Form 8922 - Third-Party Sick Pay Recap - 2015

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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.
2015
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
$
$
Instructions for Form 8922
California, Connecticut, Delaware,
District of Columbia, Idaho, Illinois,
Section references are to the Internal Revenue Code unless otherwise
Indiana, Iowa, Kentucky, Maine,
noted.
Maryland, Massachusetts, Michigan,
Minnesota, Montana, Nebraska, New
Internal Revenue Service
Future Developments
Hampshire, New Jersey, New York,
IRS SSA CAWR
For the latest information about developments related to Form 8922
North Carolina, North Dakota, Ohio,
Philadelphia, PA 19255-0533
Oregon, Pennsylvania, Rhode Island,
and its instructions, such as legislation enacted after they were
South Carolina, South Dakota, Vermont,
published, go to
Virginia, West Virginia, Wisconsin,
General Instructions
Wyoming
If your principal place of business is outside the United States, file
Do not send this form to the Social Security
!
with the Internal Revenue Service, IRS SSA CAWR, Philadelphia, PA
Administration. This form is processed solely by the IRS
19255-0533.
for third-party sick pay reporting.
CAUTION
Substitute Forms
Purpose of Form
The IRS accepts quality substitute tax forms that are consistent with
Form 8922 is filed to reconcile employment tax returns (for example,
the official forms and have no adverse impact on our processing. The
Form 941) with Forms W-2 when third-party sick pay is paid. For more
official Form 8922 is the standard for substitute forms. Because a
information, see Sick Pay Reporting in Pub. 15-A.
substitute form is a variation from the official form, you should know
the requirements of the official form for the year of use before you
Who Must File
create a substitute version. For details on the requirements for
Generally, if the liability for the employer’s share of social security tax
substitute forms, see Pub. 1167.
and Medicare tax is reported on the employer’s employment tax
Specific Instructions
return, Form 8922 must be filed by:
• The employer, if sick pay is reported on Forms W-2 under the name
Check box for employer or insurer/agent. Check the appropriate
and EIN of the insurer or agent.
box to state whether you are the employer or the insurer/agent filing
Form 8922.
• The insurer or agent, if sick pay is reported on Forms W-2 under the
name and EIN of the employer.
Filer's name. If the Employer box is checked, the employer for whom
the sick pay was paid by the insurer or agent will complete the
For more information on who must file Form 8922, see Pub. 15-A.
information with the employer's name, address, and phone number.
When To File
If the Insurer/Agent box is checked, the insurer or agent who paid
File Form 8922 by February 29, 2016.
the sick pay will complete the information with the insurer/agent's
name, address, and phone number.
Where To File
Filer's EIN. If the employer box is checked, enter the EIN of the
Send Form 8922 to the following:
employer.
If your principal business, office,
Use the following
If the Insurer/Agent box is checked, enter the EIN of the insurer or
or agency is located in
address
agent.
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
Alabama, Alaska, Arizona, Arkansas,
employer has contracts with more than one insurer or agent, the
Colorado, Florida, Georgia, Hawaii,
Internal Revenue Service
Kansas, Louisiana, Mississippi, Missouri,
employer must file a separate Form 8922 for the wages and taxes
Memphis Service Center
Nevada, New Mexico, Oklahoma,
P.O. Box 87 Mail Stop 814D6
related to each contract.
Tennessee, Texas, Utah, Washington
Memphis, TN 38101-0087
If the Insurer/Agent box is checked, the insurer or agent may, but is
not required to, provide the name and EIN of the employer. If it is
providing this information, and if it has contracts with more than one
employer, it must file a separate Form 8922 for the wages and taxes
related to each employer. Alternatively, it may file a separate Form
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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