Form W2 Correction Worksheet

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AC 2674 (Rev. 11/12)
FORM W-2 CORRECTION WORKSHEET FOR 20_ _
Separate Form Required for Each Employee
Agency Code
Batch #
Last Name
First Name, MI
NYS EMPLID
Wage Correction
NYC /
Gross Wage
Federal Tax
SS Wage
SS Tax
Med Wage
Med Tax
State Wage
State Tax
Local Wage
Yonkers Tax
Misc.
Misc.
Originally
Reported
W-2
Corrected
W-2
Difference
(+ or -)
Name Correction
Social Security Number Correction
CHANGE TO:
CHANGE TO:
Last Name
Social Security Number
First Name, MI
Special Notes:
________________________________________________________________
Unclick Retirement Checkbox
c
Reason:
________________________________________________________________
__________________________________________________________________
________________________________________________________________
__________________________________________________________________
Prepared by _________________________________ Date _______________
Reason Codes (check all that apply)
(
)
(
)
Tele. # __________________________ Fax # _________________________
Salary Refunds (AC 230s processed after deadlines.) A copy of AC 230 is required.
c
Email ___________________________________________________________
Miscellaneous Codes:
c
UTA, EDA, PPL, CPA, FRB, IMP, TXP, EXP, 414H, WCX, IRC 125, MNA, TPS
For description of codes, refer to back of Form W-2 Statement.
For OSC Use Only
SS/MED Refunds
c
Miscellaneous. Explanation required. _____________________________________
c
Audited by __________________________________ Date _______________
___________________________________________________________________

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