Attention:

This form is provided for informational purposes only. Copy A appears in red, similar to the official printed IRS form. But do not file Copy A downloaded from this website with the SSA. A penalty of $50 per information return may be imposed for filing such forms that cannot be scanned.

To order official IRS forms, call 1-800-TAX-FORMS (1-800-829- 3 676) or order online at Forms and Publications By U.S. Mail.

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 the SSA. You may also print out copies for filing with state or local governments, distribution to your employees, and for your records.

W-2 / W-3 Cover page

DO NOT CUT, FOLD OR STAPLE

a Tax year/Form corrected

/ W‑

55555

For Official Use Only

OMB No. 1545-0008

bEmployer’s name, address, and ZIP code

c

941/941-SS Military

943

944/944-SS

Kind

of

Hshld. Medicare	Third-party
emp. govt. emp.	sick pay

Payer

CT-1

For Official Use Only

Purpose of Form

Where To File

Use this form to transmit Copy A of Form(s) W-2c, Corrected Wage and Tax Statement (Rev. 1-2006). 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 or social security number (SSN). See the separate Instructions for Forms W-2c and W-3c for information on completing this form.

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

When To File

If you use a carrier other than the U.S. Postal Service, send Forms W-2c and W-3c to the following address:

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.

Social Security Administration Data Operations Center
Attn: W-2c Process
1150 E. Mountain Drive Wilkes-Barre, PA 18702-7997

Form

W-3c

(Rev. 1-2006)

Transmittal of Corrected Wage and Tax Statements
Cat. No. 101 64R

Department of the Treasury Internal Revenue Service

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

d	Number of Forms W-2c

e	Employer’s Federal EIN

f	Establishment number

g	Employer’s state ID number

h	Employer’s incorrect Federal EIN

i	Incorrect establishment number

j	Employer’s incorrect state ID number

1	Wages, tips, other compensation

1	Wages, tips, other compensation

2	Federal income tax withheld

2	Federal income tax withheld

3Social security wages

3	Social security wages

4	Social security tax withheld

4	Social security tax withheld

5	Medicare wages and tips

5Medicare wages and tips

6	Medicare tax withheld

6	Medicare tax withheld

7Social security tips

7	Social security tips

8Allocated tips

8	Allocated tips

9Advance EIC payments

9	Advance EIC payments

10	Dependent care benefits

10	Dependent care benefits

11Nonqualified plans

11	Nonqualified plans

12a-d (Coded items)

12a-d (Coded items)

14	Inc. tax W/H by 3rd party sick pay payer

14	Inc. tax W/H by 3rd 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.

19Local income tax

19	Local income tax

Explain decreases here:

Contact person

Email address

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Complete boxes h, i, or j only if incorrect on last form filed.				
Total of amounts previously reported as shown on enclosed Forms W-2c.	Total of corrected amounts as shown on enclosed Forms W-2c.	Total of amounts previously reported as shown on enclosed Forms W-2c.	Total of corrected amounts as shown on enclosed Forms W-2c.	

				

				

				

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.
Title
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