Form W-2as - American Samoa Wage And Tax Statement

Notice to Employee

your employer. Enter this amount on the wages line of your tax return. (Form 1040-

SS filers, see the instructions for Form 1040-SS, Part I, line 5.) By filing this form,

Do you have to file? Refer to the Form 1040 Instructions to determine if you are

your social security tips will be credited to your social security record (used to

required to file a tax return. Even if you do not have to file a tax return, you may be

figure your benefits).

eligible for a refund if box 2 shows an amount or if you are eligible for any credit.

(Also see the Instructions for Employee on this page and the back of Copy C.)

Copies B and C; corrections. File Copy B of this form with your 2013 American

Instructions for Employee

Samoa income tax return. Keep Copy C for your records. If your name, social

security number (SSN), or address is incorrect, correct Copies B and C and ask

(Also see Notice to Employee on this page.)

your employer to correct your employment record. Be sure to ask your employer

to file Form W-2c, Corrected Wage and Tax Statement, with the Social Security

Box 5. This amount may be required to be entered on Form 8959. See Form 1040

Administration (SSA) to correct any name, amount, or SSN error reported to the

instructions to determine if you are required to complete Form 8959.

SSA. Be sure to get your copies of Form W-2c from your employer for all

Box 6. This amount includes the 1.45% Medicare Tax withheld on all Medicare

corrections made so you may file them with your tax return.

wages and tips shown in Box 5, as well as the 0.9% Additional Medicare Tax on

Estimated tax. If you expect to owe $1,000 or more in tax (including self-

any of those Medicare wages and tips above $200,000.

employment tax) for 2014, you may have to make estimated tax payments to the

Box 11. This amount is (a) reported in box 1 if it is a distribution made to you from

U.S. Internal Revenue Service. Use Form 1040-ES, Estimated Tax for Individuals.

a nonqualified deferred compensation or nongovernmental section 457(b) plan or

(b) included in box 3 and/or 5 if it is a prior year deferral under a nonqualified or

Clergy and religious workers. If you are not subject to social security and

section 457(b) plan that became taxable for social security and Medicare taxes this

Medicare taxes, see Pub. 517, Social Security and Other Information for Members

year because there is no longer a substantial risk of forfeiture of your right to the

of the Clergy and Religious Workers.

deferred amount. This box should not be used if you had a deferral and a

Cost of employer-sponsored health coverage (if such cost is provided by the

distribution in the same calendar year. If this happens and you are or will be age

employer). The reporting in box 12, using code DD, of the cost of employer-

62 by the end of the calendar year, your employer should file Form SSA-131 with

sponsored health coverage is for your information only. The amount reported

the Social Security Administration and give you a copy.

with code DD is not taxable.

Box 12. The following list explains the codes shown in box 12. You may need this

Credit for excess social security tax. If you had more than one employer in 2013

information to complete your tax return. Elective deferrals (codes D, E, F, and S)

and designated Roth contributions (codes AA, BB, and EE) under all plans are

and more than $7,049.40 in social security tax was withheld, you can have the

generally limited to a total of $17,500 ($12,000 if you have only SIMPLE plans;

excess refunded by filing Form 843, Claim for Refund and Request for Abatement,

$20,500 for section 403(b) plans if you qualify for the 15-year rule explained in

with the Department of the Treasury, Internal Revenue Service Center, Austin, TX

Pub. 571). Deferrals under code G are limited to $17,500. Deferrals under code H

73301-0215, USA. However, if you are required to file Form 1040 with the United

are limited to $7,000.

States, you must claim the excess tax as a credit on Form 1040.

However, if you were at least age 50 in 2013, your employer may have allowed

Unreported tip income. You must file Form 4137, Social Security and Medicare

an additional deferral of up to $5,500 ($2,500 for section 401(k)(11) and 408(p)

Tax on Unreported Tip Income, with your income tax return to report at least the

SIMPLE plans). This additional deferral amount is not subject to the overall limit on

allocated tip amount unless you can prove a smaller amount with adequate

elective deferrals. For code G, the limit on elective deferrals may be higher for the

records. If you have records that show the actual amount of tips you received,

last 3 years before you reach retirement age. Contact your plan administrator for

report that amount even if it is more or less than the allocated tips. Use Form 4137

more information. Amounts in excess of the overall elective deferral limit must be

to figure the social security and Medicare tax owed on tips you did not report to

included in income. See the “Wages, Salaries, Tips, etc.” line instructions for your

tax return.

(continued on back of Copy C)

Form W-2as - American Samoa Wage And Tax Statement - 2013 Page 5

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