DO NOT CUT, FOLD, OR STAPLE
55555
a Tax year/Form corrected
/ W-
For Official Use Only
▶
OMB No. 1545-0008
b Employer’s name, address, and ZIP code c
Kind of Payer (Check one)
941/941-SS Military 943 944
CT-1
Hshld.
emp.
Medicare
govt. emp.
Kind of Employer (Check one)
None apply 501c non-govt.
State/local
non-501c
State/local
501c
Federal
govt.
Third-party
sick pay
(Check if
applicable)
d Number of Forms W-2c e Employer’s Federal EIN f Establishment number g Employer’s state ID number
Complete boxes h, i, or j only if
incorrect on last form filed.
h
Employer’s originally reported Federal EIN
i Incorrect establishment number j
Employer's incorrect state ID number
Total of amounts previously reported
as shown on enclosed Forms W-2c.
1 Wages, tips, other compensation
Total of corrected amounts as
shown on enclosed Forms W-2c.
1 Wages, tips, other compensation
Total of amounts previously reported
as shown on enclosed Forms W-2c.
2 Federal income tax withheld
Total of corrected amounts as
shown on enclosed Forms W-2c.
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 Deferred compensation 12a Deferred compensation
12b 12b
14
Inc. tax w/h by third-party sick pay payer
14
Inc. tax w/h by third-party sick pay payer
16 State wages, tips, etc. 16 State wages, tips, etc. 17 State income tax 17 State income tax
18 Local wages, tips, etc. 18 Local wages, tips, etc. 19 Local income tax 19 Local income tax
Explain decreases here:
Has an adjustment been made on an employment tax return filed with the Internal Revenue Service?
Yes No
If “Yes,” give date the return was filed
▶
Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it is true,
correct, and complete.
Signature
▶
Title
▶
Date
▶
Employer's contact person Employer's telephone number
For Official Use Only
Employer's fax number Employer's email address
Form W-3c (Rev. 11-2015)
Transmittal of Corrected Wage and Tax Statements
Department of the Treasury
Internal Revenue Service
Purpose of Form
Use this form to transmit Copy A of the most recent version of Form(s) W-2c,
Corrected Wage and Tax Statement. Make a copy of Form W-3c and keep it with
Copy D (For Employer) of Forms W-2c for your records. File Form W-3c even if
only one Form W-2c is being filed or if those Forms W-2c are being filed only to
correct an employee’s name and social security number (SSN) or the employer
identification number (EIN). See the General Instructions for Forms W-2 and W-3
for information on completing this form.
E-Filing
The SSA strongly suggests employers report Form W-3c and Forms W-2c Copy A
electronically instead of on paper. The SSA provides two free e-filing options on its
Business Services Online (BSO) website:
• W-2c Online. Use fill-in forms to create, save, print, and submit up to 25 Forms
W-2c at a time to the SSA.
• File Upload. Upload wage files to the SSA you have created using payroll or tax
software that formats the files according to the SSA’s Specifications for Filing
Forms W-2c Electronically (EFW2C).
For more information, go to www.socialsecurity.gov/employer. First time filers,
select "Go to Register"; returning filers select "Go To Log In."
When To File
File this form and Copy A of Form(s) W-2c with the Social Security Administration
as soon as possible after you discover an error on Forms W-2, W-2AS, W-2GU,
W-2CM, W-2VI, or W-2c. Provide Copies B, C, and 2 of Form W-2c to your
employees as soon as possible.
Where To File
If you use the U.S. Postal Service, send Forms W-2c and W-3c to the following address:
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 the following address:
Social Security Administration
Data Operations Center
Attn: W-2c Process
1150 E. Mountain Drive
Wilkes-Barre, PA 18702-7997
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 10164R
