W-3C Transmittal of Corrected Wage and Tax Statements

Version A, Cycle 2

DO NOT CUT, FOLD, OR STAPLE
a Tax year/Form corrected

55555

For Official Use Only

/ W-

▶

OMB No. 1545-0008
c Kind of Payer (Check one)
Kind of Employer (Check one) Third-party
sick pay
943
944/944-SS None apply 501c non-govt.

b Employer’s name, address, and ZIP code

941/941-SS Military

Hshld.
emp.

CT-1

Medicare
govt. emp.

State/local State/local
non-501c
501c

Federal
govt.

(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 incorrect Federal EIN

i Incorrect establishment number

j

Total of amounts previously reported
as shown on enclosed Forms W-2c.

Employer's incorrect state ID number

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 corrected amounts as
shown on enclosed Forms W-2c.

1 Wages, tips, other compensation

1 Wages, tips, other compensation

2 Federal income tax withheld

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

Internal Use Only
DRAFT AS OF
March 18, 2013

9 Advance EIC payments

9 Advance EIC payments

10 Dependent care benefits

10 Dependent care benefits

11 Nonqualified plans

11 Nonqualified plans

12a Deferred compensation

12a Deferred compensation

14 Inc. tax w/h by third-party sick pay payer

14 Inc. tax w/h by third-party sick pay payer

12b HIRE exempt wages and tips

12b HIRE exempt wages and tips

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?
If “Yes,” give date the return was filed ▶

Yes

No

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

▶

Contact person

Employer's telephone number

Employer's email address

Employer's fax number

Form

W-3c

(Rev. 8-2013)

Purpose of Form

For Official Use Only

Transmittal of Corrected Wage and Tax Statements
Where To File

Use this form to transmit Copy A of Form(s) W-2c, Corrected Wage
and Tax Statement (Rev. 2-2009). 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 2013
General Instructions for Forms W-2 and W-3 for information on
completing this form.

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.
For Paperwork Reduction Act Notice, see separate instructions.

▶

Department of the Treasury
Internal Revenue Service

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
Cat. No. 10164R