Year/Form corrected OMB No. 1545-0008 For Official

19 Use Only © /

Employee’s name, address, and ZIP code Employer’s name, address, and ZIP code

d Employee’s correct SSN e Employer’s SSA number f Employer’s Federal EIN g Employer’s state I.D. number

69-

Complete k and/or l only if

incorrect on the last form you

filed. Show incorrect item here.

k Employee’s incorrect SSN l Employee’s name (as incorrectly shown on previous form) ©

Def’d.

comp.

Legal

rep.

Pension

plan

DeceasedStat.

emp.

Def’d.

comp.

Legal

rep.

Pension

plan

DeceasedStat.

emp.

Previously

reported

h © IRA/SEP Corrected © IRA/SEP j Employer’s use

Form W-2 box (a) As previously reported (b) Correct information (c) Increase (decrease)

1

2 Federal income tax withheld

Wages, tips, other comp.

3

4 Social security tax withheld

Social security wages

Social security tips

5 Medicare wages and tips

6

7

Medicare tax withheld

8

CHANGES

Allocated tips

17 State wages, tips, etc.

18 State income tax

20 Local wages, tips, etc.

21 Local income tax

See back of Copy D for instructions and the Paperwork Reduction Act Notice. Copy A For Social Security Administration

Department of the Treasury Form W-2c Internal Revenue Service (Rev. 11-93) Statement of Corrected Income and Tax Amounts

Cat. No. 61437D Please do not staple.

Corrected Corrected

Do NOT Cut or Separate Forms on This Page

a Void

b c

i

Year/Form corrected OMB No. 1545-0008

19 /

Employee’s name, address, and ZIP code Employer’s name, address, and ZIP code

d Employee’s correct SSN e Employer’s SSA number f Employer’s Federal EIN g Employer’s state I.D. number

69-

Complete k and/or l only if

incorrect on the last form you

filed. Show incorrect item here.

k Employee’s incorrect SSN l Employee’s name (as incorrectly shown on previous form) ©

Def’d.

comp.

Legal

rep.

Pension

plan

DeceasedStat.

emp.

Def’d.

comp.

Legal

rep.

Pension

plan

DeceasedStat.

emp.

Previously

reported

h © IRA/SEP Corrected © IRA/SEP j Employer’s use

Form W-2 box (a) As previously reported (b) Correct information (c) Increase (decrease)

1

2 Federal income tax withheld

Wages, tips, other comp.

3

4 Social security tax withheld

Social security wages

Social security tips

5 Medicare wages and tips

6

7

Medicare tax withheld

8

CHANGES

Allocated tips

17 State wages, tips, etc.

18 State income tax

20 Local wages, tips, etc.

21 Local income tax

Copy 1 For State, City, or Local Tax Department

Department of the Treasury Form W-2c Internal Revenue Service (Rev. 11-93) Statement of Corrected Income and Tax Amounts

Corrected Corrected

a Void

b c

i

Year/Form corrected OMB No. 1545-0008

19 /

Employee’s name, address, and ZIP code Employer’s name, address, and ZIP code

d Employee’s correct SSN e Employer’s SSA number f Employer’s Federal EIN g Employer’s state I.D. number

69-

Complete k and/or l only if

incorrect on the last form you

filed. Show incorrect item here.

k Employee’s incorrect SSN l Employee’s name (as incorrectly shown on previous form) ©

Def’d.

comp.

Legal

rep.

Pension

plan

DeceasedStat.

emp.

Def’d.

comp.

Legal

rep.

Pension

plan

DeceasedStat.

emp.

Previously

reported

h © IRA/SEP Corrected © IRA/SEP j Employer’s use

Form W-2 box (a) As previously reported (b) Correct information (c) Increase (decrease)

1

2 Federal income tax withheld

Wages, tips, other comp.

3

4 Social security tax withheld

Social security wages

Social security tips

5 Medicare wages and tips

6

7

Medicare tax withheld

8

CHANGES

Allocated tips

17 State wages, tips, etc.

18 State income tax

20 Local wages, tips, etc.

21 Local income tax

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

Department of the Treasury Form W-2c Internal Revenue Service (Rev. 11-93) Statement of Corrected Income and Tax Amounts

Corrected Corrected

a Void

b c

i

Year/Form corrected OMB No. 1545-0008

19 /

Employee’s name, address, and ZIP code Employer’s name, address, and ZIP code

d Employee’s correct SSN e Employer’s SSA number f Employer’s Federal EIN g Employer’s state I.D. number

69-

Complete k and/or l only if

incorrect on the last form you

filed. Show incorrect item here.

k Employee’s incorrect SSN l Employee’s name (as incorrectly shown on previous form) ©

Def’d.

comp.

Legal

rep.

Pension

plan

DeceasedStat.

emp.

Def’d.

comp.

Legal

rep.

Pension

plan

DeceasedStat.

emp.

Previously

reported

h © IRA/SEP Corrected © IRA/SEP j Employer’s use

Form W-2 box (a) As previously reported (b) Correct information (c) Increase (decrease)

1

2 Federal income tax withheld

Wages, tips, other comp.

3

4 Social security tax withheld

Social security wages

Social security tips

5 Medicare wages and tips

6

7

Medicare tax withheld

8

CHANGES

Allocated tips

17 State wages, tips, etc.

18 State income tax

20 Local wages, tips, etc.

21 Local income tax

Copy C For Employee’s Records

Department of the Treasury Form W-2c Internal Revenue Service (Rev. 11-93) Statement of Corrected Income and Tax Amounts

Corrected Corrected

a Void

b c

i
Notice to Employee

This is a corrected version of the Form W-2,

Wage and Tax Statement, for the tax year shown

on the front of this form. This form can also be

used to correct Form W-2P, Statement for

Recipients of Annuities, Pensions, Retired Pay, or

IRA Payments, for tax years before 1991. If you

have already filed an income tax return for the

year shown, you may have to file an amended

return for that year. Compare information reported

on this form with amounts reported on your

income tax return. If the corrected amounts

change your income tax liability, file Form 1040X,

Amended U.S. Individual Income Tax Return, and

attach a copy of this Form W-2c to amend your

filed return.

If boxes h or i have any checkboxes marked,

box h will show how it was reported originally and

box i will show the corrections.

For more information, contact your nearest

Internal Revenue Service office. Employees in

American Samoa, Guam, Commonwealth of the

Northern Mariana Islands, or the Virgin Islands

should contact their local taxing authority for

more information.

If you have not yet filed an income tax return

for the year shown, attach a copy of the original

Form W-2 that you received from your employer,

and a copy of this Form W-2c, to your return.
Year/Form corrected OMB No. 1545-0008

19 /

Employee’s name, address, and ZIP code Employer’s name, address, and ZIP code

d Employee’s correct SSN e Employer’s SSA number f Employer’s Federal EIN g Employer’s state I.D. number

69-

Complete k and/or l only if

incorrect on the last form you

filed. Show incorrect item here.

k Employee’s incorrect SSN l Employee’s name (as incorrectly shown on previous form) ©

Def’d.

comp.

Legal

rep.

Pension

plan

DeceasedStat.

emp.

Def’d.

comp.

Legal

rep.

Pension

plan

DeceasedStat.

emp.

Previously

reported

h © IRA/SEP Corrected © IRA/SEP j Employer’s use

Form W-2 box (a) As previously reported (b) Correct information (c) Increase (decrease)

1

2 Federal income tax withheld

Wages, tips, other comp.

3

4 Social security tax withheld

Social security wages

Social security tips

5 Medicare wages and tips

6

7

Medicare tax withheld

8

CHANGES

Allocated tips

17 State wages, tips, etc.

18 State income tax

20 Local wages, tips, etc.

21 Local income tax

Copy 2 To Be Filed With Employee’s State, City, or Local Income Tax Return

Department of the Treasury Form W-2c Internal Revenue Service (Rev. 11-93) Statement of Corrected Income and Tax Amounts

Corrected Corrected

a Void

b c

i

Year/Form corrected OMB No. 1545-0008

19 /

Employee’s name, address, and ZIP code Employer’s name, address, and ZIP code

d Employee’s correct SSN e Employer’s SSA number f Employer’s Federal EIN g Employer’s state I.D. number

69-

Complete k and/or l only if

incorrect on the last form you

filed. Show incorrect item here.

k Employee’s incorrect SSN l Employee’s name (as incorrectly shown on previous form) ©

Def’d.

comp.

Legal

rep.

Pension

plan

DeceasedStat.

emp.

Def’d.

comp.

Legal

rep.

Pension

plan

DeceasedStat.

emp.

Previously

reported

h © IRA/SEP Corrected © IRA/SEP j Employer’s use

Form W-2 box (a) As previously reported (b) Correct information (c) Increase (decrease)

1

2 Federal income tax withheld

Wages, tips, other comp.

3

4 Social security tax withheld

Social security wages

Social security tips

5 Medicare wages and tips

6

7

Medicare tax withheld

8

CHANGES

Allocated tips

17 State wages, tips, etc.

18 State income tax

20 Local wages, tips, etc.

21 Local income tax

Copy D For Employer

Department of the Treasury Form W-2c Internal Revenue Service (Rev. 11-93) Statement of Corrected Income and Tax Amounts

Corrected Corrected

a Void

b c

i
Instructions

Paperwork Reduction Act Notice.—We

ask for the information on this form to

carry out the Internal Revenue laws of the

United States. You are required to give us

the information. We need it to ensure that

you are complying with these laws and to

allow us to figure and collect the right

amount of tax.

The time needed to complete and file

this form will vary depending on individual

circumstances. The estimated average

time is 52 minutes. If you have comments

concerning the accuracy of this time

estimate or suggestions for making this

form more simple, we would be happy to

hear from you. You can write to both the

Internal Revenue Service, Attention:

Reports Clearance Officer, PC:FP,

Washington, DC 20224; and the Office of

Management and Budget, Paperwork

Reduction Project (1545-0008),

Washington, DC 20503. DO NOT send

this form to either of these offices.

Instead, see Where To File below.

Item To Note.—There are major changes

to the format of Form W-2c, Statement

of Corrected Income and Tax Amounts.

Boxes at the top of the form are labeled

with letters. Lines 1 through 8, 17, 18, 20,

and 21 of the form are the same as

boxes 1 through 8, 17, 18, 20, and 21 of

Form W-2, Wage and Tax Statement.

Purpose of Form.—Form W-2c is used

by an employer to correct errors on

previously filed Forms W-2, W-2AS,

W-2CM, W-2GU, or W-2VI. This form can

also be used to correct Form W-2P for

tax years before 1991. Use a separate

Form W-3c, Transmittal of Corrected

Income and Tax Statements, to transmit

Forms W-2c for each type of form shown

in box a of Form W-3c.

How To File.—When making corrections,

you must use a Form W-3c to send

Forms W-2c to the Social Security

Admininstration (SSA). However, if you

are only correcting the employees’

names, addresses, or social security

numbers (SSNs), you do not have to file

Form W-3c. You must file Form W-2c

alone. Advise your employees to correct

their SSN and/or name on their original

Form W-2. To update your address of

record, see the last paragraph under

box c.

Where To File.—File only Copy A of

Form W-2c with the SSA. See Where To

File in the instructions for Form W-3c.

Distribute the remaining copies of Form

W-2c as noted on the bottom of each

form.

General Instructions

Specific Instructions

Correcting More Than One Form W-2

for an Employee.—If you are filing for an

individual who was issued more than one

Form W-2 under the same employer

identification number (EIN) for the year

being corrected, there are two ways you

can prepare a correction. You can take

into account all the Forms W-2 when

determining the amounts to be entered

Box j—Employer’s use.—This is an

optional box you may use to identify

individual forms.

Box e—Employer’s SSA number.—This

is a number beginning with “69-” that is

assigned to certain state or local

government employers. Only show this

number if years before 1987 are being

corrected. Also add the “L” indicator,

coverage group, and/or PRU number, if

these have been assigned to you by 

the SSA.

Box g—Employer’s state I.D. number.—

You are not required to complete this

item. This number is assigned by the

individual states. You may want to

complete this item if you use copies of

this form for your state returns.

Boxes k and l.—Complete items k and/or

l only if you wish to correct an

employee’s SSN or name.

Alien Residence Status Change.—If

your employee was given a new social

security card because of an adjustment

to his or her alien residence status, and

that card shows a different name or SSN

than those you showed on a Form W-2,

file Form W-2c to correct the name

and/or number. Use one Form W-2c to

correct each prior year. Advise the

employee to contact his or her local SSA

office 6 months after Form W-2c is filed,

to ensure his or her records have been

updated.

Boxes h and i.—Check the boxes in box

h as they were checked on the original

Form W-2. In box i, check the boxes as

they should have been checked. Any box

checked in error on the original should be

left blank in box i. For example: you

erroneously checked the pension plan

box on the original Form W-2. In box h,

check the pension plan box. In box i, do

not check the pension plan box.

Boxes 1–8, 17, 18, 20, and 21.—For the

items you are changing, enter in column

(a) the amount reported on the original

Form W-2. Enter in column (b) the correct

amount. Enter in column (c) the difference

between columns (a) and (b). Show any

decrease in parentheses.

Boxes 5 and 6.—Complete these boxes

to correct Medicare wages and tips and

Medicare tax withheld for 1991 and

later years. Employers should also use

these boxes to correct MQGE wages for

any year.

Blank boxes—Use these boxes to

correct the following: advance earned

income credit payments, deferred

compensation (including nonqualified plan

and section 457 distributions), dependent

care benefits, cost of group-term life

insurance coverage over $50,000,

employee business expenses, and other

fringe benefits. These boxes can also be

used to correct gross annuity, taxable

annuity, and distribution codes on Form

W-2P for tax years before 1991. Be sure

to label the items.

Boxes 17, 18, 20, and 21.—If your ONLY

changes to the original Form W-2 are to

state or local data, DO NOT send Copy A

of Form W-2c to the SSA.

Form W-2c is a six-part form. Please

make sure all copies are legible. If any

item shows a dollar change, and one of

the amounts is zero, enter -0-. Do not

leave blank. Negative amounts in column

(c) (decreases) must be shown in

parentheses.

Multiple Forms.—If a single Form W-2c

does not provide enough blank spaces

for corrections, you may use multiple

Forms W-2c.

Undeliverable Forms W-2c.—You will

need to keep for 4 years any employee

(recipient) copies of Forms W-2c that you

tried to deliver but could not.

Military Reserve Pay.—If you are

correcting military reserve pay, use

separate Forms W-2c and W-3c and note

on the Forms W-2c what wage amounts

are for active duty or active duty for

training. Do not combine these payments

with regular social security wage

payments.

Void.—Put an “X” in this box to void the

form if an error is made.

Box a—Year/Form corrected.—Enter the

year and type of form that is being

corrected. For the type of form, enter

W-2, W-2P, W-2AS, W-2CM, W-2GU, or

W-2VI. For example, 91/W-2 would

indicate that a 1991 Form W-2 was being

corrected on the Form W-2c.

Box b—Employee’s name, address, and

ZIP code.—Enter the name and address.

Include in the address the number, street,

apt. or suite no., or P. O. Box number if

mail is not delivered to a street address. If

an address is outside of the United States

or its possessions or territories, in lieu of

providing “city, town, post office, state,

and ZIP code,” the following information

is required: city, province or state, postal

code, and the name of the country. Do

not abbreviate the country name. If you

are correcting the name or address, put

an “X” in the checkbox.

Box c—Employer’s name, address, and

ZIP code.—This should be the same as

shown on your Forms 941, 942, or 943. If

you are correcting your name or address,

mark the “corrected” checkbox.

Note: A state, local, or Federal

government employer correcting only

social security wages and/or social

security tips (boxes 3 and/or 7), for a

MQGE employee, for 1991 and later

years, must also complete Medicare

wages and tips on line 5 columns (a), (b),

and (c). Enter the total Medicare wages

and tips, including MQGE-only wages,

even if there is no change to the total

Medicare wages and tips previously

reported.

Example: Two Forms W-2 were filed for

Mary Smith for tax year 1992 under the

same EIN. One form reported social

security wages of $30,000 and the

second form reported social security

wages of $20,000. A Form W-2c filed to

change $30,000 to $25,000 should show

$50,000 in column (a), $45,000 in 

column (b), and a decrease of $5,000 in

column (c).

Do not use Form W-2c to reallocate

back pay wages under statute. Contact

any SSA office for instructions.

The IRS will not use Form W-2c to

update your address of record. If you

Do not complete any of the boxes

unless you are making a change. For the

exception, see Note below.

on Form W-2c as shown in the example

below or you can file a single Form W-2c

to correct one of the multiple Forms W-2

issued for the same tax year. However,

state, local, and Federal government

employers who are preparing corrections

for employees subject to Medicare

Qualified Government Employment

(MQGE) must follow the instructions in

the Note for Boxes 5 and 6.

Printed on recycled paper

wish to change your address, complete

Form 8822, Change of Address. To get

Form 8822, or any other IRS form, call

1-800-TAX-FORM (1-800-829-3676).