Form W-2c - Corrected Wage And Tax Statement Page 2
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9DO NOT CUT, FOLD, OR STAPLE THIS FORM
For Official Use Only
▶
44444
OMB No. 1545-0008
a Employer’s name, address, and ZIP code
c Tax year/Form corrected
d Employee’s correct SSN
/ W-2
Corrected SSN and/or name (Check this box and complete boxes f and/or
e
g if incorrect on form previously filed.)
Complete boxes f and/or g only if incorrect on form previously filed
▶
f Employee’s previously reported SSN
b Employer's Federal EIN
g Employee’s previously reported name
h Employee’s first name and initial
Last name
Suff.
Note. Only complete money fields that are being corrected (exception: for
corrections involving MQGE, see the General Instructions for Forms W-2
and W-3, under Specific Instructions for Form W-2c, boxes 5 and 6).
i Employee’s address and ZIP code
Previously reported
Previously reported
Correct information
Correct information
1 Wages, tips, other compensation
1 Wages, tips, other compensation
2 Federal income tax withheld
2 Federal income tax withheld
3 Social security wages
3 Social security wages
4 Social security tax withheld
4 Social security tax withheld
5 Medicare wages and tips
5 Medicare wages and tips
6 Medicare tax withheld
6 Medicare tax withheld
7 Social security tips
7 Social security tips
8 Allocated tips
8 Allocated tips
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10 Dependent care benefits
10 Dependent care benefits
12a See instructions for box 12
12a See instructions for box 12
11 Nonqualified plans
11 Nonqualified plans
C
C
o
o
d
d
e
e
13
13
Statutory
Retirement
Third-party
Statutory
Retirement
Third-party
12b
12b
employee
plan
sick pay
employee
plan
sick pay
C
C
o
o
d
d
e
e
14 Other (see instructions)
14 Other (see instructions)
12c
12c
C
C
o
o
d
d
e
e
12d
12d
C
C
o
o
d
d
e
e
State Correction Information
Previously reported
Correct information
Previously reported
Correct information
15 State
15 State
15 State
15 State
Employer’s state ID number
Employer’s state ID number
Employer’s state ID number
Employer’s state ID number
16 State wages, tips, etc.
16 State wages, tips, etc.
16 State wages, tips, etc.
16 State wages, tips, etc.
17 State income tax
17 State income tax
17 State income tax
17 State income tax
Locality Correction Information
Previously reported
Correct information
Previously reported
Correct information
18 Local wages, tips, etc.
18 Local wages, tips, etc.
18 Local wages, tips, etc.
18 Local wages, tips, etc.
19 Local income tax
19 Local income tax
19 Local income tax
19 Local income tax
20 Locality name
20 Locality name
20 Locality name
20 Locality name
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
Copy A—For Social Security Administration
Department of the Treasury
W-2c
Corrected Wage and Tax Statement
Form
(Rev. 8-2014)
Cat. No. 61437D
Internal Revenue Service
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