Year/Form corrected Employer’s use For Official

19 Use Only © /

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

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. 11-92) 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

Void

Year/Form 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

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. 11-92) Statement of Corrected Income and Tax Amounts

Corrected Corrected

Void

Year/Form 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

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. 11-92) Statement of Corrected Income and Tax Amounts

Corrected Corrected

Void

Year/Form 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

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. 11-92) Statement of Corrected Income and Tax Amounts

Corrected Corrected

Void
Notice to Employee

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

the tax year shown on the front of this form. This

form can also be used to correct Form W-2P for

tax years 1990 and prior. 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.

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/Form 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

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. 11-92) Statement of Corrected Income and Tax Amounts

Corrected Corrected

Void

Year/Form 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

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

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. 11-92) Statement of Corrected Income and Tax Amounts

Corrected Corrected

Void

filed. Show incorrect item here.
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 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, 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 Where

To File, below.

Items You Should Note.— A box

has been added to void Form W-2c

if an error has been made on one

Form W-2c on the page.

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.

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. You must file Form

W-2c alone. 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 1991

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).

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 six months after Form

W-2c is filed, 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, 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 lines 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.

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. 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.

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 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. 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.

If a single Form W-2c does not

provide enough item 16 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 for

active duty for training. Do not

combine these payments with

regular social security wage

payments.

Year/Form 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.

Void.—Put an “X” in this box to void

the form if an error is made.