Attention: 

This form is provided for informational purposes only. Copy A appears in red, similar to the 

official IRS form. Do not file copy A downloaded from this website with the SSA. The official 

printed version of this IRS form is scannable, but the online version of it, printed from this 

website, is not. A penalty may be imposed for filing forms that can’t be scanned. See the 

penalties section in the current General Instructions for Forms W-2 and W-3 for more 

information. 

To order official IRS forms, call 1-800-TAX-FORM (1-800-829-3676) or Order Information 

Returns and Employer Returns Online, and we’ll mail you the scannable forms and other 

products. 

You may file Forms W-2 and W-3 electronically on the SSA’s website at Employer 

Reporting Instructions & Information. You can create fill-in versions of Forms W-2 and W-3 

for filing with SSA. You may also print out copies for filing with state or local governments, 

distribution to your employees, and for your records. 

See IRS Publications 1141, 1167, 1179 and other IRS resources for information about 

printing these tax forms. 
Retirement

plan

Third-party

sick pay

Statutory

employee

Employee’s first name and initial

13

Copy A—For Social Security Administration

Department of the Treasury

Internal Revenue Service Form W-2c Cat. No. 61437D Corrected Wage and Tax Statement

44444 OMB No. 1545-0008

For Official Use Only 

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

a Employer’s name, address, and ZIP code c Tax year/Form corrected

g Employee’s previously reported name

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. 2-2009)

Complete boxes f and/or g only if incorrect on form previously filed

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

(exception: for corrections involving MQGE, see the Instructions

for Forms W-2c and W-3c, boxes 5 and 6).

f Employee’s previously reported SSN

9 Advance EIC payment 9 Advance EIC payment 10 Dependent care benefits 10 Dependent care benefits

11 Nonqualified plans 11 Nonqualified plans 12a See instructions for box 12 12a See instructions for box 12 C

o

d

e

C

o

d

e

12c 12c

C

o

d

e

C

o

d

e

12b 12b

C

o

d

e

C

o

d

e

12d 12d

C

o

d

e

C

o

d

e

15

16 State wages, tips, etc. 16 State wages, tips, etc. 16 State wages, tips, etc. 16 State wages, tips, etc.

17 State income tax 17 State income tax 17 State income tax 17 State income tax

18 Local wages, tips, etc. 18 Local wages, tips, etc. 18 Local wages, tips, etc. 18 Local wages, tips, etc.

19 Local income tax 19 Local income tax 19 Local income tax 19 Local income tax

20 Locality name 20 Locality name 20 Locality name 20 Locality name

State 15 State 15 State 15 State

State Correction Information

Locality Correction Information

14 Other (see instructions) 14 Other (see instructions)



Employer’s state ID number Employer’s state ID number Employer’s state ID number Employer’s state ID number

h Last name

i Employee’s address and ZIP code

DO NOT CUT, FOLD, OR STAPLE THIS FORM

Previously reported Correct information Previously reported Correct information

Suff.

Previously reported Correct information Previously reported Correct information

b Employer’s Federal EIN

e Corrected SSN and/or name (Check this box and complete boxes f and/or

g if incorrect on form previously filed.)

d Employee’s correct SSN

/ W-2
Copy 1—State, City, or Local Tax Department

Department of the Treasury

Internal Revenue Service Form W-2c (Rev. 2-2009) Corrected Wage and Tax Statement

Retirement

plan

Third-party

sick pay

Statutory

employee

Employee’s first name and initial

13

44444 OMB No. 1545-0008

For Official Use Only 

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

a Employer’s name, address, and ZIP code c Tax year/Form corrected

g Employee’s previously reported name

Retirement

plan

Third-party

sick pay

Statutory

employee

Previously reported Correct information Previously reported Correct information

Complete boxes f and/or g only if incorrect on form previously filed

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

(exception: for corrections involving MQGE, see the Instructions

for Forms W-2c and W-3c, boxes 5 and 6).

f Employee’s previously reported SSN

9 Advance EIC payment 9 Advance EIC payment 10 Dependent care benefits 10 Dependent care benefits

11 Nonqualified plans 11 Nonqualified plans 12a See instructions for box 12 12a See instructions for box 12 C

o

d

e

C

o

d

e

12c 12c

C

o

d

e

C

o

d

e

12b 12b

C

o

d

e

C

o

d

e

12d 12d

C

o

d

e

C

o

d

e

15

16 State wages, tips, etc. 16 State wages, tips, etc. 16 State wages, tips, etc. 16 State wages, tips, etc.

17 State income tax 17 State income tax 17 State income tax 17 State income tax

18 Local wages, tips, etc. 18 Local wages, tips, etc. 18 Local wages, tips, etc. 18 Local wages, tips, etc.

19 Local income tax 19 Local income tax 19 Local income tax 19 Local income tax

20 Locality name 20 Locality name 20 Locality name 20 Locality name

State 15 State 15 State 15 State

State Correction Information

Locality Correction Information

14 Other (see instructions) 14 Other (see instructions)



Employer’s state ID number Employer’s state ID number Employer’s state ID number Employer’s state ID number

h Last name

i Employee’s address and ZIP code

Previously reported Correct information Previously reported Correct information

Suff.

Previously reported Correct information Previously reported Correct information

b Employer’s Federal EIN

e Corrected SSN and/or name (Check this box and complete boxes f and/or

g if incorrect on form previously filed.)

d Employee’s correct SSN

/ W-2
Safe, accurate,

FAST! Use

Visit the IRS website

at www.irs.gov.

Copy B—To Be Filed with Employee’s FEDERAL Tax Return

Department of the Treasury

Internal Revenue Service Form W-2c (Rev. 2-2009) Corrected Wage and Tax Statement

Retirement

plan

Third-party

sick pay

Statutory

employee

Employee’s first name and initial

13

44444 OMB No. 1545-0008

For Official Use Only 

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

a Employer’s name, address, and ZIP code c Tax year/Form corrected

g Employee’s previously reported name

Retirement

plan

Third-party

sick pay

Statutory

employee

Previously reported Correct information Previously reported Correct information

Complete boxes f and/or g only if incorrect on form previously filed

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

(exception: for corrections involving MQGE, see the Instructions

for Forms W-2c and W-3c, boxes 5 and 6).

f Employee’s previously reported SSN

9 Advance EIC payment 9 Advance EIC payment 10 Dependent care benefits 10 Dependent care benefits

11 Nonqualified plans 11 Nonqualified plans 12a See instructions for box 12 12a See instructions for box 12 C

o

d

e

C

o

d

e

12c 12c

C

o

d

e

C

o

d

e

12b 12b

C

o

d

e

C

o

d

e

12d 12d

C

o

d

e

C

o

d

e

15

16 State wages, tips, etc. 16 State wages, tips, etc. 16 State wages, tips, etc. 16 State wages, tips, etc.

17 State income tax 17 State income tax 17 State income tax 17 State income tax

18 Local wages, tips, etc. 18 Local wages, tips, etc. 18 Local wages, tips, etc. 18 Local wages, tips, etc.

19 Local income tax 19 Local income tax 19 Local income tax 19 Local income tax

20 Locality name 20 Locality name 20 Locality name 20 Locality name

State 15 State 15 State 15 State

State Correction Information

Locality Correction Information

14 Other (see instructions) 14 Other (see instructions)



Employer’s state ID number Employer’s state ID number Employer’s state ID number Employer’s state ID number

h Last name

i Employee’s address and ZIP code

Previously reported Correct information Previously reported Correct information

Suff.

Previously reported Correct information Previously reported Correct information

b Employer’s Federal EIN

e Corrected SSN and/or name (Check this box and complete boxes f and/or

g if incorrect on form previously filed.)

d Employee’s correct SSN

/ W-2
Safe, accurate,

FAST! Use

Visit the IRS website

at www.irs.gov.

Copy C—For EMPLOYEE’s RECORDS

Department of the Treasury

Internal Revenue Service Form W-2c (Rev. 2-2009) Corrected Wage and Tax Statement

Retirement

plan

Third-party

sick pay

Statutory

employee

Employee’s first name and initial

13

44444 OMB No. 1545-0008

For Official Use Only 

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

a Employer’s name, address, and ZIP code c Tax year/Form corrected

g Employee’s previously reported name

Retirement

plan

Third-party

sick pay

Statutory

employee

Previously reported Correct information Previously reported Correct information

Complete boxes f and/or g only if incorrect on form previously filed

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

(exception: for corrections involving MQGE, see the Instructions

for Forms W-2c and W-3c, boxes 5 and 6).

f Employee’s previously reported SSN

9 Advance EIC payment 9 Advance EIC payment 10 Dependent care benefits 10 Dependent care benefits

11 Nonqualified plans 11 Nonqualified plans 12a See instructions for box 12 12a See instructions for box 12 C

o

d

e

C

o

d

e

12c 12c

C

o

d

e

C

o

d

e

12b 12b

C

o

d

e

C

o

d

e

12d 12d

C

o

d

e

C

o

d

e

15

16 State wages, tips, etc. 16 State wages, tips, etc. 16 State wages, tips, etc. 16 State wages, tips, etc.

17 State income tax 17 State income tax 17 State income tax 17 State income tax

18 Local wages, tips, etc. 18 Local wages, tips, etc. 18 Local wages, tips, etc. 18 Local wages, tips, etc.

19 Local income tax 19 Local income tax 19 Local income tax 19 Local income tax

20 Locality name 20 Locality name 20 Locality name 20 Locality name

State 15 State 15 State 15 State

State Correction Information

Locality Correction Information

14 Other (see instructions) 14 Other (see instructions)



Employer’s state ID number Employer’s state ID number Employer’s state ID number Employer’s state ID number

h Last name

i Employee’s address and ZIP code

Previously reported Correct information Previously reported Correct information

Suff.

Previously reported Correct information Previously reported Correct information

b Employer’s Federal EIN

e Corrected SSN and/or name (Check this box and complete boxes f and/or

g if incorrect on form previously filed.)

d Employee’s correct SSN

/ W-2
Notice to Employee

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

(or Form W-2AS, W-2CM, W-2GU, W-2VI or W-2c) for

the tax year shown in box c. 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 c, 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.
Copy 2—To Be Filed with Employee’s State, City, or Local Income Tax Return

Department of the Treasury

Internal Revenue Service Form W-2c (Rev. 2-2009) Corrected Wage and Tax Statement

Retirement

plan

Third-party

sick pay

Statutory

employee

Employee’s first name and initial

13

44444 OMB No. 1545-0008

For Official Use Only 

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

a Employer’s name, address, and ZIP code c Tax year/Form corrected

g Employee’s previously reported name

Retirement

plan

Third-party

sick pay

Statutory

employee

Previously reported Correct information Previously reported Correct information

Complete boxes f and/or g only if incorrect on form previously filed

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

(exception: for corrections involving MQGE, see the Instructions

for Forms W-2c and W-3c, boxes 5 and 6).

f Employee’s previously reported SSN

9 Advance EIC payment 9 Advance EIC payment 10 Dependent care benefits 10 Dependent care benefits

11 Nonqualified plans 11 Nonqualified plans 12a See instructions for box 12 12a See instructions for box 12 C

o

d

e

C

o

d

e

12c 12c

C

o

d

e

C

o

d

e

12b 12b

C

o

d

e

C

o

d

e

12d 12d

C

o

d

e

C

o

d

e

15

16 State wages, tips, etc. 16 State wages, tips, etc. 16 State wages, tips, etc. 16 State wages, tips, etc.

17 State income tax 17 State income tax 17 State income tax 17 State income tax

18 Local wages, tips, etc. 18 Local wages, tips, etc. 18 Local wages, tips, etc. 18 Local wages, tips, etc.

19 Local income tax 19 Local income tax 19 Local income tax 19 Local income tax

20 Locality name 20 Locality name 20 Locality name 20 Locality name

State 15 State 15 State 15 State

State Correction Information

Locality Correction Information

14 Other (see instructions) 14 Other (see instructions)



Employer’s state ID number Employer’s state ID number Employer’s state ID number Employer’s state ID number

h Last name

i Employee’s address and ZIP code

Previously reported Correct information Previously reported Correct information

Suff.

Previously reported Correct information Previously reported Correct information

b Employer’s Federal EIN

e Corrected SSN and/or name (Check this box and complete boxes f and/or

g if incorrect on form previously filed.)

d Employee’s correct SSN

/ W-2
Copy D—For Employer

Department of the Treasury

Internal Revenue Service Form W-2c (Rev. 2-2009) Corrected Wage and Tax Statement

Retirement

plan

Third-party

sick pay

Statutory

employee

Employee’s first name and initial

13

44444 OMB No. 1545-0008

For Official Use Only 

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

a Employer’s name, address, and ZIP code c Tax year/Form corrected

g Employee’s previously reported name

Retirement

plan

Third-party

sick pay

Statutory

employee

Previously reported Correct information Previously reported Correct information

Complete boxes f and/or g only if incorrect on form previously filed

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

(exception: for corrections involving MQGE, see the Instructions

for Forms W-2c and W-3c, boxes 5 and 6).

f Employee’s previously reported SSN

9 Advance EIC payment 9 Advance EIC payment 10 Dependent care benefits 10 Dependent care benefits

11 Nonqualified plans 11 Nonqualified plans 12a See instructions for box 12 12a See instructions for box 12 C

o

d

e

C

o

d

e

12c 12c

C

o

d

e

C

o

d

e

12b 12b

C

o

d

e

C

o

d

e

12d 12d

C

o

d

e

C

o

d

e

15

16 State wages, tips, etc. 16 State wages, tips, etc. 16 State wages, tips, etc. 16 State wages, tips, etc.

17 State income tax 17 State income tax 17 State income tax 17 State income tax

18 Local wages, tips, etc. 18 Local wages, tips, etc. 18 Local wages, tips, etc. 18 Local wages, tips, etc.

19 Local income tax 19 Local income tax 19 Local income tax 19 Local income tax

20 Locality name 20 Locality name 20 Locality name 20 Locality name

State 15 State 15 State 15 State

State Correction Information

Locality Correction Information

14 Other (see instructions) 14 Other (see instructions)



Employer’s state ID number Employer’s state ID number Employer’s state ID number Employer’s state ID number

h Last name

i Employee’s address and ZIP code

Previously reported Correct information Previously reported Correct information

Suff.

Previously reported Correct information Previously reported Correct information

b Employer’s Federal EIN

e Corrected SSN and/or name (Check this box and complete boxes f and/or

g if incorrect on form previously filed.)

d Employee’s correct SSN

/ W-2
Employers, Please Note:

Specific information needed to complete Form W-2c is

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

W-3c. 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

website at www.irs.gov. Electronic filing of Form W-2c is

preferred. For information on how to file electronically,

go to the Social Security Administration website at

www.socialsecurity.gov/employer.