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 Corrected © j Hshld.

emp. © 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. 7-97) Corrected Wage and Tax Statement

Cat. No. 61437D Please do not staple.

Corrected Name

Do NOT Cut or Separate Forms on This Page

a Void

b c

i

/ W-2

Hshld.

emp.

Year/Form corrected OMB No. 1545-0008

19 / W-2

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 Corrected © j Hshld.

emp. © 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. 7-97) Corrected Wage and Tax Statement

Corrected Name

a Void

b c

i Hshld.

emp.

Year/Form corrected OMB No. 1545-0008

19 / W-2

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 Corrected © j Hshld.

emp. © 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. 7-97) Corrected Wage and Tax Statement

Corrected Name

a Void

b c

i Hshld.

emp.

Year/Form corrected OMB No. 1545-0008

19 / W-2

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 Corrected © j Hshld.

emp. © 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. 7-97) Corrected Wage and Tax Statement

Corrected Name

a Void

b c

i Hshld.

emp.
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 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, Commonwealth of the Northern

Mariana Islands, Guam, 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 / W-2

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 Corrected © j Hshld.

emp. © 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. 7-97) Corrected Wage and Tax Statement

Corrected Name

a Void

b c

i Hshld.

emp.

Year/Form corrected OMB No. 1545-0008

19 / W-2

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 Corrected © j Hshld.

emp. © 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. 7-97) Corrected Wage and Tax Statement

Corrected Name

a Void

b c

i Hshld.

emp.
General 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 Tax Forms

Committee, Western Area Distribution

Center, Rancho Cordova, CA 95743-0001.

DO NOT send the tax form to this address.

Instead, see New filing address for Forms

W-2c and W-3c only above.

New filing address for Forms W-2c and

W-3c only. If you use the U.S. Postal

Service, send Forms W-2c and W-3c,

Transmittal of Corrected Wage and Tax

Statements, to:

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). Also use Form

W-2c to provide corrected Forms W-2,

W-2AS, W-2CM, W-2GU, or W-2VI to

employees.

How to file. Use a Form W-3c to send

Forms W-2c to the SSA unless you are

correcting only the employees’ names,

addresses, or social security numbers

(SSNs).

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 (1) consider all the

Forms W-2 when determining the amounts

to enter on Form W-2c, as shown in the

example below, or (2) file a single Form

W-2c to correct one of the multiple Forms

W-2 issued. However, state, local, and

Federal government employers who are

preparing corrections for employees subject

to Medicare Qualified Government

Employment (MQGE) must follow the

instructions in the Note under Boxes 5

and 6 below.

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 that

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.

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 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 a separate Form

W-2c to correct each prior year. Advise the

employee to contact the local SSA office no

earlier than 9 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 marked on the original Form W-2;

in box i, mark them as they should have

been marked. For example, if 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. Employers should

also use these boxes to correct MQGE

wages for any year.

Blank boxes. Use these boxes to correct

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. Use

these boxes to correct an 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, and S, box

13), sick pay not includible as income,

employee business expenses, and any other

item 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. Just send Form

W-2c to the appropriate state or local

agency, and furnish copies to your

employees.

Please make sure all copies of Form

W-2c are legible. If any item shows a dollar

change and one of the amounts is zero,

enter -0-. Do not leave the box 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 copies of Forms W-2c

you tried to deliver but could not.

Void. If you make an error in completing

a Form W-2c, mark the VOID box to void

the form. Go to the next form on the

page, or use another page of Forms

W-2c, and enter the correct information.

Submit the entire page even if only one of

the forms on the page is correct.

Box a—Year/Form corrected. If you are

correcting Form W-2, enter only the last two

digits of the year of the form you are

correcting. If you are correcting Form

W-2AS, W-2CM, W-2GU, or W-2VI, enter the

last two digits of the year you are correcting,

and also enter AS, CM, GU, or VI to

designate the form you are correcting. For

example, 96 and GU shows that you are

correcting a 1996 Form W-2GU.

Box b—Employee’s name, address, and

ZIP code. Enter the employee’s correct

name and address. If you are correcting the

name, mark the “Corrected Name” checkbox

and also complete box l.

Box c—Employer’s name, address, and

ZIP code. These should be the same as

shown on your Forms 941, 943, CT-1, or

Schedule H.

Note: A state, local, or Federal government

employer correcting only social security

wages and/or social security tips (boxes 3

and/or 7), for an MQGE employee, for 1991

and later years, must also complete

Medicare wages and tips in box 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.

Method (1) example: Mary Smith received

two Forms W-2 for tax year 1996 under the

same EIN. One form incorrectly reported

social security wages of $30,000 and the

second reported social security wages of

Do not use Form W-2c to report back

pay. See Pub. 957, Reporting Back Pay and

Special Wage Payments to the Social

Security Administration, and Form SSA-131,

Employer Report of Special Wage Payments.

The IRS will not use Form W-2c to

update your address of record. 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 make an entry in any box unless

you are making a change.

Box f—Employer’s Federal EIN. Show the

correct EIN assigned to you by the IRS

(00-0000000).

Box 2—Federal income tax withheld. Use

this box only to make corrections because

of administrative errors. If correcting Forms

W-2AS, W-2CM, W-2GU, or W-2VI, box 2 is

for income tax withheld for the applicable

possession.

You are not required to provide the

information requested on a form that is

subject to the Paperwork Reduction Act

unless the form displays a valid OMB control

number. Books or records relating to a form

or its instructions must be retained as long

as their contents may become material in

the administration of any Internal Revenue

law. Generally, tax returns and return

information are confidential, as required by

Code section 6103.

Social Security Administration

Data Operations Center

P.O. Box 3333

Wilkes-Barre, PA 18767-3333.

If you use a carrier other than the U.S.

Postal Service, send Forms W-2c and W-3c

to:

Social Security Administration

Data Operations Center

Attn: W-2c Process

1150 E. Mountain Drive

Wilkes-Barre, PA 18702-7997.

Repayments. If an employee repays you for

wages received in error in a prior year, file

Form W-2c only to correct social security

and Medicare wages and tax. The wages

reported in box 1 cannot be corrected for a

repayment for a prior year.

Box d—Employee’s correct SSN. You must

enter the employee’s correct SSN even if it

was correct on the original Form W-2.

Correcting employees’ names,

addresses, and/or SSNs only. If you are

correcting only the employees’ names,

addresses, and/or SSNs, send Form W-2c

only without Form W-3c. Complete Form

W-2c through box l, as appropriate; do not

complete the CHANGES area (boxes 1

through 21). Advise your employees to

correct their SSN and/or name on their

original Form W-2.

Magnetic media reporting. To submit

Forms W-2c on magnetic media, contact the

Social Security magnetic media coordinator

for your state. Call 1-800-SSA-1213 for your

coordinator’s phone number. Forms W-2c

are not required to be filed on magnetic

media.

$20,000. A Form W-2c filed to change

$30,000 to $25,000 (correct amount) should

show $50,000 in column (a), $45,000 in

column (b), and a $5,000 decrease in

column (c).