W-2AS American Samoa Wage and Tax Statement

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.
The official printed IRS form is scannable, but forms downloaded
and printed from this website are not. A penalty of $50 per
information return may be imposed for filing forms that cannot be
scanned.
To order official IRS forms, call 1-800-TAX-FORM (1-800-8293676) 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 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

22222

a Employee’s social security number
Void

For Official Use Only

䊳

OMB No. 1545-0008

b Employer identification number (EIN)

1

Wages, tips, other compensation

2

Samoa income tax withheld

c Employer’s name, address, and ZIP code

3

Social security wages

4

Social security tax withheld

5

Medicare wages and tips

6

Medicare tax withheld

7

Social security tips

8

d Control number

9

e Employee’s first name and initial

Last name

Suff. 11
13

14

10

Nonqualified plans
Statutory
employee

Other

Retirement
plan

12a See the separate instructions
C
o
d
e

Third-party
sick pay

12b
C
o
d
e

12c
C
o
d
e

12d
C
o
d
e

f Employee’s address and ZIP code

Form

W-2AS

American Samoa
Wage and Tax Statement

2007

Copy A For Social Security Administration—Send this entire page with Copy A of
Form W-3SS to the Social Security Administration; photocopies are not acceptable.

Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction Act
Notice, see the separate instructions.
Cat. No. 10140H

Do Not Cut, Fold, or Staple Forms on This Page — Do Not Cut, Fold, or Staple Forms on This Page

22222

a Employee’s social security number
Void

OMB No. 1545-0008

b Employer identification number (EIN)

1

Wages, tips, other compensation

2

Samoa income tax withheld

c Employer’s name, address, and ZIP code

3

Social security wages

4

Social security tax withheld

5

Medicare wages and tips

6

Medicare tax withheld

7

Social security tips

8

d Control number

9

e Employee’s first name and initial

Last name

Suff.

11
13

14

10

Nonqualified plans
Statutory
employee

Other

Retirement
plan

12a
C
o
d
e

Third-party
sick pay

12b
C
o
d
e

12c
C
o
d
e

12d
C
o
d
e

f Employee’s address and ZIP code

Form

W-2AS

American Samoa
Wage and Tax Statement

Copy 1—For American Samoa Treasurer

2007

Department of the Treasury—Internal Revenue Service

a Employee’s social security number
OMB No. 1545-0008
b Employer identification number (EIN)

1

Wages, tips, other compensation

2

Samoa income tax withheld

c Employer’s name, address, and ZIP code

3

Social security wages

4

Social security tax withheld

5

Medicare wages and tips

6

Medicare tax withheld

7

Social security tips

8

d Control number

9

e Employee’s first name and initial

Last name

Suff.

11
13

14

10

12a See instructions for box 12

Nonqualified plans
Statutory
employee

Other

Retirement
plan

C
o
d
e

Third-party
sick pay

12b
C
o
d
e

12c
C
o
d
e

12d
C
o
d
e

f Employee’s address and ZIP code

Form

W-2AS

American Samoa
Wage and Tax Statement

Copy B—To Be Filed With Employee’s American Samoa Tax Return

2007

Department of the Treasury—Internal Revenue Service
This information is being furnished to the Tax
Department, American Samoa Government.

Notice to Employee
File Copy B of this form with your 2007 American Samoa income
tax return. Keep Copy C for your records. If your name, social
security number (SSN), or address is incorrect, correct Copies B
and C and ask the employer to correct your employment record.
Be sure to ask your employer to file Form W-2c, Corrected Wage
and Tax Statement, with the Social Security Administration (SSA) to
correct any name, amount, or SSN error reported to the SSA.
If you expect to owe self-employment tax of $1,000 or more for
2008, you may have to make estimated tax payments to the U.S.
Internal Revenue Service. Use Form 1040-ES, Estimated Tax for
Individuals.
Refund. Even if you do not have to file a tax return, you should file
to get a refund if box 2 shows Samoa income tax withheld.

Credit for excess social security tax. If you had more than one
employer in 2007 and more than $6,045.00 in social security tax
was withheld, you may have the excess refunded by filing Form
843, Claim for Refund and Request for Abatement, with the Internal
Revenue Service Center in Philadelphia. If you must file Form 1040
with the United States, claim the excess tax as a credit on Form
1040.
Note. Keep Copy C of Form W-2AS for at least 3 years after the
due date for filing your income tax return. However, to help protect
your social security benefits, keep Copy C until you begin
receiving social security benefits just in case there is a question
about your work record and/or earnings in a particular year. Review
the information shown on your annual (for workers over 25) Social
Security Statement.
(Also see the Instructions for Employee on the back of Copy C.)

a Employee’s social security number
OMB No. 1545-0008
b Employer identification number (EIN)

1

Wages, tips, other compensation

2

Samoa income tax withheld

c Employer’s name, address, and ZIP code

3

Social security wages

4

Social security tax withheld

5

Medicare wages and tips

6

Medicare tax withheld

7

Social security tips

8

d Control number

9

e Employee’s first name and initial

Last name

Suff.

11
13

14

10

Nonqualified plans
Statutory
employee

Other

Retirement
plan

12a See instructions for box 12
C
o
d
e

Third-party
sick pay

12b
C
o
d
e

12c
C
o
d
e

12d
C
o
d
e

f Employee’s address and ZIP code

Form

W-2AS

American Samoa
Wage and Tax Statement

2007

Copy C—For EMPLOYEE’S RECORDS (See Notice to Employee on the back of Copy B.)

Department of the Treasury—Internal Revenue Service
This information is being furnished to the Tax
Department, American Samoa Government.

Instructions for Employee
(Also see Notice to Employee, on the back of Copy B.)
Box 11. This amount is (a) reported in box 1 if it is a distribution from a nonqualified
deferred compensation or nongovernmental section 457(b) plan, or (b) included in box
3 and/or 5 if it is a prior year deferral under a nonqualified or section 457(b) plan that
became taxable for social security and Medicare taxes this year because there is no
longer a substantial risk of forfeiture of your right to the deferred amount.
Box 12. The following list explains the codes shown in box 12. You may need this
information to complete your tax return. Elective deferrals (codes D, E, F, and S) and
designated Roth contributions (codes AA and BB) under all plans are generally limited
to a total of $15,500 ($10,500 if you only have SIMPLE plans; $18,500 for section
403(b) plans if you qualify for the 15-year rule explained in Pub. 571). Deferrals under
code G are limited to $15,500. Deferrals under code H are limited to $7,000.
However, if you were at least age 50 in 2007, your employer may have allowed an
additional deferral of up to $5,000 ($2,500 for section 401(k)(11) and 408(p) SIMPLE
plans). This additional deferral amount is not subject to the overall limit on elective
deferrals. For code G, the limit on elective deferrals may be higher for the last 3 years
before you reach retirement age. Contact your plan administrator for more information.
Amounts in excess of the overall elective deferral limit must be included in income.
See the “Wages, Salaries, Tips, etc.” line instructions for your tax return.
A—Uncollected social security tax on tips. Report on U.S Form 1040.
B—Uncollected Medicare tax on tips. Report on U.S. Form 1040.
C—Taxable cost of group-term life insurance over $50,000 included in boxes 1, 3 (up
to social security wage base), and 5.
D—Elective deferrals to a section 401(k) cash or deferred arrangement. Also includes
deferrals under a SIMPLE retirement account that is part of a section 401(k)
arrangement.
E—Elective deferrals under a section 403(b) salary reduction agreement.
F—Elective deferrals under a section 408(k)(6) salary reduction SEP.
G—Elective deferrals and employer contributions (including nonelective deferrals) to a
section 457(b) deferred compensation plan.

H—Elective deferrals to a section 501(c)(18)(D) tax-exempt organization plan. (You may
be able to deduct.)
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5).
M—Uncollected social security tax on taxable cost of group-term life insurance over
$50,000 (former employees only). Report on U.S. Form 1040.
N—Uncollected Medicare tax on taxable cost of group-term life insurance over
$50,000 (former employees only). Report on U.S. Form 1040.
P—Excludable moving expense reimbursements paid directly to employee (not
included in boxes 1, 3, or 5).
Q—Nontaxable Combat Pay. See your tax return instructions for details on reporting
this amount.
R—Employer contributions to your Archer (MSA). Report on Form 8853, Archer MSAs
and Long-Term Care Insurance Contracts.
S—Employee salary reduction contributions under a section 408(p) SIMPLE (not
included in box 1).
T—Adoption benefits (not included in box 1).
V—Income from exercise of nonstatutory stock option(s) (included in boxes 1, 3 (up to
social security wage base), and 5).
W—Employer contributions to your Health Savings Account. Report on Form 8889,
Health Savings Accounts (HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under section 409A on a nonqualified deferred compensation plan. This
amount is also included in box 1. It is subject to an additional 20% tax plus interest.
See “Total Tax” in the instructions for your tax return.
AA—Designated Roth contributions under a section 401(k) plan.
BB—Designated Roth contributions under a section 403(b) plan.
Box 13. If the “Retirement plan” box is checked, special limits may apply to the
amount of traditional IRA contributions that you may deduct.

a Employee’s social security number
Void

OMB No. 1545-0008

b Employer identification number (EIN)

1

Wages, tips, other compensation

2

Samoa income tax withheld

c Employer’s name, address, and ZIP code

3

Social security wages

4

Social security tax withheld

5

Medicare wages and tips

6

Medicare tax withheld

7

Social security tips

8

d Control number

9

e Employee’s first name and initial

Last name

Suff.

11
13

14

10

Nonqualified plans
Statutory
employee

Other

Retirement
plan

12a See the separate instructions
C
o
d
e

Third-party
sick pay

12b
C
o
d
e

12c
C
o
d
e

12d
C
o
d
e

f Employee’s address and ZIP code

Form

W-2AS

Copy D—For Employer

American Samoa
Wage and Tax Statement

2007

Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction Act Notice,
see the separate instructions.

Employers, Please Note—
Note. A minimum income tax of 2% must be withheld on
wages and other compensation.
Who must file. File Form W-2AS for each employee from
whom American Samoa income tax or U.S. social security and
Medicare taxes were withheld or required to be withheld
during 2007.
Distribution of copies. By January 31, 2008, furnish Copies B
and C to each person who was your employee during 2007. For
anyone who stopped working for you before the end of 2007,
you may furnish Copies B and C to them any time after
employment ends but by January 31, 2008. If the employee
asks for Form W-2AS, furnish the completed copies within 30
days of the request or within 30 days of the final wage
payment, whichever is later. You may also file Copy A and

Form W-3SS, Transmittal of Wage and Tax Statements, with
the Social Security Administration (SSA) at the same time.
Note. If you terminate your business, see the rules on
furnishing and filing Forms W-2AS and W-3SS under
Terminating a business in the separate instructions.
When to file. By February 29, 2008, send Copy A of Forms
W-2AS and W-3SS to the SSA. However, if you file
electronically, the due date is March 31, 2008. See the separate
instructions.
Reporting electronically. If you file 250 or more Forms W-2AS,
you must file electronically. For information, visit SSA’s
Employer Reporting Instructions and Information webpage at
www.socialsecurity.gov/employer or contact your Employer
Services Liaison Officer (ESLO) at 510-970-8247.
See the Instructions for Forms W-2AS, W-2GU, W-2VI, and
Form W-3SS for more information on how to complete Form
W-2AS.