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. 10-94) 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

/ W-

Year/Form corrected OMB No. 1545-0008

19 / WEmployee’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. 10-94) Statement of Corrected Income and Tax Amounts

Corrected Corrected

a Void

b c

i

Year/Form corrected OMB No. 1545-0008

19 / WEmployee’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. 10-94) Statement of Corrected Income and Tax Amounts

Corrected Corrected

a Void

b c

i

Year/Form corrected OMB No. 1545-0008

19 / WEmployee’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. 10-94) Statement of Corrected Income and Tax Amounts

Corrected Corrected

a Void

b c

i
Notice to Employee

This is a corrected Form W-2, Wage and Tax

Statement, for the tax year shown in box a. If you

have filed an income tax return for the year

shown, you may have to file an amended return.

Compare amounts on this form with those

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, with copy B of this Form

W-2c to amend the return you already filed.

If boxes h or i have any checkboxes marked,

box h will show the original information and box i

will show the corrected information.

For more information, contact your nearest

Internal Revenue Service office. Employees in

American Samoa, Guam, Commonwealth of the

Northern Mariana Islands, or the U.S. Virgin

Islands should contact their local taxing authority

for more information.

If you have not filed your return for the year

shown in box a, attach copy B of the original

Form W-2 you received from your employer and

copy B of this Form W-2c to your return when

you file it.
Year/Form corrected OMB No. 1545-0008

19 / WEmployee’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. 10-94) Statement of Corrected Income and Tax Amounts

Corrected Corrected

a Void

b c

i

Year/Form corrected OMB No. 1545-0008

19 / WEmployee’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. 10-94) 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 simpler, we would be happy to hear

from you. You can write to the Internal

Revenue Service, Attention: Tax Forms

Committee, PC:FP, Washington, DC

20224. DO NOT send this form to this

address. Instead, see Where To File

below.

Items To Note—

Purpose of Form.—Use Form W-2c to

correct errors on Forms W-2, W-2AS,

W-2CM, W-2GU, or W-2VI filed with the

Social Security Administration (SSA). Use

a separate Form W-3c for each type of

form shown in box a of Form W-3c.

How To File.— Use a Form W-3c to send

Forms W-2c to the SSA unless you are

only correcting the employees’ names,

addresses, or social security numbers

(SSNs). If these are your only corrections,

send just Form W-2c. 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.—Send the entire first

page of Copy A of Form W-2c with the

entire first page of Form W-3c (if

applicable) to the SSA. Send to the Social

Security Administration, Data Operations

Center, Wilkes-Barre, PA 18769.

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.—There are two ways

to prepare a correction for an employee

who got more than one Form W-2 under

the same employer identification number

(EIN) for the tax year. You can consider

all the Forms W-2 when determining the

amounts to enter 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. However,

state, local, and Federal government

Box j—Employer’s use.—This is an

optional box you may use to identify

individual forms or enter the date the

form is prepared.

Box e—Employer’s SSA number.—Only

State and local government employers

who have a special agreement with the

SSA can use this box. Contact your State

Social Security Administrator before

making pre-1987 tax year corrections.

Box g—Employer’s state I.D. number.—

You do not need to complete this box.

This number is assigned by the individual

states and you may want to complete the

box if you use copies of this form for your

state returns.

Boxes k and l.—Complete these boxes

only if you wish to correct an employee’s

SSN or name.

Alien Residence Status Change.—If

your employee got a new social security

card because of a change to his or her

alien residence status, and that card

shows a different name or SSN than you

showed on a Form W-2, file Form W-2c

to correct the name and/or number. Use

one Form W-2c for each prior year

corrected. Advise the employee to

contact his or her local SSA office 6

months after you file Form W-2c to be

sure his or her records are updated.

Boxes h and i.—Mark the boxes in box h

as they were checked on the original

Form W-2; in box i, mark them as they

should have been checked. In box i, leave

blank any box marked in error on the

original. For example: you marked the

pension plan box on the original Form

W-2 by mistake. Mark the pension plan

box in box h but do not mark the pension

plan box in box i.

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 enter

corrections to items on Form W-2 not

shown separately on this form. Enter the

box number, box name, and code (if

applicable) from Form W-2. Boxes and

items corrected here are advance EIC

payment, dependent care benefits,

nonqualified plans, benefits included in

box 1, uncollected social security and/or

Medicare taxes on tips, cost of

group-term life insurance coverage over

$50,000, elective deferrals (codes D–H,

box 13), sick pay not includible as

income, employee business expenses,

and other items you reported on your

employee’s original Form W-2. 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. Show negative amounts

(decreases) in column (c) in parentheses.

Multiple Forms.—If a single Form W-2c

does not provide enough blank spaces

for corrections, use additional Forms

W-2c.

Undeliverable Forms W-2c.—Keep for 4

years any employee (recipient) copies of

Forms W-2c 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.—If you make an error, mark this

box to void the form.

Box a—Year/Form corrected.—Enter the

year and type of form corrected. For the

type, enter 2, 2AS, 2CM, 2GU, or 2VI. For

example, 93/2 would show that the Form

W-2c was correcting a 1993 Form W-2.

Box b—Employee’s name, address, and

ZIP code.—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

the United States or its possessions or

territories, instead of providing city, town,

post office, state, and ZIP code, give the

following information: 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, mark the “Corrected” checkbox.

Box c—Employer’s name, address, and

ZIP code.—These 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

Medicare 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: Mary Smith received two Forms

W-2 for tax year 1993 under the same

EIN. One form incorrectly reported social

security wages of $30,000 and the

second 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 $5,000 decrease in column (c).

Do not use Form W-2c to allocate

backpay 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

wish to change your address, file Form

8822, Change of Address. To get Form

8822, or any other IRS form, call

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

Do not put an entry in any of the boxes

unless you are making a change. For the

exception, see Note below.

Printed on recycled paper

Box f—Employer’s Federal EIN.—Show

the correct number assigned to you by

the IRS (00-0000000).

Box 2—Federal income tax withheld.—

Use this box only when making

corrections because of administrative

errors.

Single Filing Address.—Send all Forms

W-2c and W-3c, Transmittal of Corrected

Income and Tax Statments, to the Social

Security Administration’s Wilkes-Barre

Data Operations Center. See Where To

File below for the address.

Date of Form W-2c.—Box j, Employer’s

use, can be used to enter the date this

form is prepared.

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.