/91. This employee was hired in 1989 and

was subject to MQGE only. He was no longer employed by this governmental employer in 2009. (His Form W-2 for

2009 reported $30,000 for social security and $30,000 for Medicare. After the SSA allocation, he will not have any net

posted wages for 2009.)

Roland S. Adams–The back pay award was $15,000 for the periods 7/80-12/81. He was no longer employed by this

state and local government (Section 218) employer in 2009. (His Form W-2 for 2009 reported $15,000 for social

security and $15,000 for Medicare; after the SSA allocation, he will not have any net posted wages for 2009.)

Questions

you did not report to the SSA, contact your state Social

Security Administrator’s office.

If you have questions concerning back pay under a statute,

If the state Social Security Administrator’s office

go to SSA’s website at

and click

needs more information, they can contact the

on “Find a Social Security Office.” If online access is not

SSA at the following address:

available, then call 1-800-772-1213 to locate your local

Field Office.

Social Security Administration

Exception. If you are a state or local government em-

Office of Income Security Programs

ployer who was covered by an agreement under Section

Office of Earnings and Program Integrity Policy

218 of the Social Security Act before January 1, 1987, and

6401 Security Boulevard 2506 OPS

you paid a back pay award before January 1, 1987, which

Baltimore, MD 21235

Page 4

Publication 957 (May 2010)

Publication 957 - Reporting Back Pay And Special Wage Payments To The Social Security Administration Page 4

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