Form 8922 - Third-Party Sick Pay Recap - 2014

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CORRECTED
8888
FILER'S name, street address, city or town, province or state, country, ZIP
Filer is an (check one):
OMB No. 1545-0123
Third-Party
or foreign postal code, and telephone no.
2014
Employer
Sick Pay
Recap
Insurer/Agent
8922
Form
FILER'S employer identification number
1 Sick pay subject to federal
2 Federal income tax withheld
OTHER PARTY'S name (see instructions before entering)
income tax
from sick pay
$
$
3 Sick pay subject to social
4 Social security tax withheld
security tax
from sick pay
$
$
OTHER PARTY'S employer identification number (see instructions before
5 Sick pay subject to
6 Medicare tax withheld from
entering)
Medicare tax
sick pay
$
$
2014 Instructions for Form 8922,Third-Party
Connecticut, Delaware, District of
Columbia, Idaho, Illinois, Indiana, Iowa,
Sick Pay Recap
Kentucky, Maine, Maryland,
Massachusetts, Michigan, Minnesota,
Section references are to the Internal Revenue Code unless otherwise
Internal Revenue Service
Montana, Nebraska, New Hampshire,
noted.
IRS SSA CAWR
New Jersey, New York, North Carolina,
Philadelphia, PA 19225-0533
North Dakota, Ohio, Pennsylvania,
Future Developments
Rhode Island, South Carolina, South
For the latest information about developments related to Form 8922
Dakota, Vermont, Virginia, West Virginia,
and its instructions, such as legislation enacted after they were
Wisconsin, Wyoming
published, go to
If your principal place of business is outside the United States, file
with the Internal Revenue Service, IRS SSA CAWR, Philadelphia, PA
General Instructions
19225-0533.
Do not send this form to the Social Security
!
Substitute Forms
Administration. This form is processed solely by the IRS
for third-party sick pay reporting.
The IRS accepts quality substitute tax forms that are consistent with
CAUTION
the official forms and have no adverse impact on our processing. The
official Form 8922 is the standard for substitute forms. Because a
Purpose of Form
substitute form is a variation from the official form, you should know
Form 8922 is filed to reconcile employment tax returns (for example,
the requirements of the official form for the year of use before you
Form 941) with Forms W-2 when third-party sick pay is paid. For more
create a substitute version. For details on the requirements for
information, see Sick Pay Reporting in Pub. 15-A, Employer's
substitute forms, see Pub. 1167, General Rules and Specifications for
Supplemental Tax Guide.
Substitute Forms and Schedules.
Who Must File
Specific Instructions
Generally, if the liability for the employer’s share of social security tax
Check box for employer or insurer/agent. Check the appropriate
and Medicare tax is reported on the employer’s employment tax
box to state whether you are the employer or the insurer/agent filing
return, Form 8922 must be filed by:
Form 8922.
• The employer, if sick pay is reported on Forms W‐2 under the name
Filer's name. If the Employer box is checked, the employer for whom
and EIN of the insurer or agent.
the sick pay was paid by the insurer or agent will complete the
• The insurer or agent, if sick pay is reported on Forms W‐2 under the
information with the employer's name, address, and phone number.
name and EIN of the employer.
If the Insurer/Agent box is checked, the insurer or agent who paid
For more information on who must file Form 8922, see Pub. 15‐A,
the sick pay will complete the information with the insurer/agent's
Employer’s Supplemental Tax Guide (For use in 2015).
name, address, and phone number.
When To File
Filer's EIN. If the employer box is checked, enter the EIN of the
employer.
File Form 8922 by March 2, 2015.
If the Insurer/Agent box is checked, enter the EIN of the insurer or
Where To File
agent.
Send Form 8922 to the following:
Other party's name and EIN. If the Employer box is checked, the
employer must provide the name and EIN of the insurer or agent. If the
If your principal business, office,
Use the following
employer has contracts with more than one insurer or agent, the
or agency is located in
address
employer must file a separate Form 8922 for the wages and taxes
related to each contract.
If the Insurer/Agent box is checked, the insurer or agent may, but is
Alabama, Alaska, Arizona, Arkansas,
California, Colorado, Florida, Georgia,
not required to, provide the name and EIN of the employer. If it is
Internal Revenue Service
Hawaii, Kansas, Louisiana, Mississippi,
Memphis Service Center
providing this information, and if it has contracts with more than one
Missouri, Nevada, New Mexico,
P.O. Box 87 Mail Stop 814D6
employer, it must file a separate Form 8922 for the wages and taxes
Oklahoma, Oregon, Tennessee, Texas,
Memphis, TN 38101-0087
related to each employer. Alternatively, it may file a separate Form
Utah, Washington
8922 for the wages and taxes related to each employer for which it is
8922
Form
Cat. No. 37734T
IRS.gov/form8922
Department of the Treasury - Internal Revenue Service

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