W-3SS Transmittal of Wage and Tax Statements

Attention:
This form is provided for informational purposes only. Copy A appears in red, similar to the
official IRS form. Do not file Copy A downloaded from this website with the SSA. The
official printed version of this IRS form is scannable, but the online version of it, printed from
this website, is not. A penalty may be imposed for filing forms that can’t be scanned. See
the penalties section in the current General Instructions for Forms W-2 and W-3 for more
information.
To order official IRS forms, go to Online Ordering for Information Returns and Employer
Returns, 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 W-2
Filing Instructions and Information. You can create fill-in versions of Forms W-2 and W-3
for filing with SSA. You may also print out copies for filing with state or local governments,
distribution to your employees, and for your records.
See IRS Publications 1141, 1167, 1179 and other IRS resources for information about
printing these tax forms.

DO NOT STAPLE OR FOLD
a Control number

33333

(Check one)

941-SS

Military

943

944

Hshld. Medicare
emp. govt. emp.
d Establishment number

Kind
of
Employer
(Check one)

▲

Kind
of
Payer

OMB No. 1545-0008

▲

b

For Official Use Only ▶
None apply

501c non-govt.

State/local
non-501c

State/local 501c

Third-party
sick pay
(Check if
applicable)

Federal govt.

1 Wages, tips, other compensation

2 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

c Total number of Forms W-2

9

10

11 Nonqualified plans

12a Deferred compensation

h Other EIN used this year

13 For third-party sick pay use only

12b

15 Employer’s territorial ID number

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

g Employer’s address and ZIP code

18 Check the appropriate box

Employer’s contact person

W-2AS
Type of Form ▶
Employer’s telephone number

W-2CM

W-2GU

W-2VI

For Official Use Only

Employer’s email address

Employer’s fax number

Copy A—For Social Security Administration
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-3SS

Date ▶

Title ▶

Transmittal of Wage and Tax Statements

2016

Department of the Treasury
Internal Revenue Service

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

Reminder
Separate instructions. See the 2016 General Instructions for Forms W-2
and W-3 for information on completing this form. Do not file Form W-3SS for
Form(s) W-2AS, W-2CM, W-2GU, or W-2VI that were submitted electronically
to the SSA.

Purpose of Form
A Form W-3SS Transmittal is completed only when paper Copy A of Form(s)
W-2AS, W-2CM, W-2GU, or W-2VI is being filed. Do not file Form W-3SS
alone. All paper forms must comply with IRS standards and be machine
readable. Photocopies are not acceptable. Use a Form W-3SS even if only
one paper Form W-2AS, W-2CM, W-2GU, or W-2VI is being filed. Make sure
both the Form W-3SS and Form(s) W-2AS, W-2CM, W-2GU, or W-2VI 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-2AS,
W-2CM, W-2GU, or W-2VI for your records. The IRS recommends retaining
copies of these forms for four years.

E-Filing
The SSA strongly suggests employers report Form W-3SS and Form(s)
W-2AS, W-2CM, W-2GU, or W-2VI Copy A electronically instead of on paper.
The SSA provides two free e-filing options on its Business Services Online
(BSO) website:
• W-2 Online. Use fill-in forms to create, save, print, and submit up to 50
Forms W-2AS, W-2CM, W-2GU, or W-2VI 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-2 Electronically (EFW2).
W-2 Online fill-in forms or file uploads will be on time if submitted by
January 31, 2017. 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
Mail Copy A of Form W-3SS with Copy A of Form(s) W-2AS, W-2CM,
W-2GU, or W-2VI by January 31, 2017.

Where To File Paper Forms
Send this entire page with the entire Copy A page of Form(s) W-2AS,
W-2CM, W-2GU, or W-2VI to:
Social Security Administration
Data Operations Center
Wilkes-Barre, PA 18769-0001
Note: If you use “Certified Mail” to file, change the ZIP code to
“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 the
ZIP code to “18702-7997.” See Pub. 15 (Circular E), Employer’s Tax Guide,
for a list of IRS-approved private delivery services.

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10117S

DO NOT STAPLE OR FOLD
a Control number

33333

(Check one)

941-SS

Military

943

944

Hshld. Medicare
emp. govt. emp.

Kind
of
Employer
(Check one)

▲

Kind
of
Payer

OMB No. 1545-0008

▲

b

For Official Use Only ▶
None apply

501c non-govt.

State/local
non-501c

State/local 501c

Third-party
sick pay
Federal govt.

1 Wages, tips, other compensation

2 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

c Total number of Forms W-2

d Establishment number

(Check if
applicable)

10

9

11 Nonqualified plans

12a Deferred compensation

h Other EIN used this year

13 For third-party sick pay use only

12b

15 Employer’s territorial ID number

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

g Employer’s address and ZIP code

Employer’s contact person

Employer’s telephone number

Employer’s fax number

Employer’s email address

For Official Use Only

Copy 1—For Local Tax Department
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 ▶

Title ▶

Form W-3SS Transmittal of Wage and Tax Statements

Date ▶

2016

Where To File
For more information about where to file Copy 1, contact your state, city, or local tax department.
American Samoa. File Copy 1 of Form W-3SS and Forms W-2AS at the following address.
American Samoa Tax Office
Executive Office Building
First Floor
Pago Pago, AS 96799
Guam. File Copy 1 of Form W-3SS and Forms W-2GU at the following address.
Guam Department of Revenue and Taxation
P.O. Box 23607
GMF, GU 96921
U.S. Virgin Islands. File Copy 1 of Form W-3SS and Forms W-2VI at the following address.
Virgin Islands Bureau of Internal Revenue
6115 Estate Smith Bay
Suite 225
St. Thomas, VI 00802
Commonwealth of the Northern Mariana Islands. File Form OS-3710 and Copy 1 of Forms W-2CM at the following address.
Division of Revenue and Taxation
Commonwealth of the Northern Mariana Islands
P.O. Box 5234 CHRB
Saipan, MP 96950

Department of the Treasury
Internal Revenue Service