Form W-3c - Transmittal Of Corrected Wage And Tax Statements Page 2
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1
2DO NOT CUT, FOLD, OR STAPLE
a Tax year/Form corrected
For Official Use Only
▶
55555
/ W-
OMB No. 1545-0008
b Employer’s name, address, and ZIP code
c
Kind of Payer (Check one)
Kind of Employer (Check one)
Third-party
sick pay
941/941-SS Military
943
944
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 originally reported 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
9
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
12b
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
Employer's contact person
Employer's telephone number
Employer's fax number
Employer's email address
W-3c
Department of the Treasury
Transmittal of Corrected Wage and Tax Statements
Form
(Rev. 11-2015)
Internal Revenue Service
Purpose of Form
When To File
File this form and Copy A of Form(s) W-2c with the Social Security Administration
Use this form to transmit Copy A of the most recent version of Form(s) W-2c,
as soon as possible after you discover an error on Forms W-2, W-2AS, W-2GU,
Corrected Wage and Tax Statement. Make a copy of Form W-3c and keep it with
W-2CM, W-2VI, or W-2c. Provide Copies B, C, and 2 of Form W-2c to your
Copy D (For Employer) of Forms W-2c for your records. File Form W-3c even if
employees as soon as possible.
only one Form W-2c is being filed or if those Forms W-2c are being filed only to
correct an employee’s name and social security number (SSN) or the employer
Where To File
identification number (EIN). See the General Instructions for Forms W-2 and W-3
If you use the U.S. Postal Service, send Forms W-2c and W-3c to the following address:
for information on completing this form.
Social Security Administration
E-Filing
Data Operations Center
P.O. Box 3333
The SSA strongly suggests employers report Form W-3c and Forms W-2c Copy A
electronically instead of on paper. The SSA provides two free e-filing options on its
Wilkes-Barre, PA 18767-3333
Business Services Online (BSO) website:
If you use a carrier other than the U.S. Postal Service, send Forms W-2c and W-3c
• W-2c Online. Use fill-in forms to create, save, print, and submit up to 25 Forms
to the following address:
W-2c at a time to the SSA.
Social Security Administration
• File Upload. Upload wage files to the SSA you have created using payroll or tax
Data Operations Center
software that formats the files according to the SSA’s Specifications for Filing
Attn: W-2c Process
Forms W-2c Electronically (EFW2C).
1150 E. Mountain Drive
Wilkes-Barre, PA 18702-7997
For more information, go to First time filers,
select "Go to Register"; returning filers select "Go To Log In."
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 10164R
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