W-3 Transmittal of Income and Tax Statements

Version A, Cycle 2
Scanned form. Do not change dimensions of entry boxes

DO NOT STAPLE
a Control number

33333

(Check one)

941

Military

CT-1

Hshld.
emp.

943

944

Medicare
govt. emp.

Kind
of
Employer
(Check one)

None apply

501c non-govt.

State/local
non-501c

State/local 501c

Third-party
sick pay
Federal govt.

1 Wages, tips, other compensation

2 Federal income tax withheld

e Employer identification number (EIN)

3 Social security wages

4 Social security tax withheld

f Employer’s name

5 Medicare wages and tips

6 Medicare tax withheld

7 Social security tips

8 Allocated tips

c Total number of Forms W-2

d Establishment number

▲

Kind
of
Payer

OMB No. 1545-0008

▲

b

For Official Use Only ▶

(Check if
applicable)

10 Dependent care benefits

9
11 Nonqualified plans

12a Deferred compensation

h Other EIN used this year

13 For third-party sick pay use only

12b

15 State

14 Income tax withheld by payer of third-party sick pay

g Employer’s address and ZIP code

Employer’s state ID number

16 State wages, tips, etc.

17 State income tax

18 Local wages, tips, etc.

19 Local income tax

INTERNAL USE ONLY
DRAFT AS OF
March 8, 2013

Contact person

Employer's telephone number

Employer's email address

Employer's fax number

For Official Use Only

Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and
complete.
Signature ▶
Form

W-3

Date ▶

Title ▶

Transmittal of Wage and Tax Statements

2014

Department of the Treasury
Internal Revenue Service

Send this entire page with the entire Copy A page of Form(s) W-2 to the Social Security Administration (SSA).
Photocopies are not acceptable. Do not send Form W-3 if you filed electronically with the SSA.
Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3.

Reminder

Separate instructions. See the 2014 General Instructions for Forms
W-2 and W-3 for information on completing this form.

Purpose of Form
A Form W-3 Transmittal is completed only when paper Copy A of
Form(s) W-2, Wage and Tax Statement, is being filed. Do not file Form
W-3 alone. Do not file Form W-3 for Form(s) W-2 that were submitted
electronically to the SSA (see below). All paper forms must comply
with IRS standards and be machine readable. Photocopies are not
acceptable. Use a Form W-3 even if only one paper Form W-2 is being
filed. Make sure both the Form W-3 and Form(s) W-2 show the correct
tax year and Employer Identification Number (EIN). Make a copy of this
form and keep it with Copy D (For Employer) of Form(s) W-2 for your
records. The IRS recommends retaining copies of these forms for four
years.

E-Filing

When To File
Mail Form W-3 with Copy A of Form(s) W-2 by March 2, 2015.

Where To File Paper Forms
Send this entire page with the entire Copy A page of Form(s) W-2 to:

Social Security Administration
The SSA strongly suggests employers report Form W-3 and Forms W-2
Copy A electronically instead of on paper. The SSA provides two free eData Operations Center
filing options on its Business Services Online (BSO) website:
Wilkes-Barre, PA 18769-0001
• W-2 Online. Use fill-in forms to create, save, print, and submit up to
Note. If you use “Certified Mail” to file, change the ZIP code to
50 Forms W-2 at a time to the SSA.
“18769-0002.” If you use an IRS-approved private delivery service, add
“ATTN: W-2 Process, 1150 E. Mountain Dr.” to the address and change
• File Upload. Upload wage files to the SSA you have created using
the ZIP code to “18702-7997.” See Publication 15 (Circular E),
payroll or tax software that formats the files according to the SSA’s
Employer’s Tax Guide, for a list of IRS-approved private delivery
Specifications for Filing Forms W-2 Electronically (EFW2).
services.
W-2 Online fill-in forms or file uploads will be on time if submitted by
March 31, 2015. For more information, go to www.socialsecurity.gov/
employer and select “First Time Filers” or “Returning Filers” under
“BEFORE YOU FILE.”
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10159Y