DO NOT CUT, FOLD, OR STAPLE THIS FORM
44444
For Official Use Only
▶
OMB No. 1545-0008
a Employer’s name, address, and ZIP code
b Employer's Federal EIN
c Tax year/Form corrected
/ W-2
d Employee’s correct SSN
e Corrected SSN and/or name (Check this box and complete boxes f and/or
g if incorrect on form previously filed.)
Complete boxes f and/or g only if incorrect on form previously filed
▶
f Employee’s previously reported SSN
g Employee’s previously reported name
h Employee’s first name and initial Last name Suff.
i Employee’s address and ZIP code
Note. Only complete money fields that are being corrected (exception: for
corrections involving MQGE, see the General Instructions for Forms W-2
and W-3, under Specific Instructions for Form W-2c, boxes 5 and 6).
Previously reported
1 Wages, tips, other compensation
Correct information
1 Wages, tips, other compensation
Previously reported
2 Federal income tax withheld
Correct information
2 Federal income tax withheld
3 Social security wages 3 Social security wages 4 Social security tax withheld 4 Social security tax withheld
5 Medicare wages and tips 5 Medicare wages and tips 6 Medicare tax withheld 6 Medicare tax withheld
7 Social security tips 7 Social security tips
8 Allocated tips 8 Allocated tips
9
9
10 Dependent care benefits 10 Dependent care benefits
11 Nonqualified plans 11 Nonqualified plans
12a See instructions for box 12
C
o
d
e
12a See instructions for box 12
C
o
d
e
12b
C
o
d
e
12b
C
o
d
e
12c
C
o
d
e
12c
C
o
d
e
12d
C
o
d
e
12d
C
o
d
e
13
Statutory
employee
Retirement
plan
Third-party
sick pay
13
Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other (see instructions) 14 Other (see instructions)
State Correction Information
Previously reported
15 State
Correct information
15 State
Previously reported
15 State
Correct information
15 State
Employer’s state ID number Employer’s state ID number Employer’s state ID number Employer’s state ID number
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
Locality Correction Information
Previously reported
18 Local wages, tips, etc.
Correct information
18 Local wages, tips, etc.
Previously reported
18 Local wages, tips, etc.
Correct information
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
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Copy A—For Social Security Administration
Form W-2c (Rev. 8-2014)
Corrected Wage and Tax Statement
Cat. No. 61437D
Department of the Treasury
Internal Revenue Service