Federal Employment Tax Forms

Department of the Treasury

Internal Revenue Service

What forms and publications will IRS send automatically? IRS will

send you either Pub. 15 (Circular E) or Pub. 51 (Circular A) in

December. These publications explain your tax responsibilities as an

employer and will provide federal income tax withholding and advance

earned income credit payment tables for 2010. You will also receive

employment tax returns for each quarterly or annual return period

unless you filed electronically or used a paid preparer:

Information return questions. If you have questions about

information returns (Forms 1096, 1098, 1099, 1042-S, 5498, W-2,

W-2G, and W-3), call 1-866-455-7438 (toll free) or 304-263-8700 (toll

call) Monday through Friday, 8:30 a.m. to 4:30 p.m., Eastern time.

● Furnish Copies B, C, and 2 of Form W-2 to your employees by

February 1, 2010.

● Use Form W-3 to send Copy A of all Forms W-2 to the SSA by

March 1, 2010. Be sure to fill in your name, address, and correct EIN.

● Prepare and file Forms W-2 either alphabetically by employees’

last names or numerically by employees’ social security numbers.

Recordkeeping. Keep copies of Forms W-2 and W-3 and all other

employment tax records for at least 4 years.

Publication 393 ● W-2

● W-3

● Form 940, Employer’s Annual Federal Unemployment (FUTA) Tax

Return

● Form 941, Employer’s QUARTERLY Federal Tax Return

● Form 943, Employer’s Annual Federal Return for Agricultural

Employees

Electronic filing option for small businesses. Small submitters may

be able to file Forms W-2 electronically. Electronic filing is free, fast,

and secure with a later filing deadline (March 31, 2010, versus March

1, 2010, for other filing methods). To register for electronic filing or to

get more information, visit www.socialsecurity.gov/employer and

click on “Electronically File Your W-2s.” Do not mail paper Forms

W-2 or Forms W-3 to SSA if you file electronically.

Department of the Treasury

Internal Revenue Service

Ogden, UT 84201

PRSRT STD

Postage and Fees Paid

Official Business Internal Revenue Service

Penalty for Private Use, $300

Permit No. G-48

Publication 393

Cat. No. 11071P

Having employees secure a corrected social security card will

allow the SSA to process the information correctly and properly

credit employees’ social security earnings. It will also help the

employees report their wages on their income tax returns.

Federal Employment Tax Forms

How to get forms and publications. To get forms and

publications, see Quick and Easy Access to IRS Tax Help and Tax

Products on page 2. To place an order for 2009 and 2010

employer-related forms and publications online for delivery by

mail, access www.irs.gov/businesses and click on “Online Ordering

for Information Returns and Employer Returns.”

Social security wage base for 2009. Do not withhold social

security tax after an employee reaches $106,800 in social security

wages for 2009. (There is no limit on the amount of wages

subject to Medicare tax.)

● Form 944, Employer’s ANNUAL Federal Tax Return

How to complete Forms W-2 and W-3. When you complete and

file your 2009 Form W-2, Wage and Tax Statement(s), and 2009

Form W-3, Transmittal of Wage and Tax Statements:

● Show the correct social security numbers of all employees on

Forms W-2 and be sure all copies are legible. If any employees’

names changed during the year, encourage the employees to

contact their local Social Security Administration (SSA) office and

request a corrected social security card.

Reminders

● Schedule H (Form 1040), Household Employment Taxes

2009
Publication 2053-A (Rev. 9-2009)

Cat. No. 23267Z

Quick and Easy Access to IRS Tax Help and Tax Products

Department of the Treasury

Internal Revenue Service

www.irs.gov

Internet Online Services & Tax Help

Access the IRS website 24 hours a day, 7 days a week at

www.irs.gov to obtain information on:

● Online Services — Conduct business with the IRS

electronically

View & Download Products

Visit the IRS website at www.irs.gov and select Forms

and Publications, or simply type www.irs.gov/formspubs

in your Internet search window to:

● view or download current and previous year tax

products

● order current year tax products online

Online Ordering of Products

To order Tax Products delivered by mail, go to

www.irs.gov/formspubs

● For current year products, select “Forms and

publications by U.S. mail”

● For a tax booklet of forms and instructions, select

“Tax packages”

● For Employer Products (e.g. W-4, Pub. 15) and

Information Returns (e.g. W-2, W-3, 1099 series),

select “Employer forms and instructions”

● For tax products on a DVD, select “Tax products on

DVD (Pub. 1796)” See DVD below

Telephone Tax Forms & Publications

1-800-829-3676

Call to order current and prior year forms, instructions,

and publications.

You should receive your order within 10 working days.

Tax Help & Questions

Individuals: 1-800-829-1040

Business & Specialty Tax: 1-800-829-4933

Hearing Impaired TTY/TDD: 1-800-829-4059

TeleTax - 24 hour tax information: 1-800-829-4477

See instructions 1040, 1040A, or 1040EZ for topic

numbers and details.

Refund Hotline: 1-800-829-1954

Mail You can receive tax products within 10 working days after

receipt of your order. Internal Revenue Service

1201 N. Mitsubishi Motorway

Bloomington, IL 61705-6613

Community

Locations

You can pick up some of the most requested forms,

instructions, and publications at many IRS offices, post

offices, and libraries.

Also some grocery stores, copy centers, city and county

government offices, and credit unions have reproducible

tax form products available to photocopy or print from a

DVD.

DVD Purchase the IRS Publication 1796 (IRS Tax Products).

Availability:

Internet:

Telephone:

● National Technical Information Service (NTIS) at

www.irs.gov/cdorders

or

● Government Printing Office (GPO) at

http://bookstore.gpo.gov (search for Pub. 1796)

● NTIS at 1-877-233-6767

or

● GPO at 1-866-512-1800

First release—early January 

Final release—early March 

National Taxpayer Advocate Helpline

1-877-777-4778

Send written request to:

Do not send your tax return to the address

shown here. Instead, see the tax form

instructions.

To get IRS information, forms

and publications in Spanish,

select Español in upper right

corner of www.irs.gov.

The Forms and Publications page provides links to

access and acquire both electronic and print media.

Additionally, the Search function provides basic and

advanced search capabilitites for published products

available on IRS.gov.

● Taxpayer Advocate Service — Helps taxpayers resolve

problems with the IRS.

● Free File and e-file — Free Federal Online Filing

● Where’s My Refund— Your refund status anytime from

anywhere

● Free Tax Return Preparation— Free tax assistance and

preparation

● Recent Tax Changes — Highlights on newly-enacted

tax law

● Innocent Spouses — Tax Information for Innocent

Spouses

● Disaster Tax Relief — Tax relief provisions for disaster

situations

● Identity Theft and Your Tax Records — Safeguard your

identity and tax records

● Online Payment Agreement (OPA) Application —

Online agreements

● Applying for Offers in Compromise — Information on

Offers in Compromise
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief,

they are true, correct, and complete.

Signature Title Date 

Department of the Treasury

Internal Revenue Service

Cat. No. 10159Y

Total number of Forms W-2

b 941 Military 943

Kind

of

Payer

Medicare

govt. emp.

Hshld.

CT-1 emp.

c d Establishment number



1

6

2

7 Allocated tips

Advance EIC payments

8

9 10

Wages, tips, other compensation Federal income tax withheld

Social security wages Social security tax withheld

11 12

Employer’s state ID number

3 4

Medicare wages and tips

Social security tips

13

14

5

Employer identification number (EIN)

Employer’s name

Nonqualified plans

Medicare tax withheld

15

Employer’s address and ZIP code

Dependent care benefits

Deferred compensation

e

f

g

h Other EIN used this year

Income tax withheld by payer of third-party sick pay

2 00 9

Telephone number For Official Use Only

Email address Fax number

( )

( )

a Control number For Official Use Only 

OMB No. 1545-0008

Form W-3 Transmittal of Wage and Tax Statements

33333

Contact person

For third-party sick pay use only

Third-party

sick pay

16 State wages, tips, etc.

18 Local wages, tips, etc.

17

19

State income tax

Local income tax

State

Social Security Administration

Data Operations Center

Wilkes-Barre, PA 18769-0001

Note. If you use “Certified Mail” to file, change the ZIP code to

“18769-0002.” If you use an IRS-approved private delivery service, add

“ATTN: W-2 Process, 1150 E. Mountain Dr.” to the address and change

the ZIP code to “18702-7997.” See Publication 15 (Circular E),

Employer’s Tax Guide, for a list of IRS-approved private delivery services.

Send this entire page with the entire Copy A page of Form(s) W-2

to:

Where To File Paper Forms

Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3.

For Privacy Act and Paperwork Reduction Act Notice, see the back of Copy D of Form W-2.

When To File

Purpose of Form

A Form W-3 Transmittal is completed only when paper Copy A of

Form(s) W-2, Wage and Tax Statement, are being filed. Do not file

Form W-3 alone. Do not file Form W-3 for Form(s) W-2 that were

submitted electronically to the Social Security Administration (see

below). All paper forms must comply with IRS standards and be

machine readable. Photocopies and hand-printed forms are not

acceptable. Use a Form W-3 even if only one paper Form W-2 is

being filed. Make sure both the Form W-3 and Form(s) W-2 show

the correct tax year and Employer Identification Number (EIN). Make

a copy of this form and keep it with Copy D (For Employer) of

Form(s) W-2 for your records.

Mail any paper Forms W-2 under cover of this Form W-3

Transmittal by March 1, 2010. Electronic fill-in forms or uploads are

filed through SSA’s Business Services Online (BSO) Internet site

and will be on time if submitted by March 31, 2010.

Reminder

Separate instructions. See the 2009 Instructions for Forms W-2

and W-3 for information on completing this form.

944

DO NOT STAPLE

Electronic Filing

The Social Security Administration strongly suggests employers

report Form W-3 and W-2 Copy A electronically instead of on

paper. SSA provides two e-file options:

● Free online, fill-in Forms W-2 for employers who file 20 or fewer

Form(s) W-2.

● Upload a file for employers who use payroll/tax software to print

Form(s) W-2, if the vendor software creates a file that can be

uploaded to SSA.

For more information, go to www.socialsecurity.gov/employer and

select “First Time Filers” or “Returning Filers” under “BEFORE YOU

FILE.”

Send this entire page with the entire Copy A page of Form(s) W-2 to the Social Security Administration.
For Privacy Act and Paperwork Reduction

Act Notice, see back of Copy D.

1

Employee’s social security number

Retirement

plan

Third-party

sick pay

Statutory

employee

6

2

Employer’s name, address, and ZIP code

7 Allocated tips

Advance EIC payment

8

9 10

Wages, tips, other compensation Federal income tax withheld

Social security wages Social security tax withheld

11 12a

Employer’s state ID number

3 4

Employer identification number (EIN)

Medicare wages and tips

Social security tips

13

5

Control number

Employee’s first name and initial Nonqualified plans

Medicare tax withheld

15

14

16 17

Other

18

Employee’s address and ZIP code

State State wages, tips, etc. State income tax Locality name

Copy A For Social Security Administration — Send this entire page with

Form W-3 to the Social Security Administration; photocopies are not acceptable.

Department of the Treasury—Internal Revenue Service

Do Not Cut, Fold, or Staple Forms on This Page — Do Not Cut, Fold, or Staple Forms on This Page

Form

Dependent care benefits

See instructions for box 12

Cat. No. 10134D

a

b

c

d

e

f

Void

W-2 Wage and TaxStatement 2

22222

0 90

OMB No. 1545-0008

For Official Use Only 

Last name C

o

d

e

12b

C

o

d

e

12c

C

o

d

e

Local wages, tips, etc. 19 Local income tax 20

12d

C

o

d

e

Suff.
1

Retirement

plan

Third-party 

sick pay

Statutory

employee

6

2

Employer’s name, address, and ZIP code

7 Allocated tips

Advance EIC payment

8

9 10

Wages, tips, other compensation Federal income tax withheld

Social security wages Social security tax withheld

11 12a

Employer’s state ID number

3 4

Employer identification number (EIN)

Medicare wages and tips

Social security tips

13

5

Control number

Employee’s first name and initial Nonqualified plans

Medicare tax withheld

15

14

16 17

Other

18

Employee’s address and ZIP code

State State wages, tips, etc. State income tax Locality name

Copy 1—For State, City, or Local Tax Department

Department of the Treasury—Internal Revenue Service

Form

Dependent care benefits

b

c

d

e

f

W-2 Wage and Tax

Statement 20 90

OMB No. 1545-0008

Last name C

o

d

e

12b

C

o

d

e

12c

C

o

d

e

Local wages, tips, etc. 19 Local income tax 20

12d

C

o

d

e

Suff.

a Employee’s social security number 22222
1

Retirement

plan

Third-party 

sick pay

Statutory

employee

6

2

Employer’s name, address, and ZIP code

7 Allocated tips

Advance EIC payment

8

9 10

Wages, tips, other compensation Federal income tax withheld

Social security wages Social security tax withheld

11 12a

Employer’s state ID number

3 4

Employer identification number (EIN)

Medicare wages and tips

Social security tips

13

5

Control number

Employee’s first name and initial Nonqualified plans

Medicare tax withheld

15

14

16 17

Other

18

Employee’s address and ZIP code

State State wages, tips, etc. State income tax Locality name

Copy B—To Be Filed With Employee’s FEDERAL Tax Return.

This information is being furnished to the Internal Revenue Service.

Department of the Treasury—Internal Revenue Service

Form

Dependent care benefits

See instructions for box 12

b

c

d

e

f

W-2 Wage and TaxStatement 20 90

Last name C

o

d

e

12b

C

o

d

e

12c

C

o

d

e

Local wages, tips, etc. 19 Local income tax 20

12d

C

o

d

e

Safe, accurate,

FAST! Use

Visit the IRS website

at www.irs.gov/efile.

Suff.

a Employee’s social security number

OMB No. 1545-0008
Notice to Employee

Refund. Even if you do not have to file a tax return, you

should file to get a refund if box 2 shows federal income tax

withheld or if you can take the earned income credit.

Earned income credit (EIC). You must file a tax return if

any amount is shown in box 9.

You may be able to take the EIC for 2009 if (a) you do not

have a qualifying child and you earned less than $13,440

($16,560 if married filing jointly), (b) you have one qualifying

child and you earned less than $35,463 ($38,583 if married

filing jointly), or (c) you have more than one qualifying child

and you earned less than $40,295 ($43,415 if married filing

jointly). You and any qualifying children must have valid

social security numbers (SSNs). You cannot take the EIC if

your investment income is more than $3,100. Any EIC that

is more than your tax liability is refunded to you, but only

if you file a tax return. If you have at least one qualifying

child, you may get as much as $1,826 of the EIC in advance

by completing Form W-5, Earned Income Credit Advance

Payment Certificate, and giving it to your employer.

Corrections. If your name, SSN, or address is incorrect,

correct Copies B, C, and 2 and ask your employer to correct

your employment record. Be sure to ask the employer to file

Form W-2c, Corrected Wage and Tax Statement, with the

Social Security Administration (SSA) to correct any name,

SSN, or money amount error reported to the SSA on Form

W-2. If your name and SSN are correct but are not the same

as shown on your social security card, you should ask for a

new card that displays your correct name at any SSA office

or by calling 1-800-772-1213.

Credit for excess taxes. If you had more than one

employer in 2009 and more than $6,621.60 in social security

and/or Tier I railroad retirement (RRTA) taxes were withheld,

you may be able to claim a credit for the excess against

your federal income tax. If you had more than one railroad

employer and more than $3,088.80 in Tier II RRTA tax was

withheld, you also may be able to claim a credit. See your

Form 1040 or Form 1040A instructions and Publication 505,

Tax Withholding and Estimated Tax.

Clergy and religious workers. If you are not subject to

social security and Medicare taxes, see Publication 517,

Social Security and Other Information for Members of the

Clergy and Religious Workers.

(Also see Instructions for Employee on the back of Copy C.)
1

Retirement

plan

Third-party 

sick pay

Statutory

employee

6

2

Employer’s name, address, and ZIP code

7 Allocated tips

Advance EIC payment

8

9 10

Wages, tips, other compensation Federal income tax withheld

Social security wages Social security tax withheld

11 12a

Employer’s state ID number

3 4

Employer identification number (EIN)

Medicare wages and tips

Social security tips

13

5

Control number

Employee’s first name and initial Nonqualified plans

Medicare tax withheld

15

14

16 17

Other

18

Employee’s address and ZIP code

State State wages, tips, etc. State income tax Locality name

Copy C—For EMPLOYEE’S RECORDS (See Notice to

Employee on the back of Copy B.)

Department of the Treasury—Internal Revenue Service

Form

Dependent care benefits

See instructions for box 12

b

c

d

e

f

W-2 Wage and Tax

Statement 20 90

Last name C

o

d

e

12b

C

o

d

e

12c

C

o

d

e

Local wages, tips, etc. 19 Local income tax 20

12d

C

o

d

e

This information is being furnished to the Internal Revenue Service. If you

are required to file a tax return, a negligence penalty or other sanction

may be imposed on you if this income is taxable and you fail to report it.

Safe, accurate,

FAST! Use

Suff.

a Employee’s social security number

OMB No. 1545-0008
However, if you were at least age 50 in 2009, your employer

may have allowed an additional deferral of up to $5,500 ($2,500

for section 401(k)(11) and 408(p) SIMPLE plans). This additional

deferral amount is not subject to the overall limit on elective

deferrals. For code G, the limit on elective deferrals may be

higher for the last 3 years before you reach retirement age.

Contact your plan administrator for more information. Amounts

in excess of the overall elective deferral limit must be included

in income. See the “Wages, Salaries, Tips, etc.” line instructions

for Form 1040.

Box 11. This amount is (a) reported in box 1 if it is a distribution

made to you from a nonqualified deferred compensation or

nongovernmental section 457(b) plan or (b) included in box 3

and/or 5 if it is a prior year deferral under a nonqualified or

section 457(b) plan that became taxable for social security and

Medicare taxes this year because there is no longer a

substantial risk of forfeiture of your right to the deferred

amount.

Box 8. This amount is not included in boxes 1, 3, 5, or 7. For

information on how to report tips on your tax return, see your

Form 1040 instructions.

Box 9. Enter this amount on the advance earned income credit

payments line of your Form 1040 or Form 1040A.

Box 2. Enter this amount on the federal income tax withheld

line of your tax return.

D—Elective deferrals to a section 401(k) cash or deferred

arrangement. Also includes deferrals under a SIMPLE retirement

account that is part of a section 401(k) arrangement.

Box 1. Enter this amount on the wages line of your tax return.

Box 10. This amount is the total dependent care benefits that

your employer paid to you or incurred on your behalf (including

amounts from a section 125 (cafeteria) plan). Any amount over

$5,000 is also included in box 1. You must complete Schedule

2 (Form 1040A) or Form 2441, Child and Dependent Care

Expenses, to compute any taxable and nontaxable amounts.

A—Uncollected social security or RRTA tax on tips. Include this

tax on Form 1040. See “Total Tax” in the Form 1040

instructions.

C—Taxable cost of group-term life insurance over $50,000

(included in boxes 1, 3 (up to social security wage base), and 5)

Instructions for Employee (Also see Notice to

Employee, on the back of Copy B.)

B—Uncollected Medicare tax on tips. Include this tax on Form

1040. See “Total Tax” in the Form 1040 instructions.

Note. If a year follows code D through H, S, Y, AA, or BB, you

made a make-up pension contribution for a prior year(s) when

you were in military service. To figure whether you made excess

deferrals, consider these amounts for the year shown, not the

current year. If no year is shown, the contributions are for the

current year.

Box 12. The following list explains the codes shown in 

box 12. You may need this information to complete your tax

return. Elective deferrals (codes D, E, F, and S) and designated

Roth contributions (codes AA and BB) under all plans are

generally limited to a total of $16,500 ($11,500 if you only have

SIMPLE plans; $19,500 for section 403(b) plans if you

E—Elective deferrals under a section 403(b) salary reduction

agreement

qualify for the 15-year rule explained in Pub. 571). Deferrals

under code G are limited to $16,500. Deferrals under code H

are limited to $7,000.

(continued on back of Copy 2)
1

Retirement

plan

Third-party 

sick pay

Statutory

employee

6

2

Employer’s name, address, and ZIP code

7 Allocated tips

Advance EIC payment

8

9 10

Wages, tips, other compensation Federal income tax withheld

Social security wages Social security tax withheld

11 12a

Employer’s state ID number

3 4

Employer identification number (EIN)

Medicare wages and tips

Social security tips

13

5

Control number

Employee’s first name and initial Nonqualified plans

Medicare tax withheld

15

14

16 17

Other

18

Employee’s address and ZIP code

State State wages, tips, etc. State income tax Locality name

Copy 2—To Be Filed With Employee’s State, City, or Local

Income Tax Return.

Department of the Treasury—Internal Revenue Service

Form

Dependent care benefits

b

c

d

e

f

W-2 Wage and TaxStatement 20 90

Last name C

o

d

e

12b

C

o

d

e

12c

C

o

d

e

Local wages, tips, etc. 19 Local income tax 20

12d

C

o

d

e

Suff.

a Employee’s social security number

OMB No. 1545-0008
Box 13. If the “Retirement plan” box is checked, special

limits may apply to the amount of traditional IRA

contributions that you may deduct.

G—Elective deferrals and employer contributions (including

nonelective deferrals) to a section 457(b) deferred

compensation plan

H—Elective deferrals to a section 501(c)(18)(D) tax-exempt

organization plan. See “Adjusted Gross Income” in the Form

1040 instructions for how to deduct.

J—Nontaxable sick pay (information only, not included in

boxes 1, 3, or 5)

K—20% excise tax on excess golden parachute payments.

See “Total Tax” in the Form 1040 instructions.

L—Substantiated employee business expense

reimbursements (nontaxable)

M—Uncollected social security or RRTA tax on taxable cost

of group-term life insurance over $50,000 (former employees

only). See “Total Tax” in the Form 1040 instructions.

N—Uncollected Medicare tax on taxable cost of group-term

life insurance over $50,000 (former employees only). See

“Total Tax” in the Form 1040 instructions.

P—Excludable moving expense reimbursements paid

directly to employee (not included in boxes 1, 3, or 5)

Note. Keep Copy C of Form W-2 for at least 3 years after

the due date for filing your income tax return. However, to

help protect your social security benefits, keep Copy C

until you begin receiving social security benefits, just in case

there is a question about your work record and/or earnings

in a particular year. Compare the Social Security wages and

the Medicare wages to the information shown on your

annual (for workers over 25) Social Security Statement.

Instructions for Employee (continued from back of

Copy C)

R—Employer contributions to your Archer MSA. Report on

Form 8853, Archer MSAs and Long-Term Care Insurance

Contracts.

S—Employee salary reduction contributions under a section

408(p) SIMPLE (not included in box 1)

T—Adoption benefits (not included in box 1). You must

complete Form 8839, Qualified Adoption Expenses, to

compute any taxable and nontaxable amounts.

V—Income from exercise of nonstatutory stock option(s)

(included in boxes 1, 3 (up to social security wage base),

and 5)

W—Employer contributions to your Health Savings Account.

Report on Form 8889, Health Savings Accounts (HSAs).

Q—Nontaxable combat pay. See the instructions for Form

1040 or Form 1040A for details on reporting this amount.

Y—Deferrals under a section 409A nonqualified deferred

compensation plan.

Z—Income under section 409A on a nonqualified deferred

compensation plan. This amount is also included in box 1. It

is subject to an additional 20% tax plus interest. See “Total

Tax” in the Form 1040 instructions.

AA—Designated Roth contributions under a section 401(k)

plan.

BB—Designated Roth contributions under a section 403(b)

plan.

F—Elective deferrals under a section 408(k)(6) salary

reduction SEP
1

Retirement

plan

Third-party 

sick pay

Statutory

employee

6

2

Employer’s name, address, and ZIP code

7 Allocated tips

Advance EIC payment

8

9 10

Wages, tips, other compensation Federal income tax withheld

Social security wages Social security tax withheld

11 12a

Employer’s state ID number

3 4

Employer identification number (EIN)

Medicare wages and tips

Social security tips

13

5

Control number

Employee’s first name and initial Nonqualified plans

Medicare tax withheld

15

14

16 17

Other

18

Employee’s address and ZIP code

State State wages, tips, etc. State income tax Locality name

Copy D—For Employer.

Department of the Treasury—Internal Revenue Service

Form

Dependent care benefits

See instructions for box 12

b

c

d

e

f

W-2 Wage and TaxStatement 20 90

Last name C

o

d

e

12b

C

o

d

e

12c

C

o

d

e

Local wages, tips, etc. 19 Local income tax 20

12d

C

o

d

e

For Privacy Act and Paperwork Reduction

Act Notice, see the back of Copy D.

Suff.

a Employee’s social security number

Void

OMB No. 1545-0008
Employers, Please Note—

Specific information needed to complete Form W-2 is

available in a separate booklet titled 2009 Instructions for

Forms W-2 and W-3. You can order those instructions and

additional forms by calling 1-800-TAX-FORM

(1-800-829-3676). You can also get forms and instructions

from the IRS website at www.irs.gov.

Due dates. Furnish Copies B, C, and 2 to the employee

generally by February 1, 2010.

File Copy A with the SSA by March 1, 2010. Send all

Copies A with Form W-3, Transmittal of Wage and Tax

Statements. If you file electronically, the due date is March

31, 2010.

Caution. You cannot file Forms W-2/W-2c and W-3/W-3c

that you print from the IRS website with SSA because they

process paper forms by machine. Instead, you can use the

SSA website at www.ssa.gov/employer/bsohbnew.htm to

create and file electronic fill-in versions of Forms W-2/W-2c

and W-3/W-3c. If you use SSA’s online application to create

W-2 or W-2c, the W-3 or W-3c will be automatically created.

Privacy Act and Paperwork Reduction Act Notice. We ask

for the information on Forms W-2 and W-3 to carry out the

Internal Revenue laws of the United States. We need it to

figure and collect the right amount of tax. Section 6051 and

its regulations require you to furnish wage and tax

statements to employees and to the Social Security

Administration. Section 6109 requires you to provide your

employer identification number (EIN). If you fail to provide

this information in a timely manner, you may be subject to

penalties.

You are not required to provide the information requested

on a form that is subject to the Paperwork Reduction Act

unless the form displays a valid OMB control number. Books

or records relating to a form or its instructions must be

retained as long as their contents may become material in

the administration of any Internal Revenue law.

Generally, tax returns and return information are

confidential, as required by section 6103. However,

section 6103 allows or requires the Internal Revenue

Service to disclose or give the information shown on your

return to others as described in the Code. For example, we

may disclose your tax information to the Department of

Justice for civil and/or criminal litigation, and to cities,

states, the District of Columbia, and U.S. commonwealths

and possessions for use in administering their tax laws. We

may also disclose this information to other countries under a

tax treaty, to federal and state agencies to enforce federal

nontax criminal laws, or to federal law enforcement and

intelligence agencies to combat terrorism.

The time needed to complete and file these forms will vary

depending on individual circumstances. The estimated

average times are: Form W-2—30 minutes, and Form

W-3—28 minutes. If you have comments concerning the

accuracy of these time estimates or suggestions for making

these forms simpler, we would be happy to hear from you.

You can write to the Internal Revenue Service, Tax Products

Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111

Constitution Ave. NW, IR-6526, Washington, DC 20224. Do

not send Forms W-2 and W-3 to this address. Instead, see

Where to file paper forms in the Instructions for Forms W-2

and W-3.
Department of the Treasury 2009 Internal Revenue Service

Instructions for Forms W-2

and W-3

Wage and Tax Statement and

Transmittal of Wage and Tax Statements

Section references are to the Internal Revenue Code unless Electronic payee statements. If your employees give their

otherwise noted. consent, you may be able to furnish Copies B, C, and 2 of

Contents Page Forms W-2 to your employees electronically. See Pub. 15-A,

What’s New Employer’s Supplemental Tax Guide, for additional ..................................1

information. Reminders ...................................1

Need Help? ..................................1 Extended due date for electronic filers. If you file your

How To Get Forms and Publications ...............2 2009 Forms W-2 with the Social Security Administration

Common Errors on Forms W-2 ...................2 (SSA) electronically, the due date is extended to

General Instructions for Forms W-2 and W-3 ........2 March 31, 2010. For information on how to file electronically,

Special Reporting Situations for Form W-2 ..........4 see Online filing of Forms W-2 and W-3 below and

Penalties Electronic reporting on page 3. ....................................8

Specific Instructions for Form W-2 ................9 Form 944. Use the “944” checkbox in box b of Form W-3 if

Specific Instructions for Form W-3 . . . . . . . . . . . . . . . 14 you filed Form 944, Employer’s ANNUAL Federal Tax

Reconciling Forms W-2, W-3, 941, 943, 944, Return. Also use the “944” checkbox if you filed Forma

CT-1, and Schedule H (Form 1040) . . . . . . . . . . . . . 15 944(SP), the Spanish version of Form 944.

Form W-2 Reference Guide for Box 12 Codes . . . . . . . 16 Nonqualified deferred compensation plans. Section Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 409A, added by the American Jobs Creation Act of 2004,

provides that all amounts deferred under a nonqualified

What’s New deferred compensation (NQDC) plan for all taxable years

are includible in gross income unless certain requirements

are satisfied. See Nonqualified deferred compensation plans Military differential pay. Payments made after 2008 to on page 7. former employees while they are on active duty for more

than 30 days in the Armed Forces or other uniformed Online filing of Forms W-2 and W-3. You may file Forms

services are now treated as wages. Report these payments W-2 and W-3 electronically by visiting SSA’s website at

in box 1 of Form W-2. www.socialsecurity.gov/employer, and selecting “Business

Services Online (BSO).” Once registered, you can upload Reporting for nonqualified deferred compensation electronic wage files or use SSA’s “Create Forms W-2 plans. You are not required to complete box 12 with code Online” to send electronic information to Social Security. Y (deferrals under nonqualified plans subject to section W-2 Online allows you to create “fill-in” versions of Forms 409A). W-2 for filing with the SSA and to print out copies of the

forms for filing with state or local governments, distribution

Reminders to your employees, and for your records. Form W-3 will be

calculated for you based on your Forms W-2. For more Distributions from governmental section 457(b) plans of information, see Online wage reporting on page 2. state and local agencies. Generally, report distributions

from section 457(b) plans of state and local agencies on Substitute forms. If you are not using the official IRS form

Form 1099-R, Distributions From Pensions, Annuities, to furnish Form W-2 to employees or to file with the SSA,

Retirement or Profit-Sharing Plans, IRAs, Insurance you may use an acceptable substitute form that complies

Contracts, etc. See Notice 2003-20 for details. You can find with the rules in Pub. 1141, General Rules and

Notice 2003-20 on page 894 of Internal Revenue Bulletin Specifications for Substitute Forms W-2 and W-3.

2003-19 at www.irs.gov/pub/irs-irbs/irb03-19.pdf. Pub. 1141, which is revised annually, is a revenue

procedure that explains the requirements for format and Earned income credit (EIC) notice. You must notify content of substitute Forms W-2 and W-3. Your substitute

employees who have no income tax withheld that they may forms must comply with the requirements in Pub. 1141. be able to claim an income tax refund because of the EIC.

You can do this by using the official IRS Form W-2 with the Need Help? EIC notice on the back of Copy B or a substitute Form W-2

with the same statement. You must give your employee Information reporting customer service site. The IRS

Notice 797, Possible Federal Tax Refund Due to the Earned operates a centralized customer service site to answer

Income Credit (EIC), or your own statement that contains questions about reporting on Forms W-2, W-3, 1099, and

the same wording if (a) you use a substitute Form W-2 that other information returns. If you have questions about

does not contain the EIC notice, (b) you are not required to reporting on these forms, call 1-866-455-7438 (toll free). If

furnish Form W-2, or (c) you do not furnish a timely Form you have questions about electronic filing of Forms W-2,

W-2 to your employee. For more information, see section 10 contact the SSA at 1-800-772-6270 or visit the SSA website

in Pub. 15 (Circular E). at www.socialsecurity.gov/employer.

Cat. No. 25979S
Help for people with disabilities. Telephone help is fee) or call 1-877-233-6767 toll free to purchase the DVD for

available using TTY/TDD equipment. If you have questions $30 (plus a $6 handling fee).

about reporting on information returns (Forms 1096, 1098, By phone and in person. You can order forms and 1099, 3921, 3922, 5498, W-2, W-2G, and W-3) you may call publications by calling 1-800-TAX-FORM (1-800-829-3676). 304-267-3367. For any other tax information, call You can also get most forms and publications at your local 1-800-829-4059. IRS office.

Online wage reporting. Using a personal computer, you

can access SSA’s Business Services Online (BSO) to Common Errors on Forms W-2

electronically report wage data. To obtain information Forms W-2 provide information to your employees, the SSA, regarding filing wage data electronically with SSA or to the IRS, and state and local governments. Avoid making the access BSO, visit the SSA’s W- 2 Filing Instructions and following errors, which cause processing delays. Information website at www.socialsecurity.gov/employer.

Corrections to previously filed wage data can be made by Do not: accessing BSO. Call the SSA at 1-888-772-2970 if you • Omit the decimal point and cents from entries. experience problems using any of the services within BSO. • Use ink that is too light to make entries. Use only black The website includes information on electronic filing, ink.

some IRS and SSA publications, and general topics of • Make entries that are too small or too large. Use 12-point interest about annual wage reporting. You can also use Courier font, if possible. BSO to ask questions about wage reporting. • Add dollar signs to the money-amount boxes. They have

Employers can also electronically file EFW2 (formerly been removed from Copy A and are not required.

MMREF-1) wage reports. See Electronic reporting on • Inappropriately check the “Retirement plan” checkbox in

page 3. box 13. See Retirement plan on page 13.

• Misformat the employee’s name in box e. Enter the Employment tax information. Detailed employment tax employee’s first name and middle initial in the first box, his information is given in: or her surname in the second box, and his or her suffix • Pub. 15 (Circular E), Employer’s Tax Guide, (optional) in the third box. • Pub. 15-A, Employer’s Supplemental Tax Guide,

• Pub. 15-B, Employer’s Tax Guide to Fringe Benefits, and

• Pub. 51 (Circular A), Agricultural Employer’s Tax Guide. General Instructions for Forms

You can also call the IRS with your employment tax W-2 and W-3 questions at 1-800-829-4933 or visit the IRS website at

www.irs.gov and type “Employment Taxes” in the Keyword/ Who must file Form W-2. Employers must file Form W-2

Search Terms box. for wages paid to each employee from whom:

• Income, social security, or Medicare tax was withheld or

How To Get Forms and Publications • Income tax would have been withheld if the employee had

claimed no more than one withholding allowance or had not Internet. You can access the IRS website 24 hours a day, claimed exemption from withholding on Form W-4, 7 days a week at www.irs.gov to: Employee’s Withholding Allowance Certificate. • Download forms, instructions, and publications. Also, every employer engaged in a trade or business who • Order IRS products online. pays remuneration for services performed by an employee, • See answers to frequently asked tax questions. including noncash payments, must file a Form W-2 for each • Search publications online by topic or keyword. employee even if the employee is related to the employer. • Send us comments or request help by email.

• Sign up to receive local and national tax news by email. If you are required to file 250 or more Forms W-2, see

Electronic reporting on page 3. Do not file Copy A of Forms W-2, W-3, W-2c, and

W-3c downloaded from the IRS website with the Who must file Form W-3. Anyone required to file Form

W-2 must file Form W-3 to transmit Copy A of Forms W-2. CAUTION SSA. They are provided for informational purposes

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Make a copy of Form W-3; keep it and Copy D (For only. A penalty of $50 per information return may be Employer) of Forms W-2 with your records for 4 years. Be imposed for filing such forms that cannot be scanned. sure to use Form W-3 for the correct year. If you are filing

DVD for Tax Products. You can order Publication Forms W-2 electronically, see Electronic reporting on

1796, IRS Tax Products DVD, and obtain: page 3.

Household employers. Even employers with only one • Current-year forms, instructions, and publications. household employee must file Form W-3 if filing a paper • Prior-year forms, instructions, and publications. Form W-2. On Form W-3 check the “Hshld. emp.” checkbox • Tax Map: an electronic research tool and finding aid. in box b. For more information, see Schedule H (Form • Tax law frequently asked questions. 1040), Household Employment Taxes, and its separate • Tax Topics from the IRS telephone response system. instructions. You must have an EIN. See Box b—Employer • Internal Revenue Code—Title 26 identification number (EIN) on page 9. • Fill-in, print, and save features for most tax forms. Who may sign Form W-3. A transmitter or sender • Internal Revenue Bulletins. (including a service bureau, reporting agent, paying agent, • Toll-free and email technical support. or disbursing agent) may sign Form W-3 (or use its PIN on • The DVD is released twice during the year. electronic filings) for the employer or payer only if the –The first release will ship the beginning of January sender: 2009. • Is authorized to sign by an agency agreement (either oral,

–The final release will ship the beginning of March 2009. written, or implied) that is valid under state law and

• Writes “For (name of payer)” next to the signature (paper

Form W-3 only).

Purchase the DVD from National Technical Information If an authorized sender signs for the payer, the payer is

Service (NTIS) at www.irs.gov/cdorders for $30 (no handling still responsible for filing, when due, a correct and complete

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Form W-3 and related Forms W-2, and is subject to any You are encouraged to file electronically even if

penalties that result from not complying with these you are filing fewer than 250 Forms W-2. Small

requirements. Be sure that the payer’s name and employer submitters may be able to file Forms W-2 online. For

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identification number (EIN) on Forms W-2 and W-3 are the more information, visit SSA’s Business Services Online

same as those used on the Form 941, Employer’s website at www.socialsecurity.gov/bso/bsowelcome.htm and

QUARTERLY Federal Tax Return; Form 943, Employer’s select “Tutorial.”

Annual Federal Tax Return for Agricultural Employees; You may request a waiver on Form 8508, Request Form 944, Employer’s ANNUAL Federal Tax Return; Form for Waiver From Filing Information Returns Electronically. CT-1, Employer’s Annual Railroad Retirement Tax Return; Submit Form 8508 to the IRS at least 45 days before the or Schedule H (Form 1040) filed by or for the payer. due date of Form W-2. See Form 8508 for filing information.

When to file. File Copy A of Form W-2 with the entire If you file electronically, do not file the same returns page of Form W-3 by March 1, 2010. However, if you file on paper. electronically, the due date is March 31, 2010. You may owe CAUTION

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a penalty for each Form W-2 that you file late. See Penalties

on page 8. If you terminate your business, see Terminating Electronic reporting specifications for Form W-2 are in the

a business on page 7. SSA’s EFW2 (formerly MMREF-1), a publication that can be

downloaded by accessing SSA’s W-2 Filing Instructions and Extension to file. You may request an automatic Information website at www.socialsecurity.gov/employer and extension of time to file Form W-2 with the SSA by sending selecting “E-Filing Format (formerly MMREF).” You can also Form 8809, Application for Extension of Time To File get electronic specifications by calling SSA’s Employer Information Returns, to the address shown on Form 8809. Reporting Branch at 1-800-772-6270. You must request the extension before the due date of Reporting instructions for electronic filing differ in a few Forms W-2. You will have an additional 30 days to file. See situations from paper reporting instructions. For example, Form 8809 for details. electronic filers may enter more than four items in box 12 in

Even if you request an extension to file Form W-2, one individual’s wage report, but paper filers are limited to

you must still furnish Form W-2 to your employees four entries in box 12 on Copy A of each Form W-2. See TIP

CAUTION by February 1, 2010. But see Extension to furnish On Copy A (Form W-2), do not enter more than four !

Forms W-2 to employees items in box 12 on page 11. below.

Furnishing Copies B, C, and 2 to employees. Furnish Where to file paper forms. File the entire Copy A page of Copies B, C, and 2 of Form W-2 to your employees, Form W-2 with the entire page of Form W-3 at the following generally, by February 1, 2010. You will meet the “furnish” address: requirement if the form is properly addressed and mailed on

or before the due date.

Social Security Administration If employment ends before December 31, 2009, you may Data Operations Center furnish copies to the employee at any time after employment Wilkes-Barre, PA 18769-0001 ends, but no later than February 1, 2010. If an employee

asks for Form W-2, give him or her the completed copies If you use “Certified Mail” to file, change the ZIP within 30 days of the request or within 30 days of the final code to “18769-0002.” If you use an IRS-approved wage payment, whichever is later. However, if you terminate private delivery service, add “ATTN: W-2 Process,

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your business, see Terminating a business on page 7. 1150 E. Mountain Dr.” to the address and change the ZIP You may furnish Forms W-2 to employees on IRS official code to “18702-7997.” See Pub. 15 (Circular E) for a list of forms or on acceptable substitute forms. See Substitute IRS-approved private delivery services. forms on page 1. Be sure the Forms W-2 you provide to

Do not send cash, checks, money orders, etc., with employees are clear and legible and comply with the

the Forms W-2 and W-3 that you submit to the SSA. requirements in Pub. 1141.

CAUTION Employment tax forms (for example, Form 941 or Extension to furnish Forms W-2 to employees. You

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Form 943), remittances, and Forms 1099 must be sent to may request an extension of time to furnish Forms W-2 to the IRS. employees by sending a letter to:

Send Copy 1 of Form W-2 to your state, city, or local tax

department. For more information concerning Copy 1 IRS–Enterprise Computing Center–Martinsburg

(including how to complete boxes 15 through 20), contact Information Reporting Program

your state, city, or local tax department. Attn: Extension of Time Coordinator

240 Murall Drive Shipping and mailing. If you file more than one type of Kearneysville, WV 25430 employment tax form, group Forms W-2 of the same type

with a separate Form W-3 for each type, and send them in Mail your letter on or before the due date for furnishing

separate groups. See the specific instructions for box b of Forms W-2 to employees. It must include:

Form W-3 on page 14. • Your name and address,

• Your employer identification number (EIN), Prepare and file Forms W-2 either alphabetically by • A statement that you are requesting an extension to employees’ last names or numerically by employees’ social furnish “Forms W-2” to employees, security numbers. Do not staple or tape Form W-3 to the • Reason for delay, and related forms W-2 or Forms W-2 to each other. These forms • Your signature or that of your authorized agent. are machine read. Staple holes or tears interfere with Undeliverable Forms W-2. Keep for 4 years any machine reading. Also, do not fold Forms W-2 and W-3. employee copies of Forms W-2 that you tried to but could Send the forms to the SSA in a flat mailing. not deliver. However, if the undelivered W-2 can be

Electronic reporting. If you are required to file 250 or produced electronically through April 15th of the fourth year

more Forms W-2, you must file them electronically unless after the year of issue, you do not need to keep

the IRS granted you a waiver. You may be charged a undeliverable employee copies. Do not send undeliverable

penalty if you fail to file electronically when required. Forms W-2 to SSA.

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Taxpayer identification numbers (TINs). Employers use employer, the employee should claim a refund on Form 843,

an employer identification number (EIN) (00-0000000). Claim for Refund and Request for Abatement.

Employees use a social security number (SSN) Archer MSA. An employer’s contribution to an employee’s (000-00-0000). When you list a number, separate the nine Archer MSA is not subject to federal income tax withholding, digits properly to show the kind of number. Do not accept an or social security, Medicare, or railroad retirement taxes if it individual taxpayer identification number (ITIN) for is reasonable to believe at the time of the payment that the employment purposes. For more information, see section 4 contribution will be excludable from the employee’s income. of Pub. 15 (Circular E). However, if it is not reasonable to believe at the time of

 The IRS uses SSNs to check the payments that you payment that the contribution will be excludable from the

report against the amounts shown on the employees’ tax employee’s income, employer contributions are subject to

returns. The SSA uses SSNs to record employees’ earnings income tax withholding and social security and Medicare

for future social security and Medicare benefits. When you taxes (or railroad retirement taxes, if applicable) and must

prepare Form W-2, be sure to show the correct SSN for be reported in boxes 1, 3, and 5.

each employee. For information on verification of SSNs, see You must report all employer contributions to an Archer section 4 of Pub. 15 (Circular E) or go to www. MSA in box 12 of Form W-2 with code R. Employer socialsecurity.gov/employer/ssnv.htm. contributions to an Archer MSA that are not excludable from

the income of the employee also must be reported in box 1. Special Reporting Situations for An employee’s contributions to an Archer MSA are Form W-2 includible in income as wages and are subject to federal

income tax withholding and social security and Medicare Adoption benefits. Amounts paid or expenses incurred by taxes (or railroad retirement taxes, if applicable). Employee an employer for qualified adoption expenses under an contributions are deductible, within limits, on the employee’s adoption assistance program are not subject to federal Form 1040. income tax withholding and are not reportable in box 1.

However, these amounts (including adoption benefits paid See Notice 96-53, 1996-2 C.B. 219 and Pub. 969, Health

from a section 125 (cafeteria) plan, but not including Savings Accounts and Other Tax-Favored Health Plans, for

adoption benefits forfeited from a cafeteria plan) are subject more information. You can find Notice 96-53 on page 5 of

to social security, Medicare, and railroad retirement taxes Internal Revenue Bulletin 1996-51 at www.irs.gov/pub/

and must be reported in boxes 3 and 5. Also, the total irs-irbs/irb96-51.pdf.

amount must be reported in box 12 with code T. Clergy and religious workers. For certain members of

See Notice 97-9, 1997-1 C.B. 365, for more information the clergy and religious workers who are not subject to

on adoption benefits. You can find Notice 97-9 on page 35 social security and Medicare taxes as employees, boxes 3

of Internal Revenue Bulletin 1997-2 at and 5 of Form W-2 should be left blank. You may include a

www.irs.gov/pub/irs-irbs/irb97-02.pdf. Advise your minister’s parsonage and/or utilities allowance in box 14. For

employees to see the Instructions for Form 8839, Qualified information on the rules that apply to ministers and certain

Adoption Expenses. other religious workers, see Pub. 517, Social Security and

Agent reporting. Generally, an agent who has an Other Information for Members of the Clergy and Religious

Workers, and Section 4–Religious Exemptions in approved Form 2678, Employer/Payer Appointment of Pub. 15-A. Agent, should enter the agent’s name as the employer in

box c of Form W-2, and file only one Form W-2 for each Corrections. Use the current version of Form W-2c,

employee. However, if the agent (a) is acting as an agent for Corrected Wage and Tax Statement, to correct errors (such

two or more employers or is an employer and is acting as an as incorrect name, SSN, or amount) on a previously filed

agent for another employer, and (b) pays social security Form W-2. To file your corrections electronically, see Online

wages for more than one employer in excess of the wage wage reporting on page 2.

base to an individual, the agent must file separate Forms If the SSA issues your employee a replacement card W-2 for the affected employee reflecting the wages paid by after a name change, or a new card with a different social each employer. On each Form W-2, the agent should enter security number after a change in alien work status, file a the following in box c of Form W-2: Form W-2c to correct the name/SSN reported on the most (Name of agent) recently filed Form W-2. It is not necessary to correct the Agent for (name of employer) prior years if the previous name and number were used for Address of agent the years prior to the most recently filed Form W-2.

File Form W-3c, Transmittal of Corrected Wage and Tax Each Form W-2 should reflect the EIN of the agent in box Statements, whenever you file a Form W-2c with the SSA, b. An agent files one Form W-3 for all of the Forms W-2 and even if you are only filing a Form W-2c to correct an enters its own information in boxes e, f, and g of Form W-3 employee’s name or SSN. However, see Incorrect address

as it appears on the agent’s related employment tax returns on employee’s Form W-2 on page 5 for information on (for example, Form 941). Enter the client-employer’s EIN in correcting an employee’s address. See the Instructions for box h of Form W-3 if the Forms W-2 relate to only one Forms W-2c and W-3c if an error was made on a previously employer (other than the agent); if not, leave box h blank. filed Form W-3.

See Rev. Proc. 70-6, 1970-1 C.B. 420, for procedures to be If you discover an error on Form W-2 after you issue it to followed in applying to be an agent. your employee but before you send it to the SSA, check the

Generally, an agent is not responsible for refunding “Void” box at the top of the incorrect Form W-2 on Copy A.

excess social security or railroad retirement (RRTA) Prepare a new Form W-2 with the correct information, and

tax on employees. If an employee worked for more send Copy A to the SSA. Write “CORRECTED” on the

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than one employer during 2009 and had more than employee’s new copies (B, C, and 2), and furnish them to

$6,621.60 in social security and Tier I RRTA tax withheld, he the employee. If the “Void” Form W-2 is on a page with a

or she should claim the excess on the appropriate line of correct Form W-2, send the entire page to the SSA. The

Form 1040 or Form 1040A. If an employee had more than “Void” form will not be processed. Do not write

$3,088.80 in Tier II RRTA tax withheld from more than one “CORRECTED” on Copy A of Form W-2.

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After December 31, 2008, if you are making a correction • Box f – Employee A’s address

for a previously filed Form 941, Form 943, or Form 944, use • Box 1 – 10000.00 (does not include the $3,000 accrued

Form 941-X, Adjusted Employer’s QUARTERLY Federal wages and vacation pay)

Tax Return or Claim for Refund, Form 943-X, Adjusted • Box 2 – 1500.00

Employer’s ANNUAL Federal Tax Return for Agricultural • Box 3 – 13000.00 (includes the $3,000 accrued wages

Employees or Claim for Refund, or Form 944-X, Adjusted and vacation pay)

Employer’s ANNUAL Federal Tax Return or Claim for • Box 4 – 806.00 (6.2% of the amount in box 3)

Refund, for the return period in which you found the error. • Box 5 – 13000.00 (includes the $3,000 accrued wages

See the Instructions for Form 941-X for more details. Issue and vacation pay)

the employee a Form W-2c if the error discovered was for • Box 6 – 188.50 (1.45% of the amount in box 5)

the prior year. If you are correcting social security or Employer X also must complete Form 1099-MISC as Medicare wages or tips, also file the entire Copy A page of follows: Form W-2c and Form W-3c with the SSA to correct the CAUTION

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social security records and any other items on the original • Boxes for: Recipient’s name, address, and TIN—The Form W-2 (or previously filed Form W-2c) that were in error. estate’s name, address, and TIN Incorrect address on employee’s Form W-2. If you • Box 3: 3000.00 (Even though amounts were withheld for filed a Form W-2 with the SSA showing an incorrect address social security and Medicare taxes, the gross amount is for the employee but all other information on the Form W-2 reported here.) is correct, do not file Form W-2c with the SSA merely to If Employer X made the payment after the year of death, correct the address. However, if the address was incorrect the $3,000 would not be subject to social security and on the Form W-2 furnished to the employee, you must do Medicare taxes and would not be shown on Form W-2. one of the following. However, the employer would still file Form 1099-MISC. • Issue a new, corrected Form W-2 to the employee,

including the new address. Indicate “REISSUED Designated Roth contributions. Under section 402A, a

STATEMENT” on the new copies. Do not send copy A to the participant in a section 401(k) plan or under a 403(b) salary

SSA. reduction agreement that includes a qualified Roth

• Issue a Form W-2c to the employee showing the correct contribution program may elect to make designated Roth

address in box i and all other correct information. Do not contributions to the plan or program in lieu of elective

send copy A to the SSA. deferrals. Designated Roth contributions are subject to

• Reissue a Form W-2 with the incorrect address to the federal income tax withholding and social security and

employee in an envelope showing the correct address or Medicare taxes (and railroad retirement taxes, if applicable)

otherwise deliver it to the employee. and must be reported in boxes 1, 3, and 5.

Deceased employee’s wages. Section 402A requires separate reporting of the yearly If an employee dies during

the year, you must report the accrued wages, vacation pay, designated Roth contributions. Designated Roth

and other compensation paid after the date of death. Follow contributions to 401(k) plans will be reported using code AA

in box 12; designated Roth contributions under 403(b) salary the instructions below even if you reissued the deceased

employee’s uncashed paycheck in the name of his or her reduction agreements will be reported using code BB in

estate or beneficiary. box 12. For reporting instructions, see Code AA and Code

BB on page 13. If you made the payment in the same year the employee Educational assistance programs. A $5,250 exclusion died, you must withhold social security and Medicare taxes for employer-provided educational assistance applies to on the payment and report the payment on the employee’s benefits provided to your employees under an educational Form W-2 only as social security and Medicare wages to assistance program. However, educational assistance that ensure proper social security and Medicare credit is exceeds $5,250 may be excludable from an employee’s received. wages if it qualifies as a working condition benefit. See Pub. On the employee’s Form W-2, show the payment as 970, Tax Benefits for Education, and section 2 of Pub. 15-B social security wages (box 3) and Medicare wages and tips for more information. Also see Box 1—Wages, tips, other (box 5) and the social security and Medicare taxes withheld compensation on page 9. in boxes 4 and 6. Do not show the payment in box 1. Election workers. Report on Form W-2 payments of $600 If you made the payment after the year of death, do not or more to election workers for services performed in state, report it on Form W-2, and do not withhold social security county, and municipal elections. File Form W-2 for and Medicare taxes. payments of less than $600 paid to election workers if social

Whether the payment is made in the year of death or security and Medicare taxes were withheld under a section

after the year of death, you also must report it in box 3 of 218 (Social Security Act) agreement. Do not report election

Form 1099-MISC, Miscellaneous Income, for the payment to worker payments on Form 1099-MISC.

the estate or beneficiary. Use the name and taxpayer If the election worker is employed in another capacity

identification number (TIN) of the payment recipient on Form with the same government entity, see Rev. Rul. 2000-06 on

1099-MISC. page 512 of Internal Revenue Bulletin 2000-06 at

Example. Before Employee A’s death on June 15, 2009, www.irs.gov/pub/irs-irbs/irb00-06.pdf.

A was employed by Employer X and received $10,000 in Employee business expense reimbursements.

wages on which federal income tax of $1,500 was withheld. Reimbursements to employees for business expenses must

When A died, X owed A $2,000 in wages and $1,000 in be reported as follows:

accrued vacation pay. The total of $3,000 (less the social • Generally, payments made under an accountable plan are

security and Medicare taxes withheld) was paid to A’s estate excluded from the employee’s gross income and are not

on July 20, 2009. Because X made the payment during the reported on Form W-2. However, if you pay a per diem or

year of death, X must withhold social security and Medicare mileage allowance and the amount paid for substantiated

taxes on the $3,000 payment and must complete Form W-2 miles or days traveled exceeds the amount treated as

as follows: substantiated under IRS rules, you must report as wages on

• Box a – Employee A’s SSN Form W-2 the amount in excess of the amount treated as

• Box e – Employee A’s name substantiated. The excess amount is subject to income tax

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withholding and social security and Medicare taxes. Report year and full social security and Medicare taxes for part of

the amount treated as substantiated (that is, the nontaxable the year.

portion) in box 12 using code L. See Code L— Option one (which the SSA prefers) is to file a single Substantiated employee business expense reimbursements Form W-2 reflecting the employees’ wages for the entire on page 12. year, even if only part of the year’s wages was subject to • Payments made under a nonaccountable plan are both social security and Medicare taxes. The Form W-3 reported as wages on Form W-2 and are subject to federal must have the “941” box checked in box b. The wages in income tax withholding and social security and Medicare box 5 must be equal to or greater than the wages in box 3 taxes. on Form W-2.

For more information on accountable plans, Option two is to file two Forms W-2 and two Forms W-3. nonaccountable plans, amounts treated as substantiated File one Form W-2 for wages subject to Medicare tax only. under a per diem or mileage allowance, the standard Be sure to check the “Medicare govt. emp.” box in box b of mileage rate, the per diem substantiation method, and the Form W-3. File the second Form W-2 for wages subject to high-low substantiation method, see Pub. 463, Travel, both social security and Medicare taxes with the “941” box Entertainment, Gift, and Car Expenses; Pub. 1542, Per checked in box b of Form W-3. The wages in box 5 on each Diem Rates; and section 5 of Pub. 15 (Circular E). Form W-2 must be equal to or greater than the wages in

Employee’s social security and Medicare taxes paid by box 3 on that same Form W-2.

employer. If you paid your employee’s share of social Group-term life insurance. If you paid for group-term life security and Medicare taxes rather than deducting them insurance over $50,000 for an employee or a former from the employee’s wages, you must include these employee, you must report the taxable cost of excess payments as wages subject to federal income tax coverage, determined by using the table in section 2 of Pub. withholding and social security, Medicare, and federal 15-B, in boxes 1, 3, and 5 of Form W-2. Also, show the unemployment (FUTA) taxes. The amount to include as amount in box 12 with code C. For employees, you must wages is determined by using the formula contained in the withhold social security and Medicare taxes, but not federal discussion of Employee’s Portion of Taxes Paid by income tax. Former employees must pay the employee part Employer in section 7 of Pub. 15-A. of social security and Medicare taxes on the taxable cost of

group-term life insurance over $50,000 on Form 1040. You This does not apply to household and agricultural are not required to collect those taxes. However, you must employers. If you pay a household or agricultural report the uncollected social security tax with code M and CAUTION employee’s social security and Medicare taxes, you

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the uncollected Medicare tax with code N in box 12 of must include these payments in the employee’s wages for Form W-2. income tax withholding purposes. However, the wage

increase due to the tax payments is not subject to social Health Savings Account (HSA). An employer’s

security, Medicare, or FUTA taxes. For information on contribution (including an employee’s contributions through

completing Forms W-2 and W-3 in this situation, see the a cafeteria plan) to an employee’s HSA is not subject to

federal income tax withholding, or social security, Medicare, Instructions for Schedule H (Form 1040), Household

Employers, and section 3 of Pub. 51 (Circular A). or railroad retirement taxes (or FUTA tax) if it is reasonable

to believe at the time of the payment that the contribution Fringe benefits. Include all taxable fringe benefits in box 1 will be excludable from the employee’s income. However, if of Form W-2 as wages, tips, and other compensation and, if it is not reasonable to believe at the time of payment that the applicable, in boxes 3 and 5 as social security and Medicare contribution will be excludable from the employee’s income, wages. Although not required, you may include the total employer contributions are subject to federal income tax value of fringe benefits in box 14 (or on a separate withholding and social security and Medicare taxes (or statement). However, if you provided your employee a railroad retirement taxes, if applicable) and FUTA tax and vehicle and included 100% of its annual lease value in the must be reported in boxes 1, 3, and 5 (and on Form 940, employee’s income, you must separately report this value to Employer’s Annual Federal Unemployment (FUTA) Tax the employee in box 14 (or on a separate statement). The Return). employee can then figure the value of any business use of

the vehicle and report it on Form 2106, Employee Business You must report all employer contributions to an HSA in

Expenses. Also see Pub. 15-B for more information. box 12 of Form W-2 with code W. Employer contributions to

an HSA that are not excludable from the income of the

If you used the commuting rule or the vehicle employee also must be reported in boxes 1, 3, and 5. cents-per-mile rule to value the personal use of the An employee’s contributions to an HSA (unless made CAUTION vehicle, you cannot include 100% of the value of the

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through a cafeteria plan) are includible in income as wages use of the vehicle in the employee’s income. See Pub. 15-B. and are subject to federal income tax withholding and social

Golden parachute payments. Include any golden security and Medicare taxes (or railroad retirement taxes, if

parachute payments in boxes 1, 3, and 5 of Form W-2. applicable). Employee contributions are deductible, within

Withhold federal income, social security, and Medicare limits, on the employee’s Form 1040. For more information

taxes as usual and report them in boxes 2, 4, and 6, about HSAs, see Notice 2004-2 and Notice 2004-50. You

respectively. Excess parachute payments are also subject to can find Notice 2004-2 on page 269 of Internal Revenue

a 20% excise tax. If the excess payments are considered Bulletin 2004-2 at www.irs.gov/pub/irs-irbs/irb04-02.pdf. You

wages, withhold the 20% excise tax and include it in box 2 can find Notice 2004-50 on page 196 of Internal Revenue

as income tax withheld. Also report the excise tax in box 12 Bulletin 2004-33 at www.irs.gov/pub/irs-irbs/irb04-33.pdf.

with code K. For definitions and additional information, see Also see Form 8889, Health Savings Accounts (HSAs), and

Regulations section 1.280G-1 and Rev. Proc. 2003-68. You Pub. 969.

can find Rev. Proc. 2003-68 on page 398 of Internal Lost Form W-2—reissued statement. If an employee Revenue Bulletin 2003-34 at www.irs.gov/pub/irs-irbs/ loses a Form W-2, write “REISSUED STATEMENT” on the irb03-34.pdf. new copy and furnish it to the employee. You do not have to

Government employers. Federal, state, and local add “REISSUED STATEMENT” on Forms W-2 provided to

agencies have two options for reporting their employees’ employees electronically. Do not send Copy A of the

wages that are subject only to Medicare tax for part of the reissued Form W-2 to the SSA. Employers are not

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prohibited (by the Internal Revenue Code) from charging a information will help the employee account for such

fee for the issuance of a duplicate Form W-2. repayments on his or her federal income tax return.

Moving expenses. Report moving expenses as follows: If the repayment was for a prior year, you must file Form • Qualified moving expenses that an employer paid to a W-2c with the SSA to correct only social security and

third party on behalf of the employee (for example, to a Medicare wages and taxes. Do not correct “Wages” in box 1 moving company) and services that an employer furnished on Form W-2c for the amount paid in error. For information

in kind to an employee are not reported on Form W-2. on reporting adjustments to Form 941, Form 943, or Form • Qualified moving expense reimbursements paid directly to 944, see section 13 of Pub. 15 (Circular E) or section 9 of

an employee by an employer are reported only in box 12 of Pub. 51 (Circular A).

Form W-2 with code P.

Tell your employee that the wages paid in error in a • Nonqualified moving expense reimbursements are prior year remain taxable to him or her for that year. reported in boxes 1, 3, and 5 of Form W-2. These amounts This is because the employee received and had use

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are subject to federal income tax withholding and social of those funds during that year. The employee is not entitled security and Medicare taxes (or railroad retirement taxes, if to file an amended return (Form 1040X) to recover the applicable). income tax on these wages. Instead, the employee is Nonqualified deferred compensation plans. Section entitled to a deduction (or a credit, in some cases) for the 409A, added by the American Jobs Creation Act of 2004, repaid wages on his or her Form 1040 for the year of provides that all amounts deferred under a nonqualified repayment. deferred compensation (NQDC) plan for all tax years are

currently includible in gross income unless certain Scholarship and fellowship grants. Give a Form W-2 to

requirements are met. If section 409A requires an amount to each recipient of a scholarship or fellowship grant only if you

be included in gross income, the section imposes a are reporting amounts includible in income under section

substantial additional tax. Section 409A, generally, is 117(c) (relating to payments for teaching, research, or other

effective with respect to amounts deferred in tax years services required as a condition for receiving the qualified

beginning after December 31, 2004, but deferrals made scholarship). Also see Pub. 15-A and Pub. 970. These

prior to that year may be subject to section 409A under payments are subject to federal income tax withholding.

some circumstances. However, their taxability for social security and Medicare

taxes depends on the nature of the employment and the It is not necessary to show amounts deferred during the status of the organization. See Students in section 15 of year under an NQDC plan subject to section 409A. For more Pub. 15 (Circular E). information, see Notice 2008-115 available at www.irs.gov/

irb/2008-52_IRB/index.html. If you report section 409A Sick pay. If you had employees who received sick pay in

deferrals, show the amount in Box 12 using code Y. 2009 from an insurance company or other third-party payer

and the third party notified you of the amount of sick pay Income included under section 409A from an NQDC plan involved, you may be required to report the information on will be reported in box 1, and in box 12 using code Z. This the employees’ Forms W-2. If the insurance company or income is also subject to an additional tax reported on Form other third-party payer did not notify you in a timely manner 1040. For more information, see section 5 of Pub. 15-A. For about the sick pay payments, it must prepare Forms W-2 more information on amounts includible in gross income, and W-3 for your employees showing the sick pay. For see Notice 2008-113, available at www.irs.gov/irb/ specific reporting instructions, see Sick Pay Reporting in 2008-51_IRB/ar12.html and Notice 2008-115, available at section 6 of Pub. 15-A. www.irs.gov/irb/2008-52_IRB/index.html. SIMPLE retirement account. An employee’s salary Railroad employers. Railroad employers must file Form reduction contributions to a SIMPLE (savings incentive W-2 to report their employees’ wages and income tax match plan for employees) retirement account are not withholding in boxes 1 and 2. Electronic reporting may be subject to federal income tax withholding but are subject to required; see Electronic reporting on page 3. If you have social security, Medicare, and railroad retirement taxes. Do both FICA employees and RRTA employees, you must file a not include an employee’s contribution in box 1 but do separate Form W-3 to transmit the Forms W-2 for each include it in boxes 3 and 5. An employee’s total contribution group of employees. also must be included in box 12 with code D or S.

If an employee is covered by social security and An employer’s matching or nonelective contribution to an Medicare, also complete boxes 3, 4, 5, 6, and 7 of Form

W-2 to show the social security and Medicare wages and employee’s SIMPLE is not subject to federal income tax

withholding or social security, Medicare, or railroad the amounts withheld for social security and Medicare taxes. retirement taxes and is not to be shown on Form W-2. On the Form W-3 used to transmit these Forms W-2, check

the “941” box in box b. See Notice 98-4, 1998-1 C.B. 269, for more information

on SIMPLE retirement accounts. You can find Notice 98-4 For employees covered by RRTA tax, you also must on page 25 of Internal Revenue Bulletin 1998-2 at www.irs. report the Tier I and Tier II taxes withheld in box 14 of Form

W-2. Label them “Tier I tax” and “Tier II tax.” Boxes 3, 4, 5, gov/pub/irs-irbs/irb98-02.pdf.

6, and 7 apply only to covered social security and Medicare Successor/predecessor employers. If you buy or sell a

employees and are not to be used to report railroad business during the year, see Rev. Proc. 2004-53 for

retirement wages and taxes. On the Form W-3 used to information on who must file Forms W-2 and employment

transmit these Forms W-2, check the “CT-1” box in box b. tax returns. You can find Rev. Proc. 2004-53 on page 320 of

Repayments. Internal Revenue Bulletin 2004-34 at www.irs.gov/pub/ If an employee repays you for wages irs-irbs/irb04-34.pdf. received in error, do not offset the repayments against

current year’s wages unless the repayments are for Terminating a business. If you terminate your business,

amounts received in error in the current year. Repayments you must provide Forms W-2 to your employees for the

made in the current year, but related to a prior year or years, calendar year of termination by the due date of your final

must be repaid in gross, not net, and require special tax Form 941. You must also file Forms W-2 with the SSA by

treatment by employees in some cases. You may advise the the last day of the month that follows the due date of your

employee of the total repayments made during the current final Form 941. If filing on paper, make sure you obtain

year and the amount (if any) related to prior years. This Forms W-2 and W-3 preprinted with the correct year. If filing

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electronically, make sure your software has been updated Exceptions to the penalty. The following are

for the current tax year. exceptions to the failure to file correct information returns

penalty: However, if any of your employees are immediately

employed by a successor employer, see Successor/ 1. The penalty will not apply to any failure that you can

predecessor employers on page 7. Also, see Rev. Proc. show was due to reasonable cause and not to willful

96-57, 1996-2 C.B. 389 for information on automatic neglect. In general, you must be able to show that your

extensions for furnishing Forms W-2 to employees and filing failure was due to an event beyond your control or due to

Forms W-2. You can find Rev. Proc. 96-57 on page 14 of significant mitigating factors. You must also be able to show

Internal Revenue Bulletin 1996-53 at www.irs.gov/pub/ that you acted in a responsible manner and took steps to

irs-irbs/irb96-53.pdf. avoid the failure.

2. An inconsequential error or omission is not considered Get Schedule D (Form 941), Report of Discrepancies a failure to include correct information. An inconsequential Caused by Acquisitions, Statutory Mergers, or error or omission does not prevent or hinder the SSA/IRS Consolidations, for information on reconciling wages from processing the Form W-2, from correlating the

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and taxes reported on Forms W-2 with amounts reported on information required to be shown on the form with the Forms 941, Form 943, or Form 944. information shown on the payee’s tax return, or from

Uniformed Services Employment and Reemployment otherwise putting the form to its intended use. Errors and

Rights Act of 1994 (USERRA) makeup amounts to a omissions that are never inconsequential are those relating

pension plan. If an employee returned to your employment to:

after military service and certain makeup amounts were • A TIN,

contributed to a pension plan for a prior year(s) under the • A payee’s surname, and

USERRA, report the prior year contributions separately in • Any money amounts.

box 12. See the TIP above Code D on page 12. You also 3. De minimis rule for corrections. Even though you

may report certain makeup amounts in box 14. See cannot show reasonable cause, the penalty for failure to file

Box 14—Other on page 14. correct Forms W-2 will not apply to a certain number of

returns if you: Instead of reporting in box 12 (or box 14), you may • Filed those Forms W-2 on or before the required filing choose to provide a separate statement to your employee date, showing USERRA makeup contributions. The statement • Either failed to include all of the information required on must identify the type of plan, the year(s) to which the the form or included incorrect information, and contributions relate, and the amount contributed for each • Filed corrections of these forms by August 2. year.

If you meet all of the conditions above, the penalty for Penalties filing incorrect information returns (including Form W-2) will

The following penalties generally apply to the person not apply to the greater of 10 information returns (including

Form W-2) or 1 required to file Form W-2. The penalties apply to paper filers /2 of 1% of the total number of information

as well as to electronic filers. returns (including Form W-2) that you are required to file for

the calendar year. Use of a reporting agent or other third-party payroll Lower maximum penalties for small businesses. For service provider does not relieve an employer of the purposes of the lower maximum penalties shown in CAUTION responsibility to ensure that Forms W-2 are furnished

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parentheses above, you are a small business if your to employees and are filed correctly and on time. average annual gross receipts for the 3 most recent tax Failure to file correct information returns by the due years (or for the period that you were in existence, if shorter) date. If you fail to file a correct Form W-2 by the due date ending before the calendar year in which the Forms W-2 and cannot show reasonable cause, you may be subject to were due are $5 million or less.

a penalty as provided under section 6721. The penalty Intentional disregard of filing requirements. If any applies if you: failure to file a correct Form W-2 is due to intentional • Fail to file timely, disregard of the filing or correct information requirements, • Fail to include all information required to be shown on the penalty is at least $100 per Form W-2 with no maximum Form W-2, penalty. • Include incorrect information on Form W-2, Failure to furnish correct payee statements. If you fail to • File on paper when you were required to file provide correct payee statements (Forms W-2) to your electronically, employees and you cannot show reasonable cause, you • Report an incorrect TIN, may be subject to a penalty. The penalty applies if you fail to • Fail to report a TIN, or provide the statement by February 1, if you fail to include all • Fail to file paper Forms W-2 that are machine readable. information required to be shown on the statement, or if you The amount of the penalty is based on when you file the include incorrect information on the statement. correct Form W-2. The penalty is: The penalty is $50 per statement, no matter when the • $15 per Form W-2 if you correctly file within 30 days;

maximum penalty $75,000 per year ($25,000 for small correct statement is furnished, with a maximum of $100,000

per year. The penalty is not reduced for furnishing a correct businesses, defined later). statement by August 2. • $30 per Form W-2 if you correctly file more than 30 days

after the due date but by August 2; maximum penalty Exception. An inconsequential error or omission is not

$150,000 per year ($50,000 for small businesses). considered a failure to include correct information. An

• $50 per Form W-2 if you file after August 2 or you do not inconsequential error or omission cannot reasonably be

file required Forms W-2; maximum penalty $250,000 per expected to prevent or hinder the payee from timely

year ($100,000 for small businesses). receiving correct information and reporting it on his or her

income tax return or from otherwise putting the statement to If you do not file corrections and you do not meet any its intended use. Errors and omissions that are never

of the exceptions to the penalty stated below, the inconsequential are those relating to: CAUTION penalty is $50 per information return.

! • A dollar amount,

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• A significant item in a payee’s address, and If the employee has applied for a card but the number is

• The appropriate form for the information provided, such not received in time for filing, enter “Applied For” in box a on

as whether the form is an acceptable substitute for the paper Forms W-2 filed with the SSA. (Enter zeros

official IRS form. (000-00-0000) if Form W-2 is filed electronically with the

SSA.) Intentional disregard of payee statement

requirements. If any failure to provide a correct payee Ask the employee to inform you of the number and name

statement (Form W-2) to an employee is due to intentional as they are shown on the social security card when it is

disregard of the requirements to furnish a correct payee received. Then correct your previous report by filing Form

statement, the penalty is at least $100 per Form W-2 with no W-2c showing the employee’s SSN. If the employee needs

maximum penalty. to change his or her name from that shown on the card, the

Civil damages for fraudulent filing of Forms W-2. employee should call the SSA at 1-800-772-1213. If you

willfully file a fraudulent Form W-2 for payments that you If you do not provide the correct employee name and TIN

claim you made to another person, that person may be able on Form W-2, you may owe a penalty unless you have

to sue you for damages. You may have to pay $5,000 or reasonable cause. For more information, see Publication

more. 1586, Reasonable Cause Regulations and Requirements for

Missing/Incorrect Name/TINs.

Box b—Employer identification number (EIN). Show the

Specific Instructions for Form W-2 employer identification number (EIN) assigned to you by the

IRS (00-0000000). This should be the same number that How to complete Form W-2. Form W-2 is a six-part form. you used on your federal employment tax returns (Form Ensure all copies are legible. Send Copy A to the SSA; 941, Form 943, Form 944, Form CT-1, or Schedule H (Form Copy 1 to your state, city, or local tax department; and 1040)). Do not use a prior owner’s EIN. If you do not have Copies B, C, and 2 to your employee. Keep Copy D, and a an EIN when filing Forms W-2, enter “Applied For” in box b; copy of Form W-3, with your records for 4 years. do not use your SSN. You can get an EIN by applying online

Type the entries on Form W-2 using black ink in 12-point at www.irs.gov, by calling the toll-free number

Courier font. Copy A is read by machine and must be typed 1-800-829-4933, or by filing Form SS-4, Application for

clearly with no corrections made to the entries or entries Employer Identification Number. Also see Agent reporting

exceeding the size of the boxes. Entries completed by hand, on page 4.

in script or italics fonts, or in colors other than black cannot Box c—Employer’s name, address, and ZIP code. This

be read by the machines. Make all dollar entries on Copy A entry should be the same as shown on your Form 941, Form without the dollar sign and comma but with the decimal point 943, Form 944, Form CT-1, or Schedule H (Form 1040). (00000.00). Show the cents portion of the money amounts. Also see Agent reporting on page 4. If a box does not apply, leave it blank. Box d—Control number. You may use this box to identify Send the whole Copy A page of Form W-2 with Form individual Forms W-2. You do not have to use this box.

W-3 to SSA even if one of the Forms W-2 on the page is Boxes e and f—Employee’s name and address. Enter blank or void. Do not staple Forms W-2 together or to Form the name as shown on your employee’s social security card W-3. File Forms W-2 either alphabetically by employees’ (first, middle initial, last). Generally, do not enter “Jr.,” “Sr.,” last names or numerically by employees’ SSNs. etc., in the “Suff.” box on Copy A unless the suffix appears

Calendar year basis. The entries on Form W-2 must be on the card. However, SSA still prefers that you do not enter

based on wages paid during the calendar year. Use Form the suffix on Copy A. If the name does not fit, you may show

W-2 for the correct tax year. For example, if the employee first name initial, middle initial, and last name (and ignore

worked from December 21, 2009, through January 3, 2010, the vertical line). If the name has changed, the employee

and the wages for that period were paid on January 5, 2010, must get a corrected card from any SSA office. Use the

include those wages on the 2010 Form W-2. name on the original card until you see the corrected card.

Multiple forms. Do not show titles or academic degrees, such as “Dr.,” “RN,” If necessary, you can issue more than one

Form W-2 to an employee. For example, you may need to or “Esq.,” at the beginning or end of the employee’s name.

report more than four coded items in box 12 or you may Include in the address the number, street, and apartment

want to report other compensation on a second form. If you or suite number (or P.O. box number if mail is not delivered

issue a second Form W-2, complete boxes b, c, d, e, and f to a street address). For a foreign address, give the

with the same information as on the first Form W-2. Show information in the following order: city, province or state, and

any items that were not included on the first Form W-2 in the country. Follow the country’s practice for entering the postal

appropriate boxes. Also, see the TIP below Box 12—Codes code. Do not abbreviate the country name.

on page 11. Third-party payers of sick pay filing third-party sick pay

Do not report the same federal tax data to the SSA on recap Forms W-2 and W-3 must enter “Third-Party Sick Pay

more than one Copy A. Recap” in place of the employee’s name in box e. Also, do

not enter the employee’s SSN in box a. See Sick Pay For each Form W-2 showing an amount in box 3 or Reporting in section 6 of Pub. 15-A. box 7, make certain that box 5 equals or exceeds the Box 1—Wages, tips, other compensation. Show the sum of boxes 3 and 7.

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total taxable wages, tips, and other compensation (before

Void. Check this box when an error is made on Form W-2 any payroll deductions) that you paid to your employee

and you are voiding it because you are going to complete a during the year. However, do not include elective deferrals

new Form W-2. Do not include any amounts shown on (such as employee contributions to a section 401(k) or

“Void” forms in the totals you enter on Form W-3. See 403(b) plan) except section 501(c)(18) contributions. Include

Corrections on page 4. the following:

Box a—Employee’s social security number. Enter the 1. Total wages, bonuses (including signing bonuses),

number shown on the employee’s social security card. If the prizes, and awards paid to employees during the year. See

employee does not have a card, he or she should apply for Calendar year basis above.

one by completing Form SS-5, Application for a Social 2. Total noncash payments, including certain fringe

Security Card. benefits. See Fringe benefits on page 6.

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3. Total tips reported by the employee to the employer security tax but not including social security tips and

(not allocated tips). allocated tips. See Box 7—Social security tips and

4. Certain employee business expense reimbursements Box 8—Allocated tips on page 11. Generally, noncash

(see Employee business expense reimbursements on payments are considered to be wages. Include employee

page 5). business expense reimbursements reported in box 1. If you

5. The cost of accident and health insurance premiums paid the employee’s share of social security and Medicare

for 2% or more shareholder-employees paid by an S taxes rather than deducting them from wages, see

corporation. Employee’s social security and Medicare taxes paid by

6. Taxable benefits from a section 125 (cafeteria) plan if employer on page 6. The total of boxes 3 and 7 cannot

the employee chooses cash. exceed $106,800 (2009 maximum social security wage

7. Employee contributions to an Archer MSA. base). Include in box 5 any amounts reported in box 3.

8. Employer contributions to an Archer MSA if includible Report in box 3 elective deferrals to certain qualified cash in the income of the employee. See Archer MSA on page 4. or deferred compensation arrangements and to retirement 9. Employer contributions for qualified long-term care plans described in box 12 (codes D, E, F, G, and S) even services to the extent that such coverage is provided though the deferrals are not includible in box 1. Also report through a flexible spending or similar arrangement. in box 3 designated Roth contributions made under a 10. Taxable cost of group-term life insurance in excess of section 401(k) plan or under a section 403(b) salary $50,000. See Group-term life insurance on page 6. reduction agreement described in box 12 (codes AA 11. Unless excludable under Educational assistance and BB). programs (see page 5), payments for non-job-related

education expenses or for payments under a Amounts deferred (plus earnings) under a nonqualified or nonaccountable plan. See Pub. 970. section 457(b) plan must be included in boxes 3 and/or 5 as 12. The amount includible as wages because you paid social security and/or Medicare wages as of the later of your employee’s share of social security and Medicare when the services giving rise to the deferral are performed taxes. See Employee’s social security and Medicare taxes or when there is no substantial forfeiture risk of the rights to paid by employer on page 6. If you also paid your the deferred amount. Include both elective and nonelective employee’s income tax withholding, treat the grossed-up deferrals for purposes of section 457(b) plans. amount of that withholding as supplemental wages and

report those wages in boxes 1, 3, 5, and 7. No exceptions to Also include in box 3: this treatment apply to household or agricultural wages. • Signing bonuses an employer pays for signing or ratifying 13. Designated Roth contributions made under a section an employment contract. See Rev. Rul. 2004-109. You can 401(k) plan or under a section 403(b) salary reduction find Rev. Rul. 2004-109 on page 958 of Internal Revenue agreement. See Designated Roth contributions on page 5. Bulletin 2004-50 at www.irs.gov/pub/irs-irbs/irb04-50.pdf. 14. Distributions to an employee or former employee from • Taxable cost of group-term life insurance over $50,000 an NQDC plan (including a rabbi trust) or a included in box 1. See Group-term life insurance on page 6. nongovernmental section 457(b) plan. • Cost of accident and health insurance premiums for 2% or 15. Amounts includible in income under section 457(f) more shareholder-employees paid by an S corporation, but because the amounts are no longer subject to a substantial only if not excludable under section 3121(a)(2)(B). risk of forfeiture. • Employee and nonexcludable employer contributions to 16. Payments to statutory employees who are subject to an MSA or HSA. However, do not include employee social security and Medicare taxes but not subject to federal contributions to an HSA that were made through a cafeteria income tax withholding must be shown in box 1 as other plan. See Archer MSA on page 4 and Health Savings compensation. See Statutory employee on page 13. Account (HSA) on page 6. 17. Cost of current insurance protection under a • Employee contributions to a SIMPLE retirement account. compensatory split-dollar life insurance arrangement. See SIMPLE retirement account on page 7. 18. Employee contributions to a Health Savings Account • Adoption benefits. See Adoption benefits on page 4. (HSA).

19. Employer contributions to an HSA if includible in the Box 4—Social security tax withheld. Show the total

income of the employee. See Health Savings Account employee social security tax (not your share) withheld, (HSA) on page 6. including social security tax on tips. Do not reduce this 20. Amounts includible in income under an NQDC plan amount by any advance EIC payments made to the because of section 409A. See Nonqualified deferred employee. For 2009, the amount should not exceed compensation plans on page 7. $6,621.60 ($106,800 × 6.2%). Include only taxes withheld 21. Payments made to former employees while they are (or paid by you for the employee) for 2009 wages and tips. If on active duty for more than 30 days in the Armed Forces or you paid your employee’s share, see Employee’s social other uniformed services. security and Medicare taxes paid by employer on page 6. 22. All other compensation, including certain scholarship

and fellowship grants (see page 7). Other compensation Box 5—Medicare wages and tips. The wages and tips

includes taxable amounts that you paid to your employee subject to Medicare tax are the same as those subject to

from which federal income tax was not withheld. You may social security tax (boxes 3 and 7) except that there is no

show other compensation on a separate Form W-2. See wage base limit for Medicare tax. Enter the total Medicare

Multiple forms on page 9. wages and tips in box 5. Be sure to enter tips that the

employee reported even if you did not have enough

Box 2—Federal income tax withheld. Show the total employee funds to collect the Medicare tax for those tips.

federal income tax withheld from the employee’s wages for See Box 3—Social security wages above for payments to

report in this box. If you paid your employee’s share of the year (do not reduce the wages by any advance EIC

payments made to the employee). Include the 20% excise taxes, see Employee’s social security and Medicare taxes

paid by employer on page 6. tax withheld on excess parachute payments. See Golden

parachute payments on page 6. If you are a federal, state, or local agency with employees

Box 3—Social security wages. Show the total wages paying only the 1.45% Medicare tax, enter the Medicare

paid (before payroll deductions) subject to employee social wages in this box. See Government employers on page 6.

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Example of how to report social security and Annuities, Retirement or Profit-Sharing Plans, IRAs,

Medicare wages. You paid your employee $140,000 in Insurance Contracts, etc., not in box 1 of Form W-2.

wages. Enter in box 3 (social security wages) 106800.00 but If you did not make distributions this year, show deferrals enter in box 5 (Medicare wages and tips) 140000.00. There (plus earnings) under a nonqualified or any section 457(b) is no limit on the amount reported in box 5. If the amount of plan that became taxable for social security and Medicare wages paid was $106,800 or less, the amounts entered in taxes during the year (but were for prior year services) boxes 3 and 5 would be the same. because the deferred amounts were no longer subject to a Box 6—Medicare tax withheld. Enter the total employee substantial risk of forfeiture. Also report these amounts in Medicare tax (not your share) withheld. Include only tax boxes 3 (up to the social security wage base) and 5. Do not withheld for 2009 wages and tips. Do not reduce this report in box 11 deferrals included in boxes 3 and/or 5 and amount by any advance EIC payments made to the deferrals for current year services (such as those with no employee. If you paid your employee’s share of the taxes, risk of forfeiture).

see Employee’s social security and Medicare taxes paid by

employer on page 6. If you made distributions and are also reporting any

deferrals in box(es) 3 and/or 5, do not complete box Box 7—Social security tips. Show the tips that the CAUTION 11. See Pub. 957, Reporting Back Pay and Special

!

employee reported to you even if you did not have enough Wage Payments to the Social Security Administration, and employee funds to collect the social security tax for the tips. Form SSA-131, Employer Report of Special Wage The total of boxes 3 and 7 should not be more than Payments, for instructions on reporting these and other $106,800 (the maximum social security wage base for kinds of compensation earned in prior years. However, do 2009). Report all tips in box 1 along with wages and other not file Form SSA-131 if this situation applies but the compensation. Include any tips reported in box 7 in box 5 employee will not be age 62 or older by the end of that also. year. Box 8—Allocated tips. If you are a food or beverage Unlike qualified plans, NQDC plans do not meet the establishment, show the tips allocated to the employee. See qualification requirements for tax-favored status for this the Instructions for Form 8027, Employer’s Annual purpose. NQDC plans include those arrangements Information Return of Tip Income and Allocated Tips. Do not traditionally viewed as deferring the receipt of current include this amount in boxes 1, 3, 5, or 7. compensation. Accordingly, welfare benefit plans, stock Box 9—Advance EIC payment. Show the total paid to the option plans, and plans providing dismissal pay, termination employee as advance earned income credit (EIC) pay, or early retirement pay are not NQDC plans. payments. Report distributions from NQDC or section 457 plans to Box 10—Dependent care benefits. Show the total beneficiaries of deceased employees on Form 1099-R, not dependent care benefits under a dependent care assistance on Form W-2. program (section 129) paid or incurred by you for your

employee. Include the fair market value (FMV) of care in a Military employers must report military retirement

daycare facility provided or sponsored by you for your payments on Form 1099-R.

employee and amounts paid or incurred for dependent care Do not report special wage payments, such as assistance in a section 125 (cafeteria) plan. Report all accumulated sick pay or vacation pay, in box 11. For amounts paid or incurred (regardless of any employee more information on reporting special wage

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forfeitures), including those in excess of the $5,000 payments, see Pub. 957. exclusion. This may include (a) the FMV of benefits provided

in kind by the employer, (b) an amount paid directly to a Box 12—Codes. Complete and code this box for all items

daycare facility by the employer or reimbursed to the described below. Note that the codes do not relate to where

employee to subsidize the benefit, or (c) benefits from the they should be entered in boxes 12a–12d on Form W-2. For

pre-tax contributions made by the employee under a section example, if you are only required to report code D in box 12,

125 dependent care flexible spending account. Include any you can enter code D and the amount in box 12a of Form

amounts over $5,000 in boxes 1, 3, and 5. For more W-2. Do not report in box 12 any items that are not listed as

information, see Pub. 15-B. codes A–BB. Also, do not report in box 12 section 414(h)(2)

contributions (relating to certain state or local government An employer that amends its cafeteria plan to plans). Instead, use box 14 for these items and any other provide a grace period for dependent care information that you wish to give to your employee. For assistance may continue to rely on Notice 89-111, by

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example, union dues and uniform payments may be reporting in Box 10 of Form W-2 the salary reduction reported in box 14. amount elected by the employee for the year for dependent

care assistance (plus any employer matching contributions On Copy A (Form W-2), do not enter more than

attributable to dependent care). four items in box 12. If more than four items need

to be reported in box 12, use a separate Form W-2

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Box 11—Nonqualified plans. The purpose of box 11 is to report the additional items (but enter no more than four for the SSA to determine if any part of the amount reported items on each Copy A (Form W-2)). On all other copies of in box 1 or boxes 3 and/or 5 was earned in a prior year. The

SSA uses this information to verify that they have properly Form W-2 (Copies B, C, etc.), you may enter more than four

applied the social security earnings test and paid the correct items in box 12 when using an approved substitute Form

W-2. See Multiple forms on page 9. amount of benefits.

Use the IRS code designated below for the item you are Reporting in box 11 is unaffected by the changes entering, followed by the dollar amount for that item. Even if made by the American Jobs Creation Act of 2004. only one item is entered, you must use the IRS code TIP

designated for that item. Enter the code using a capital

Show distributions to an employee from a nonqualified letter. Use decimal points but not dollar signs or commas.

plan or a nongovernmental section 457(b) plan. Also report For example, if you are reporting $5,300.00 in elective

these distributions in box 1. Make only one entry in this box. deferrals under a section 401(k) plan, the entry would be

Distributions from governmental section 457(b) plans must D 5300.00 (not A 5300.00 even though it is the first or only

be reported on Form 1099-R, Distributions From Pensions, entry in this box). Report the IRS code to the left of the

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vertical line in boxes 12a–12d and money amount to the • Employer matching contributions.

right of the vertical line. Code D—Elective deferrals under section 401(k) cash

See the Form W-2 Reference Guide for Box 12 Codes on or deferred arrangement (plan). Also show deferrals

page 16. See also the detailed instructions below for each under a SIMPLE retirement account that is part of a section

code. 401(k) arrangement.

Code A—Uncollected social security or RRTA tax on Example of reporting excess elective deferrals and

tips. Show the employee social security or Railroad designated Roth contributions under a section 401(k)

Retirement Tax Act (RRTA) tax on all of the employee’s tips plan. For 2009, Employee A (age 45) elected to defer

that you could not collect because the employee did not $18,300 under a section 401(k) plan. The employee also

have enough funds from which to deduct it. Do not include made a designated Roth contribution to the plan of $1,000,

this amount in box 4. and made a voluntary (non-Roth) after-tax contribution of

Code B—Uncollected Medicare tax on tips. Show $600. In addition, the employer, on A’s behalf, made a

the employee Medicare tax or RRTA Medicare tax on tips qualified nonelective contribution of $2,000 to the plan and a

nonelective profit-sharing employer contribution of $3,000. that you could not collect because the employee did not

have enough funds from which to deduct it. Do not include Even though the 2009 limit for elective deferrals and

this amount in box 6. designated Roth contributions is $16,500, the employee’s

Code C—Taxable cost of group-term life insurance total elective deferral amount of $18,300 is reported in box

over $50,000. Show the taxable cost of group-term life 12 with code D (D 18300.00). The designated Roth

insurance coverage over $50,000 provided to your contribution is reported in box 12 with code AA (AA

employee (including a former employee). See 1000.00). The employer must separately report the actual Group-term

life insurance on page 6. Also include this amount in boxes amounts of $18,300 and $1,000 in box 12 with the

1, 3 (up to the social security wage base), and 5. appropriate codes. The amount deferred in excess of the

limit is not reported in box 1. The return of excess salary Codes D through H, S, Y, AA, and BB. Use these deferrals and excess designated contributions, including codes to show elective deferrals and designated Roth earnings on both, is reported on Form 1099-R. contributions made to the plans listed. Do not report

amounts for other types of plans. See below for an example The $600 voluntary after-tax contribution may be reported

of reporting elective deferrals under a section 401(k) plan. in box 14 (this is optional) but not in box 12. The $2,000

nonelective contribution and the $3,000 nonelective The amount reported as elective deferrals and profit-sharing employer contribution are not required to be designated Roth contributions is only the part of the reported on Form W-2, but may be reported in box 14. employee’s salary (or other compensation) that he or she Check the “Retirement plan” box in box 13. did not receive because of the deferrals or designated Roth

contributions. Only elective deferrals and designated Roth Code E—Elective deferrals under a section 403(b)

contributions should be reported in box 12 for all coded salary reduction agreement.

plans; except, when using code G for section 457(b) plans, Code F—Elective deferrals under a section 408(k)(6) include both elective and nonelective deferrals. salary reduction SEP.

For employees who were 50 years of age or older at any Code G—Elective deferrals and employer

time during the year and made elective deferral and/or contributions (including nonelective deferrals) to any

designated Roth “catch-up” contributions, report the elective governmental or nongovernmental section 457(b)

deferrals and the elective deferral “catch-up” contributions deferred compensation plan. Do not report either section

as a single sum in box 12 using the appropriate code, and 457(b) or section 457(f) amounts that are subject to a

the designated Roth contributions and designated Roth substantial risk of forfeiture.

“catch-up” contributions as a single sum in box 12 using the Code H—Elective deferrals under section appropriate code. 501(c)(18)(D) tax-exempt organization plan. Be sure to

include this amount in box 1 as wages. The employee will If any elective deferrals, salary reduction amounts, or deduct the amount on his or her Form 1040. nonelective contributions under a section 457(b) plan

during the year are makeup amounts under the Code J—Nontaxable sick pay. Show any sick pay that

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Uniformed Services Employment and Reemployment Rights was paid by a third-party and was not includible in income

Act of 1994 (USERRA) for a prior year, you must enter the (and not shown in boxes 1, 3, and 5) because the employee

prior year contributions separately. Beginning with the contributed to the sick pay plan. Do not include nontaxable

earliest year, enter the code, the year, and the amount. For disability payments made directly by a state.

example, elective deferrals of $2,250 for 2007 and $1,250 Code K—20% excise tax on excess golden parachute for 2008 under USERRA under a section 401(k) plan are payments. If you made excess “golden parachute” reported in box 12 as follows: payments to certain key corporate employees, report the

D 07 2250.00, D 08 1250.00. A 2009 contribution of 20% excise tax on these payments. If the excess payments

$7,000 does not require a year designation; enter it as are considered to be wages, report the 20% excise tax

D 7000.00. Report the code (and year for prior year withheld as income tax withheld in box 2.

USERRA contributions) to the left of the vertical line in Code L—Substantiated employee business expense

boxes 12a through 12d. reimbursements. Use this code only if you reimbursed

The following are not elective deferrals and may be your employee for employee business expenses using a per

diem or mileage allowance and the amount that you reported in box 14, but not in box 12. reimbursed exceeds the amount treated as substantiated • Nonelective employer contributions made on behalf of an under IRS rules. See Employee business expense employee. reimbursements on page 5. • After-tax contributions that are not designated Roth

contributions, such as voluntary contributions to a pension Report in box 12 only the amount treated as

plan that are deducted from an employee’s pay. See the substantiated (such as the nontaxable part). In boxes 1, 3

instructions in codes AA and BB for reporting designated (up to the social security wage base), and 5, include the part

Roth contributions on page 13. of the reimbursement that is more than the amount treated

• Required employee contributions. as substantiated.

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Code M—Uncollected social security or RRTA tax on current year and prior year deferrals. See Nonqualified

taxable cost of group-term life insurance over $50,000 deferred compensation plans on page 7.

(for former employees). If you provided your former Code Z—Income under section 409A on a employees (including retirees) more than $50,000 of nonqualified deferred compensation plan. Enter all group-term life insurance coverage for periods during which amounts deferred (including earnings on amounts deferred) an employment relationship no longer exists, enter the that are includible in income under section 409A because amount of uncollected social security or RRTA tax on the the NQDC plan fails to satisfy the requirements of section coverage in box 12. Also see Group-term life insurance on 409A. Do not include amounts properly reported on a Form page 6. 1099-MISC, corrected Form 1099-MISC, Form W-2, or Form Code N—Uncollected Medicare tax on taxable cost of W-2c for a prior year. Also, do not include amounts that are group-term life insurance over $50,000 (for former considered to be subject to a substantial risk of forfeiture for employees). If you provided your former employees purposes of section 409A. For more information, see (including retirees) more than $50,000 of group-term life Regulations sections 1.409A-1 through 1.409A-6, Notice insurance coverage for periods during which an employment 2008-113, available at www.irs.gov/irb/2008-51_IRB/ar12. relationship no longer exists, enter the amount of html, and Notice 2008-115, available at www.irs.gov/irb/ uncollected Medicare tax or RRTA Medicare tax on the 2008-52_IRB/index.html. coverage in box 12. Also see Group-term life insurance on

page 6. The amount reported in box 12 using code Z is also

reported in box 1, and is subject to an additional tax Code P—Excludable moving expense reported on the employee’s Form 1040. See Nonqualified reimbursements paid directly to employee. Show the deferred compensation plans on page 7. total moving expense reimbursements that you paid directly

to your employee for qualified (deductible) moving Code AA—Designated Roth contributions under a

expenses. See Moving expenses on page 7. section 401(k) plan. Use this code to report designated

Code Q—Nontaxable combat pay. If you are a military Roth contributions under a section 401(k) plan. Do not use

employer, report any nontaxable combat pay in box 12. this code to report elective deferrals under code D. See

Designated Roth contributions on page 5. Code R—Employer contributions to an Archer MSA.

Show any employer contributions to an Archer MSA. See Code BB—Designated Roth contributions under a

Archer MSA on page 4. section 403(b) plan. Use this code to report designated

Roth contributions under a section 403(b) plan. Do not use Code S—Employee salary reduction contributions this code to report elective deferrals under code E. See under a section 408(p) SIMPLE. Show deferrals under a Designated Roth contributions on page 5. section 408(p) salary reduction SIMPLE retirement account.

However, if the SIMPLE is part of a section 401(k) Box 13—Checkboxes. Check all boxes that apply. arrangement, use code D. If you are reporting prior year • Statutory employee. Check this box for statutory contributions under USERRA, see the TIP above Code D on employees whose earnings are subject to social security page 12. and Medicare taxes but not subject to federal income tax

Code T—Adoption benefits. Show the total that you withholding. Do not check this box for common-law

paid or reimbursed for qualified adoption expenses employees. There are workers who are independent

furnished to your employee under an adoption assistance contractors under the common-law rules but are treated by

program. Also include adoption benefits paid or reimbursed statute as employees. They are called statutory employees.

from the pre-tax contributions made by the employee under 1. A driver who distributes beverages (other than milk), a section 125 (cafeteria) plan. However, do not include or meat, vegetable, fruit, or bakery products; or who picks adoption benefits forfeited from a section 125 (cafeteria) up and delivers laundry or dry cleaning if the driver is your plan. Report all amounts including those in excess of the agent or is paid on commission. $12,150 exclusion. For more information, see Adoption 2. A full-time life insurance sales agent whose principal benefits on page 4. business activity is selling life insurance or annuity

Code V—Income from the exercise of nonstatutory contracts, or both, primarily for one life insurance company.

stock option(s). Show the spread (that is, the fair market 3. An individual who works at home on materials or

value of stock over the exercise price of option(s) granted to goods that you supply and that must be returned to you or to

your employee with respect to that stock) from your a person you name if you also furnish specifications for the

employee’s (or former employee’s) exercise of nonstatutory work to be done.

stock option(s). Include this amount in boxes 1, 3 (up to the 4. A full-time traveling or city salesperson who works on

social security wage base), and 5. your behalf and turns in orders to you from wholesalers,

retailers, contractors, or operators of hotels, restaurants, or This reporting requirement does not apply to the exercise other similar establishments. The goods sold must be of a statutory stock option, or the sale or disposition of stock merchandise for resale or supplies for use in the buyer’s acquired pursuant to the exercise of a statutory stock option. business operation. The work performed for you must be the For more information about the taxability of employee stock salesperson’s principal business activity. options, see Pub. 15-B. For details on statutory employees and common-law

Code W—Employer contributions to a Health employees, see section 1 in Pub. 15–A.

Savings Account (HSA). Show any employer • Retirement plan. Check this box if the employee was an

contributions (including amounts the employee elected to “active participant” (for any part of the year) in any of the

contribute using a section 125 (cafeteria) plan) to an HSA. following:

See Health Savings Account (HSA) on page 6. 1. A qualified pension, profit-sharing, or stock-bonus plan

Code Y—Deferrals under a section 409A nonqualified described in section 401(a) (including a 401(k) plan).

deferred compensation plan. It is not necessary to show 2. An annuity plan described in section 403(a).

deferrals in box 12 with code Y. For more information, see 3. An annuity contract or custodial account described in

Notice 2008-115, available at www.irs.gov/irb/2008-52_IRB/ section 403(b).

index.html. However, if you report these deferrals, show 4. A simplified employee pension (SEP) plan described

current year deferrals, including earnings during the year on in section 408(k).

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5. A SIMPLE retirement account described in section W-3. Type entries using black ink. Scanners will not read

408(p). entries if type is too light.

6. A trust described in section 501(c)(18). Amounts reported on related employment tax forms 7. A plan for federal, state, or local government (for example, Form W-2, Form 941, Form 943, or employees or by an agency or instrumentality thereof (other Form 944) should agree with the amounts reported

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than a section 457(b) plan). on Form W-3. If there are differences, you may be contacted Generally, an employee is an active participant if covered by the IRS and SSA. You should retain a reconciliation for by (a) a defined benefit plan for any tax year that he or she future reference. See Reconciling Forms W-2, W-3, 941, is eligible to participate in or (b) a defined contribution plan 943, 944, CT-1, and Schedule H (Form 1040) on page 15. (for example, a section 401(k) plan) for any tax year that

employer or employee contributions (or forfeitures) are Box a—Control number. This is an optional box that you

added to his or her account. For additional information on may use for numbering the whole transmittal.

employees who are eligible to participate in a plan, contact Box b—Kind of Payer. Check the box that applies to you.

your plan administrator. For details on the active participant Check only one box unless the second checked box is

rules, see Notice 87-16, 1987-1 C.B. 446, Notice 98-49, “Third-party sick pay.” If you have more than one type of

1998-2 C.B. 365, section 219(g)(5), and Pub. 590, Individual Form W-2, send each type (except “Third-party sick pay”)

Retirement Arrangements (IRAs). You can find Notice 98-49 with a separate Form W-3. (The “Third-party sick pay”

on page 5 of Internal Revenue Bulletin 1998-38 at indicator box does not designate a separate kind of payer.)

www.irs.gov/pub/irs-irbs/irb98-38.pdf. 941. Check this box if you file Form 941, Employer’s

QUARTERLY Federal Tax Return, and no other category Do not check this box for contributions made to a (except “Third-party sick pay”) applies. A church or church nonqualified or section 457(b) plan. organization should check this box even if it is not required TIP

to file Form 941 or Form 944. • Third-party sick pay. Check this box only if you are a Military. Check this box if you are a military employer third-party sick pay payer filing a Form W-2 for an insured’s sending Forms W-2 for members of the uniformed services. employee or are an employer reporting sick pay payments

made by a third party. See 943. Check this box if you are an agricultural employer Sick Pay Reporting in section 6 and file Form 943, Employer’s Annual Federal Tax Return of Pub. 15-A. for Agricultural Employees, and you are sending Forms W-2 Box 14—Other. The lease value of a vehicle provided to for agricultural employees. For nonagricultural employees, your employee and reported in box 1 must be reported here send their Forms W-2 with a separate Form W-3, checking or on a separate statement to your employee. You may also the appropriate box. use this box for any other information that you want to give 944. Check this box if you file Form 944, Employer’s to your employee. Label each item. Examples include state ANNUAL Federal Tax Return (or Forma 944(SP), its disability insurance taxes withheld, union dues, uniform Spanish version), and no other category (except “Third-party payments, health insurance premiums deducted, nontaxable sick pay”) applies. income, educational assistance payments, or a member of CT-1. Check this box if you are a railroad employer the clergy’s parsonage allowance and utilities. In addition, sending Forms W-2 for employees covered under the you may enter the following contributions to a pension plan: Railroad Retirement Tax Act (RRTA). Do not show (a) nonelective employer contributions made on behalf of an employee RRTA tax in boxes 3–7. These boxes are only for employee, (b) voluntary after-tax contributions (but not social security and Medicare information. If you also have designated Roth contributions) that are deducted from an employees who are subject to social security and Medicare employee’s pay, (c) required employee contributions, and taxes, send that group’s Forms W-2 with a separate Form (d) employer matching contributions. W-3 and check the “941” box on that Form W-3.

If you are reporting prior year contributions under Hshld. emp. Check this box if you are a household USERRA (see the TIP above Code D on page 12 and employer sending Forms W-2 for household employees and Uniformed Services Employment and Reemployment Rights you did not include the household employee’s taxes on Act of 1994 (USERRA) makeup amounts to a pension plan Form 941, Form 943, or Form 944. on page 8), you may report in box 14 makeup amounts for Medicare govt. emp. Check this box if you are a U.S., nonelective employer contributions, voluntary after-tax state, or local agency filing Forms W-2 for employees contributions, required employee contributions, and subject only to the 1.45% Medicare tax. See Government employer matching contributions. Report such amounts employers on page 6. separately for each year. Railroad employers, see page 7. Third-party sick pay. Check this box and another box

Boxes 15 through 20—State and local income tax such as the “941” box if you are a third-party sick pay payer information. Use these boxes to report state and local (or are reporting sick pay payments made by a third party) income tax information. Enter the two-letter abbreviation for filing Forms W-2 with the “Third-party sick pay” checkbox in the name of the state. The employer’s state ID numbers are box 13 checked. File a single Form W-3 for the regular and assigned by the individual states. The state and local “Third-party sick pay” Forms W-2. See 941 above.

information boxes can be used to report wages and taxes Box c—Total number of Forms W-2. Show the number for two states and two localities. Keep each state’s and of completed individual Forms W-2 that you are transmitting locality’s information separated by the broken line. If you with this Form W-3. Do not count “Void” Forms W-2. need to report information for more than two states or Box d—Establishment number. You may use this box to localities, prepare a second Form W-2. See Multiple forms identify separate establishments in your business. You may on page 9. Contact your state or locality for specific file a separate Form W-3, with Forms W-2, for each reporting information. establishment even if they all have the same EIN; or you

may use a single Form W-3 for all Forms W-2 of the same

type. Specific Instructions for Form W-3 Box e—Employer identification number (EIN). If you

How to complete Form W-3. The instructions under How received a preprinted Form W-3 from the IRS with Pub. 393,

to complete Form W-2 on page 9 generally apply to Form Federal Employment Tax Forms, or Pub. 2184, Form W-3

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Package (Including Alternative Ways To Get Employment them as one sum in the appropriate box on Form W-3.

Tax Forms and Instructions), verify that your employer Verify the amount reported in each box is an accurate total

identification number (EIN) is correct. Make any necessary of the Forms W-2.

corrections on the form.

If you did not receive a form with a preprinted EIN, enter Reconciling Forms W-2, W-3, 941, 943, 944, the nine-digit EIN assigned to you by the IRS. The number CT-1, and Schedule H (Form 1040) should be the same as shown on your Form 941, Form 943, Reconcile the amounts shown in boxes 2, 3, 5, 7, and 9 Form 944, Form CT-1, or Schedule H (Form 1040) and in

the following format: 00-0000000. Do not use a prior owner’s from all 2009 Forms W-3 with their respective amounts from

the 2009 yearly totals from the quarterly Forms 941, or EIN. See Box h—Other EIN used this year below. annual Form 943, Form 944, Form CT-1 (box 2 only), and

If you do not have an EIN when filing your Form W-3, Schedule H (Form 1040). When there are discrepancies

enter “Applied For” in box e, not your social security number between amounts reported on Forms W-2 and W-3 filed with

(SSN), and see Box b—Employer identification number the SSA and on Form 941, Form 943, Form 944, Form

(EIN) on page 9. CT-1, or Schedule H (Form 1040) filed with the IRS, you will

be contacted to resolve the discrepancies. Box f—Employer’s name. If you are not using a

preprinted Form W-3, enter the same name as shown on To help reduce discrepancies on Forms W-2: your Form 941, Form 943, Form 944, or Form CT-1. Make

any necessary corrections on your preprinted Form W-3. • Report bonuses as wages and as social security and

Medicare wages on Form W-2, and on Forms 941, 943, 944, Box g—Employer’s address and ZIP code. If you are and Schedule H (Form 1040). not using a preprinted Form W-3, enter your address. Make • Report both social security and Medicare wages and any necessary corrections on your preprinted Form W-3. taxes separately on Forms W-2 and W-3, and on Forms

Box h—Other EIN used this year. If you have used an 941, 943, 944, and Schedule H (Form 1040).

EIN (including a prior owner’s EIN) on Form 941, Form 943, • Report social security taxes withheld on Form W-2 in Form 944, or Form CT-1 submitted for 2009 that is different box 4, not in box 3. from the EIN reported on Form W-3 in box e, enter the other • Report Medicare taxes withheld on Form W-2 in box 6, EIN used. Agents generally report the employer’s EIN in not in box 5. box h. See Agent reporting on page 4. • Make sure that the social security wage amount for each Contact person, telephone number, fax number, and employee does not exceed the annual social security wage email address. Include this information for use by the SSA base limit ($106,800 for 2009). if any questions arise during processing. • Do not report noncash wages that are not subject to

social security or Medicare taxes as social security or The amounts to enter in boxes 1 through 19, Medicare wages. described below, are totals from only the Forms W-2 • If you use an EIN on any quarterly Form 941 for the year that you are sending with this Form W-3.

TIP

(or annual Forms 943, 944, CT-1, and Schedule H (Form

Boxes 1 through 10. Enter the totals reported in boxes 1 1040)) that is different from the EIN reported in box e on

through 10 on the Forms W-2. Form W-3, enter the other EIN in box h on Form W-3.

Box 11—Nonqualified plans. Enter the total reported in To reduce the discrepancies between amounts box 11 on Forms W-2. reported on Forms W-2 and W-3, and Forms 941, 943, Box 12—Deferred compensation. Enter one total of all 944, CT-1, and Schedule H (Form 1040): amounts reported with codes D through H, S, Y, AA, and BB • Be sure that the amounts on Form W-3 are the total in box 12 on Forms W-2. Do not enter a code. amounts from Forms W-2.

Box 13—For third-party sick pay use only. Third-party • Reconcile Form W-3 with your four quarterly Forms 941

payers of sick pay (or employers using the optional rule for (or annual Forms 943, 944, CT-1, and Schedule H (Form

Form W-2 described in section 6 of Pub. 15-A) filing 1040)) by comparing amounts reported for:

third-party sick pay recap Forms W-2 and W-3 must enter 1. Income tax withholding (box 2). “Third-Party Sick Pay Recap” in this box. 2. Social security wages, Medicare wages and tips, and

Box 14—Income tax withheld by payer of third-party social security tips (boxes 3, 5, and 7). Form W-3 should

sick pay. Complete this box only if you are the employer include Form 941 or Forms 943, 944, and Schedule H (Form

and have employees who had federal income tax withheld 1040) adjustments only for the current year. If the Form 941,

on third-party payments of sick pay. Show the total income Form 943, or Form 944 adjustments include amounts for a

tax withheld by third-party payers on payments to all of your prior year, do not report those prior year adjustments on the

employees. Although this tax is included in the box 2 total, it current year Forms W-2 and W-3.

must be separately shown here. 3. Social security and Medicare taxes (boxes 4 and 6).

The amounts shown on the four quarterly Forms 941 (or Box 15—State/Employer’s state ID number. Enter the annual Form 943, Form 944, and Schedule H (Form 1040)), two-letter abbreviation for the name of the state being including current year adjustments, should be approximately reported on Form(s) W-2. Also enter your state-assigned ID twice the amounts shown on Form W-3. number. If the Forms W-2 being submitted with this Form

W-3 contain wage and income tax information from more 4. Advance EIC payment (box 9).

than one state, enter an “X” under “State” and do not enter

any state ID number. Amounts reported on Forms W-2, and W-3, and Forms

Boxes 16—19. Enter the total of state/local wages and 941, 943, 944, CT-1, and Schedule H (Form 1040) may not

income tax shown in their corresponding boxes on the match for valid reasons. If they do not match, you should

Forms W-2 included with this Form W-3. If the Forms W-2 determine that the reasons are valid. Keep your

show amounts from more than one state or locality, report reconciliation in case of inquiries from the IRS or the SSA.

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Form W-2 Reference Guide for Box 12 Codes (See the box 12 instructions.)

A Uncollected social security or RRTA tax on J Nontaxable sick pay S Employee salary reduction contributions

tips under a section 408(p) SIMPLE

B Uncollected Medicare tax on tips K 20% excise tax on excess golden T Adoption benefits

parachute payments

C Taxable cost of group-term life insurance L Substantiated employee business expense V Income from exercise of nonstatutory

over $50,000 reimbursements (federal rate) stock option(s)

D Elective deferrals under a section 401(k) M Uncollected social security or RRTA tax on W Employer contributions (including

cash or deferred arrangement (including a taxable cost of group-term life (for former employee contributions through a

SIMPLE 401(k) arrangement) employees) cafeteria plan) to an employee’s Health

Savings Account (HSA)

E Elective deferrals under a section 403(b) N Uncollected Medicare tax on taxable cost Y Deferrals under a section 409A

salary reduction agreement of group-term life insurance over $50,000 nonqualified deferred compensation plan

(for former employees)

F Elective deferrals under a section P Excludable moving expense Z Income under section 409A on a

408(k)(6) salary reduction SEP reimbursements paid directly to employee nonqualified deferred compensation plan

G Elective deferrals and employer Q Nontaxable combat pay AA Designated Roth contributions under a

contributions (including nonelective section 401(k) plan

deferrals) under a section 457(b) deferred

H Elective deferrals under a section R Employer contributions to an Archer MSA BB Designated Roth contributions under a

501(c)(18)(D) tax-exempt organization section 403(b) plan

plan

Index

A Golden parachute payments . . . . . . . . . . . . . . . . . . 6, 12 S

Adoption benefits . . . . . . . . . . . . . . . . . . . . . . . . 4, 10, 13 Government employers . . . . . . . . . . . . . . . . . . . . . . 6, 14 Scholarships ................................... 7

Advance EIC payment . . . . . . . . . . . . . . . . . . . . . . . . . 11 Group-term life insurance . . . . . . . . . . . . . . . . 6, 10, 12 Shipping and mailing ........................... 3

Agent reporting ................................ 4 Sick pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7, 12, 15

Agricultural employers . . . . . . . . . . . . . . . . . . . . . . . 6, 14 Signing bonuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 H Allocated tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 SIMPLE retirement account . . . . . . . . . . . . 7, 10, 12, 13 Health Savings Account (HSA) . . . . . . . . . . . . . . . . 6, 13 Archer MSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4, 10, 13 Social security number .......................... 9 Help .......................................... 1 Social security number (SSN) .................... 4 Household employers . . . . . . . . . . . . . . . . . . . . . . . . 6, 14 Social security tax withheld . . . . . . . . . . . . . . . . . . . . . 10 C How to complete Form W-2 ...................... 9 Social security wages/tips .................. 10, 11 Calendar year basis ............................ 9 How to complete Form W-3 . . . . . . . . . . . . . . . . . . . . . 14 State and local tax information . . . . . . . . . . . . . . . . . . 14 Clergy ........................................ 4 How to get forms and publications ................ 2 Statutory employee ........................ 10, 13 Codes for box 12, Form W-2 . . . . . . . . . . . . . . . . . . . . 11 Substitute forms ................................ 1 Corrections and void Forms W-2 . . . . . . . . . . . . . . . 4, 9 I Successor/predecessor employers ............... 7

Income tax withheld ....................... 10, 15

D T Deceased employee’s wages .................... 5 L Taxpayer identification numbers (TINs) ........... 4 Deferred compensation .................... 10, 15 Lost Form W-2 ................................. 6 Terminating a business ......................... 7 Dependent care benefits . . . . . . . . . . . . . . . . . . . . . . . 11 Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9, 10, 11, 12 Designated Roth contributions . . . . . . . . . . . . . . . . 5, 10

Due date(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1, 3 M

Medicare tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . . 11 U

Medicare wages and tips . . . . . . . . . . . . . . . . . . . . . . . 10 Uncollected taxes on group-term life E Military employers ......................... 11, 14 insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Earned income credit notification ................. 1 Moving expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7, 13 Uncollected taxes on tips . . . . . . . . . . . . . . . . . . . . . . . 12 Educational assistance programs . . . . . . . . . . . . . 5, 10 Multiple Forms W-2 issued to employee ........... 9 Undeliverable Forms W-2 ....................... 3 Election workers ............................... 5 USERRA contributions . . . . . . . . . . . . . . . . . . . 8, 12, 14 Elective deferrals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Electronic reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . 1, 3 N

Employee business expense reimbursements . . . . 5, Nonqualified deferred compensation plans . . . . . . 1, 7 V

10, 12 Void Forms W-2 Nonqualified plans ......................... 11, 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4, 9

Employee’s taxes paid by employer . . . . . . . . . . . 6, 10 Nonstatutory stock option(s) . . . . . . . . . . . . . . . . . . . . 13

Employer identification number (EIN) . . . . . . . 4, 9, 14 W Errors, common ................................ 2 P Wages ........................................ 9 Extension to file/furnish Form(s) W-2 ............. 3 Penalties ...................................... 8 When and where to file .......................... 3

When to furnish Forms W-2 to employees ......... 3

F Who must file Forms W-2 and W-3 ............... 2 R

Fellowship grants ............................... 7 Railroad employers . . . . . . . . . . . . . . . . . . . . . . . . . . 7, 14 Fringe benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6, 9 Reconciling Forms W-2, W-3, 941, 943, 944, CT-1, ■

Furnishing Forms W-2 to employees .............. 3 and Schedule H (Form 1040) . . . . . . . . . . . . . . . . . 15

Reissued Form W-2 ............................ 6

G Religious workers .............................. 4

Getting forms, publications, and help ............. 2 Repayments, wages received in error ............. 7

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