Tax year/Form corrected

Retirement

plan

Third-party 

sick pay

Statutory

employee

Employee’s name, address, and ZIP code

13

Employee’s correct SSN

Employee’s incorrect SSN

Copy A—For Social Security Administration

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 Cat. No. 61437D

a

b

d

g

Void

W-2c Corrected Wage and Tax Statement

44444

OMB No. 1545-0008

For Official Use Only 

/ W-2

1

6

2

7 8 Allocated tips

Wages, tips, other compensation Federal income tax withheld

3 Social security wages 4 Social security tax withheld

Medicare wages and tips

Social security tips

5 Medicare tax withheld

c Employer’s name, address, and ZIP code

e Employer’s Federal EIN f Employer’s state ID number

h Employee’s name (as incorrectly shown on previous form)

Retirement

plan

Third-party 

sick pay

Statutory

employee

Previously reported Correct information Previously reported Correct information

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

(Rev. 12-2001)

Complete boxes g and/or h (below)

only if incorrect on last form filed.

Corrected name

(if checked, also

complete box h)

1

7

Wages, tips, other compensation

3 Social security wages

Medicare wages and tips

Social security tips

5 6

2

8 Allocated tips

Federal income tax withheld

4 Social security tax withheld

Medicare tax withheld

13

Note: Only complete money fields that are

being corrected (except MQGE).
Tax year/Form corrected

Retirement

plan

Third-party 

sick pay

Statutory

employee

Employee’s name, address, and ZIP code

13

Employee’s correct SSN

Employee’s incorrect SSN

Copy 1—For State, City, or Local

Tax Department

Department of the Treasury

Internal Revenue Service

Form

a

b

d

g

W-2c Corrected Wage and Tax Statement

OMB No. 1545-0008 / W-2

1

6

2

7 8 Allocated tips

Wages, tips, other compensation Federal income tax withheld

3 Social security wages 4 Social security tax withheld

Medicare wages and tips

Social security tips

5 Medicare tax withheld

c Employer’s name, address, and ZIP code

e Employer’s Federal EIN f Employer’s state ID number

h Employee’s name (as incorrectly shown on previous form)

Retirement

plan

Third-party 

sick pay

Statutory

employee

Previously reported Correct information Previously reported Correct information

(Rev. 12-2001)

Complete boxes g and/or h (below)

only if incorrect on last form filed.

Corrected name

(if checked, also

complete box h)

1

7

Wages, tips, other compensation

3 Social security wages

Medicare wages and tips

Social security tips

5 6

2

8 Allocated tips

Federal income tax withheld

4 Social security tax withheld

Medicare tax withheld

13
Tax year/Form corrected

Retirement

plan

Third-party 

sick pay

Statutory

employee

Employee’s name, address, and ZIP code

13

Employee’s correct SSN

Employee’s incorrect SSN

Copy B—To Be Filed With Employee’s

FEDERAL Tax Return

Department of the Treasury

Internal Revenue Service

Form

a

b

d

g

W-2c Corrected Wage and Tax Statement

OMB No. 1545-0008 / W-2

1

6

2

7 8 Allocated tips

Wages, tips, other compensation Federal income tax withheld

3 Social security wages 4 Social security tax withheld

Medicare wages and tips

Social security tips

5 Medicare tax withheld

c Employer’s name, address, and ZIP code

e Employer’s Federal EIN f Employer’s state ID number

h Employee’s name (as incorrectly shown on previous form)

Retirement

plan

Third-party 

sick pay

Statutory

employee

Previously reported Correct information Previously reported Correct information

(Rev. 12-2001)

Complete boxes g and/or h (below)

only if incorrect on last form filed.

Corrected name

Safe, accurate,

FAST! Use

Visit the IRS Web Site

at www.irs.gov.

(if checked, also

complete box h)

1

7

Wages, tips, other compensation

3 Social security wages

Medicare wages and tips

Social security tips

5 6

2

8 Allocated tips

Federal income tax withheld

4 Social security tax withheld

Medicare tax withheld

13
Tax year/Form corrected

Retirement

plan

Third-party 

sick pay

Statutory

employee

Employee’s name, address, and ZIP code

13

Employee’s correct SSN

Employee’s incorrect SSN

Copy C—For EMPLOYEE’S RECORDS

Department of the Treasury

Internal Revenue Service

Form

a

b

d

g

W-2c Corrected Wage and Tax Statement

OMB No. 1545-0008 / W-2

1

6

2

7 8 Allocated tips

Wages, tips, other compensation Federal income tax withheld

3 Social security wages 4 Social security tax withheld

Medicare wages and tips

Social security tips

5 Medicare tax withheld

c Employer’s name, address, and ZIP code

e Employer’s Federal EIN f Employer’s state ID number

h Employee’s name (as incorrectly shown on previous form)

Retirement

plan

Third-party 

sick pay

Statutory

employee

Previously reported Correct information Previously reported Correct information

(Rev. 12-2001)

Complete boxes g and/or h (below)

only if incorrect on last form filed.

Corrected name

Safe, accurate,

FAST! Use

Visit the IRS Web Site

at www.irs.gov.

(if checked, also

complete box h)

1

7

Wages, tips, other compensation

3 Social security wages

Medicare wages and tips

Social security tips

5 6

2

8 Allocated tips

Federal income tax withheld

4 Social security tax withheld

Medicare tax withheld

13
Notice to Employee

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

(or Form W-2AS, W-2CM, W-2GU, or W-2VI) 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 U.S. income tax, 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 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.

For more information, contact your nearest Internal

Revenue Service office. Employees in American Samoa,

Commonwealth of the Northern Mariana Islands, Guam,

or the U.S. Virgin Islands should contact their local

taxing authority for more information.
Tax year/Form corrected

Retirement

plan

Third-party 

sick pay

Statutory

employee

Employee’s name, address, and ZIP code

13

Employee’s correct SSN

Employee’s incorrect SSN

Copy 2—To Be Filed With Employee’s

State, City, or Local Income

Tax Return

Department of the Treasury

Internal Revenue Service

Form

a

b

d

g

W-2c Corrected Wage and Tax Statement

OMB No. 1545-0008 / W-2

1

6

2

7 8 Allocated tips

Wages, tips, other compensation Federal income tax withheld

3 Social security wages 4 Social security tax withheld

Medicare wages and tips

Social security tips

5 Medicare tax withheld

c Employer’s name, address, and ZIP code

e Employer’s Federal EIN f Employer’s state ID number

h Employee’s name (as incorrectly shown on previous form)

Retirement

plan

Third-party 

sick pay

Statutory

employee

Previously reported Correct information Previously reported Correct information

(Rev. 12-2001)

Complete boxes g and/or h (below)

only if incorrect on last form filed.

Corrected name

(if checked, also

complete box h)

1

7

Wages, tips, other compensation

3 Social security wages

Medicare wages and tips

Social security tips

5 6

2

8 Allocated tips

Federal income tax withheld

4 Social security tax withheld

Medicare tax withheld

13
Tax year/Form corrected

Retirement

plan

Third-party 

sick pay

Statutory

employee

Employee’s name, address, and ZIP code

13

Employee’s correct SSN

Employee’s incorrect SSN

Copy D—For Employer

Department of the Treasury

Internal Revenue Service Form

a

b

d

g

Void

W-2c Corrected Wage and Tax Statement

OMB No. 1545-0008 / W-2

1

6

2

7 8 Allocated tips

Wages, tips, other compensation Federal income tax withheld

3 Social security wages 4 Social security tax withheld

Medicare wages and tips

Social security tips

5 Medicare tax withheld

c Employer’s name, address, and ZIP code

e Employer’s Federal EIN f Employer’s state ID number

h Employee’s name (as incorrectly shown on previous form)

Retirement

plan

Third-party 

sick pay

Statutory

employee

Previously reported Correct information Previously reported Correct information

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

(Rev. 12-2001)

Complete boxes g and/or h (below)

only if incorrect on last form filed.

Corrected name

(if checked, also

complete box h)

h

1

7

Wages, tips, other compensation

3 Social security wages

Medicare wages and tips

Social security tips

5 6

2

8 Allocated tips

Federal income tax withheld

4 Social security tax withheld

Medicare tax withheld

13
Employers, Please Note:

Specific information needed to complete Form W-2c is

given in the separate Instructions for Forms W-2c and

W-3c (December 2001). 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 Web Site at www.irs.gov.