Year and Form being corrected Employer’s use For Official

19 Use Only © /

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

Use carbon paper to make copies. 1 Employee’s correct SSN 2 Employer’s SSA number 3 Employer’s Federal EIN 4 Employer’s state I.D. number

69-

Complete 5 and/or 6 only if

incorrect on the last form you

filed. Show incorrect item here.

5 Employee’s incorrect SSN 6 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

7 © IRA/SEP 8 Corrected © IRA/SEP OMB No. 1545-0008

Expires 1-31-93

Item (a) As previously reported (b) Correct information (c) Increase (decrease)

9 Federal income tax withheld

10 Wages, tips, other comp.

11 Social security tax withheld

12 Social security wages

13 Social security tips

14 Medicare wages and tips

15 Medicare tax withheld

16a

CHANGES

16b

16c

17 Allocated tips

18

19 State wages

State tax withheld

20

21 Local wages

Local tax withheld

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. 9-91) 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

Year and Form being corrected Employer’s use

19 /

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

1 Employee’s correct SSN 2 Employer’s SSA number 3 Employer’s Federal EIN 4 Employer’s state I.D. number

69-

Complete 5 and/or 6 only if

incorrect on the last form you

filed. Show incorrect item here.

5 Employee’s incorrect SSN 6 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

7 © IRA/SEP 8 Corrected © IRA/SEP OMB No. 1545-0008

Expires 1-31-93

Item (a) As previously reported (b) Correct information (c) Increase (decrease)

9 Federal income tax withheld

10 Wages, tips, other comp.

11 Social security tax withheld

12 Social security wages

13 Social security tips

14 Medicare wages and tips

15 Medicare tax withheld

16a

CHANGES

16b

16c

17 Allocated tips

18

19 State wages

State tax withheld

20

21 Local wages

Local tax withheld

Copy 1 For State, City, or Local Tax Department

Department of the Treasury Form W-2c Internal Revenue Service (Rev. 9-91) Statement of Corrected Income and Tax Amounts

Corrected Corrected

Year and Form being corrected Employer’s use

19 /

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

1 Employee’s correct SSN 2 Employer’s SSA number 3 Employer’s Federal EIN 4 Employer’s state I.D. number

69-

Complete 5 and/or 6 only if

incorrect on the last form you

filed. Show incorrect item here.

5 Employee’s incorrect SSN 6 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

7 © IRA/SEP 8 Corrected © IRA/SEP OMB No. 1545-0008

Expires 1-31-93

Item (a) As previously reported (b) Correct information (c) Increase (decrease)

9 Federal income tax withheld

10 Wages, tips, other comp.

11 Social security tax withheld

12 Social security wages

13 Social security tips

14 Medicare wages and tips

15 Medicare tax withheld

16a

CHANGES

16b

16c

17 Allocated tips

18

19 State wages

State tax withheld

20

21 Local wages

Local tax withheld

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

Department of the Treasury Form W-2c Internal Revenue Service (Rev. 9-91) Statement of Corrected Income and Tax Amounts

Corrected Corrected

Year and Form being corrected Employer’s use

19 /

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

1 Employee’s correct SSN 2 Employer’s SSA number 3 Employer’s Federal EIN 4 Employer’s state I.D. number

69-

Complete 5 and/or 6 only if

incorrect on the last form you

filed. Show incorrect item here.

5 Employee’s incorrect SSN 6 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

7 © IRA/SEP 8 Corrected © IRA/SEP OMB No. 1545-0008

Expires 1-31-93

Item (a) As previously reported (b) Correct information (c) Increase (decrease)

9 Federal income tax withheld

10 Wages, tips, other comp.

11 Social security tax withheld

12 Social security wages

13 Social security tips

14 Medicare wages and tips

15 Medicare tax withheld

16a

CHANGES

16b

16c

17 Allocated tips

18

19 State wages

State tax withheld

20

21 Local wages

Local tax withheld

Copy C For Employee’s Records

Department of the Treasury Form W-2c Internal Revenue Service (Rev. 9-91) Statement of Corrected Income and Tax Amounts

Corrected Corrected
Notice to Employee

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

W-2P (for tax years 1990 and prior only) for the

tax year shown on the front of this form. 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

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

your filed return.

If boxes 7 or 8 have any checkboxes marked,

box 7 will show how it was reported originally and

box 8 will show the corrections. If there are any

corrections that will change your tax liability, file

Form 1040X.

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,

along with a copy of this Form W-2c, to your

return.
Year and Form being corrected Employer’s use

19 /

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

1 Employee’s correct SSN 2 Employer’s SSA number 3 Employer’s Federal EIN 4 Employer’s state I.D. number

69-

Complete 5 and/or 6 only if

incorrect on the last form you

filed. Show incorrect item here.

5 Employee’s incorrect SSN 6 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

7 © IRA/SEP 8 Corrected © IRA/SEP OMB No. 1545-0008

Expires 1-31-93

Item (a) As previously reported (b) Correct information (c) Increase (decrease)

9 Federal income tax withheld

10 Wages, tips, other comp.

11 Social security tax withheld

12 Social security wages

13 Social security tips

14 Medicare wages and tips

15 Medicare tax withheld

16a

CHANGES

16b

16c

17 Allocated tips

18

19 State wages

State tax withheld

20

21 Local wages

Local tax withheld

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. 9-91) Statement of Corrected Income and Tax Amounts

Corrected Corrected

Year and Form being corrected Employer’s use

19 /

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

1 Employee’s correct SSN 2 Employer’s SSA number 3 Employer’s Federal EIN 4 Employer’s state I.D. number

69-

Complete 5 and/or 6 only if

incorrect on the last form you

filed. Show incorrect item here.

5 Employee’s incorrect SSN 6 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

7 © IRA/SEP 8 Corrected © IRA/SEP OMB No. 1545-0008

Expires 1-31-93

Item (a) As previously reported (b) Correct information (c) Increase (decrease)

9 Federal income tax withheld

10 Wages, tips, other comp.

11 Social security tax withheld

12 Social security wages

13 Social security tips

14 Medicare wages and tips

15 Medicare tax withheld

16a

CHANGES

16b

16c

17 Allocated tips

18

19 State wages

State tax withheld

20

21 Local wages

Local tax withheld

Copy D For Employer

Department of the Treasury Form W-2c Internal Revenue Service (Rev. 9-91) Statement of Corrected Income and Tax Amounts

Corrected Corrected
Instructions for Preparing

Form W-2c

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 this

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 49

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, Washington, DC 20224,

Attention: IRS Reports Clearance

Officer, T:FP; and the Office of

Management and Budget,

Paperwork Reduction Project

(1545-0008), Washington, DC 20503.

DO NOT send this tax form to either

of these offices. Instead, see the

instructions below for information on

where to file.

Items You Should Note.—

Corrections to Form W-2P,

Statement for Recipients of

Annuities, Pensions, Retired Pay, or

IRA Payments, can be made on this

form for tax years 1990 and prior

only. Enter the gross and taxable

annuity amounts on lines 16a and

16b. Changes to distribution codes

can be shown on line 16c. Beginning

1991, annuities and pensions are

reported and corrected on Form

1099-R, Distributions From

Pensions, Annuities, Retirement or

Profit-Sharing Plans, IRAs, Insurance

Contracts, etc.

The format of this form has been

revised so that line items 9-15 are

the same as Boxes 9-15 on the

1991 Form W-2, Wage and Tax

Statement.

Purpose of Form.—Form W-2c is

used by an employer (or other payer,

in the case of Form W-2P) to correct

errors on previously filed Forms W-2,

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

W-2VI. 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 6 of Form W-3c.

Note: Section 218 filers (certain state

and local government employers)

should follow the instructions

received from their State Social

Security Administrator when

preparing corrections for years

before 1987. These corrections must

be filed with Form W-3c.

How To File.—When making

corrections, you must use a Form

W-3c to send Forms W-2c to SSA.

However, if you are only correcting the

employees’ names or social security

numbers (SSNs), you do not have to

file Form W-3c. Advise your employees

to correct their SSN and/or name on

their original Form W-2.

Where To File.—File Copy A of Form

W-2c with the Social Security

Administration (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 Information

Specific Information

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, you must take

into account all the Forms W-2 when

determining the amounts to be

entered on Form W-2c.

Example: Two Forms W-2 were filed

for Mary Smith for tax year 1989

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) and

$45,000 in column (b).

If you are correcting military reserve pay (active duty or weekly),

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

and annotate the Form W-2c to

Year And Form Being Corrected.—

Enter the year this Form W-2c is

correcting and the type of Form W-2

you are correcting. For type of form,

enter W-2, W-2P, W-2AS, W-2CM,

W-2GU, or W-2VI.

Employer’s Use.—This is an

optional item that employers may

use to identify individual forms.

Item 2—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 SSA.

Item 4—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.

Items 5 and 6.—Complete items 5

and/or 6 only if you wish to correct

an employee’s SSN or name.

Note: 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 social

security number 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 later in the year to ensure

his or her records have been

updated.

Items 7 and 8.—Check the boxes in

item 7 as they were checked on the

original Form W-2. In item 8, check

the boxes as they should have been

checked. Any box checked in error

on the original should be left blank in

item 8. For example: you erroneously

checked the pension plan box on

the original Form W-2. In item 7,

check the pension plan box. In item

8, do not check the pension plan

box.

Items 9–21.—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.

Items 14 and 15.—Complete these

lines to correct Medicare wages and

tips and Medicare tax withheld for

1991 and later years. Employers who

reported Medicare only wages for

years prior to 1991 that need to be

corrected must enter the Medicare

wages and tips in item 14 and the

Medicare tax in item 15.

Items 16a, b, and c.—Use these

lines to correct the following:

advance earned income credit

payments, taxable fringe benefits,

deferred compensation (including

nonqualified plan and section 457

distributions), dependent care

benefits, cost of group-term life

insurance coverage over $50,000,

gross annuity, taxable annuity, and

distribution codes on Form W-2P for

tax years before 1991. Be sure to

label the items.

Items 18–21.—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 SSA.

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

carbon paper to make copies.

Please make sure all copies are

legible. If any item shows a dollar

change, and one of the amounts is

zero, enter “zero” or “0.” Do not

leave blank. Negative amounts in

column (c) (decreases) must be

shown in parentheses.

Enter the employee’s and employer’s

names and addresses on the form

as indicated. Include in the

addresses the number, street, apt.,

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

mail is not delivered to street

address, city, town, state and ZIP

code. 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. Complete items 1–8

as applicable. For items 9–21,

complete only those items that are

being corrected. Otherwise, leave

blank. For descriptions of individual

items, see the Instructions for Form

W-2.

Line items for Medicare wages

and tips and Medicare tax withheld

were added to this form.

show what wage amounts are for

active duty or for active duty for

training. Do not combine these

payments with regular social security

wage payments.