Form W-3c - Transmittal Of Corrected Wage And Tax Statements Page 2
ADVERTISEMENT
1
2DO NOT CUT, FOLD, OR STAPLE
a Tax year/Form corrected
For Official Use Only
▶
55555
/ W-
OMB No. 1545-0008
Kind of Payer (Check one)
Kind of Employer (Check one)
b Employer’s name, address, and ZIP code
c
Third-party
sick pay
941/941-SS Military
943
944/944-SS
None apply 501c non-govt.
(Check if
Hshld.
Medicare
State/local
State/local
Federal
applicable)
CT-1
emp.
govt. emp.
non-501c
501c
govt.
d Number of Forms W-2c
e Employer’s Federal EIN
f Establishment number
g Employer’s state ID number
h Employer’s incorrect Federal EIN
i Incorrect establishment number
j
Employer's incorrect state ID number
Complete boxes h, i, or j only if
incorrect on last form filed.
Total of amounts previously reported
Total of corrected amounts as
Total of amounts previously reported
Total of corrected amounts as
as shown on enclosed Forms W-2c.
shown on enclosed Forms W-2c.
as shown on enclosed Forms W-2c.
shown on enclosed Forms W-2c.
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
9 Advance EIC payments
9 Advance EIC payments
10 Dependent care benefits
10 Dependent care benefits
11 Nonqualified plans
11 Nonqualified plans
12a Deferred compensation
12a Deferred compensation
14 Inc. tax w/h by third-party sick pay payer
14 Inc. tax w/h by third-party sick pay payer
12b HIRE exempt wages and tips
12b HIRE exempt wages and tips
16 State wages, tips, etc.
16 State wages, tips, etc.
17 State income tax
17 State income tax
18 Local wages, tips, etc.
18 Local wages, tips, etc.
19 Local income tax
19 Local income tax
Explain decreases here:
Has an adjustment been made on an employment tax return filed with the Internal Revenue Service?
Yes
No
If “Yes,” give date the return was filed
▶
Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it is true,
correct, and complete.
Signature
Title
Date
▶
▶
▶
For Official Use Only
Contact person
Telephone number
Email address
Fax number
W-3c
Department of the Treasury
Transmittal of Corrected Wage and Tax Statements
Form
(Rev. 12-2011)
Internal Revenue Service
Purpose of Form
Where To File
If you use the U.S. Postal Service, send Forms W-2c and W-3c to the
Use this form to transmit Copy A of Form(s) W-2c, Corrected Wage
following address:
and Tax Statement (Rev. 2-2009). Make a copy of Form W-3c and keep
Social Security Administration
it with Copy D (For Employer) of Forms W-2c for your records. File Form
W-3c even if only one Form W-2c is being filed or if those Forms W-2c
Data Operations Center
are being filed only to correct an employee’s name and social security
P.O. Box 3333
number (SSN) or the employer identification number (EIN). See the 2012
Wilkes-Barre, PA 18767-3333
General Instructions for Forms W-2 and W-3 for information on
If you use a carrier other than the U.S. Postal Service, send Forms
completing this form.
W-2c and W-3c to the following address:
When To File
Social Security Administration
Data Operations Center
File this form and Copy A of Form(s) W-2c with the Social Security
Attn: W-2c Process
Administration as soon as possible after you discover an error on
1150 E. Mountain Drive
Forms W-2, W-2AS, W-2GU, W-2CM, W-2VI, or W-2c. Provide Copies
Wilkes-Barre, PA 18702-7997
B, C, and 2 of Form W-2c to your employees as soon as possible.
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 10164R
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial