8922 Third-Party Sick Pay Recap

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CORRECTED

8888

FILER’S name, street address, city or town, province or state, country, ZIP
or foreign postal code, and telephone no.

Filer is an (check one):

OMB No. 1545-0123

Employer

2023

Insurer/Agent

Third-Party
Sick Pay
Recap

Form 8922

FILER’S employer identification number

TREASURY/IRS
AND OMB USE
ONLY DRAFT
▲ July 20, 2023
DO NOT FILE
1 Sick pay subject to federal
income tax

2 Federal income tax withheld
from sick pay

$

$

3 Sick pay subject to social
security tax

4 Social security tax withheld
from sick pay

$

$

5 Sick pay subject to
Medicare tax

6 Medicare tax withheld from
sick pay

$

$

OTHER PARTY’S name (see instructions before entering)

OTHER PARTY’S employer identification number (see instructions before
entering)

Instructions for Form 8922

Section references are to the Internal Revenue Code unless otherwise
noted.

Future Developments

For the latest information about developments related to Form 8922
and its instructions, such as legislation enacted after they were
published, go to www.irs.gov/Form8922.

General Instructions

!

Don’t send this form to the Social Security Administration.
This form is processed solely by the IRS for third-party sick
pay reporting.

CAUTION

Purpose of Form

Form 8922 is filed to reconcile employment tax returns (for example,
Form 941) with Forms W-2 when third-party sick pay is paid. For more
information, see Sick Pay Reporting in Pub. 15-A. For purposes of
these instructions, all references to “sick pay” mean ordinary sick pay,
not qualified sick leave wages. See the instructions for your
employment tax return for more information about qualified sick leave
wages.

Who Must File
Generally, if the liability for the employer’s share of social security tax
and Medicare tax is reported on the employer’s employment tax
return, Form 8922 must be filed by:
• The employer, if sick pay is reported on Forms W-2 under the name
and employer identification number (EIN) of the insurer or agent; or
• The insurer or agent, if sick pay is reported on Forms W-2 under the
name and EIN of the employer.
For more information on who must file Form 8922, see Pub. 15-A.

When To File
File Form 8922 by February 29, 2024.

Where To File
Send Form 8922 to the following address.
If your principal business, office,
or agency is located in

Use the following
address

Alabama, Alaska, Arizona, Arkansas,
Colorado, Florida, Georgia, Hawaii,
Kansas, Louisiana, Mississippi, Missouri,
Nevada, New Mexico, Oklahoma,
Tennessee, Texas, Utah, Washington

Internal Revenue Service
Memphis Service Center
P.O. Box 87 Mail Stop 814 D6
Memphis, TN 38101-0087

California, Connecticut, Delaware, District
of Columbia, Idaho, Illinois, Indiana, Iowa,
Kentucky, Maine, Maryland,
Massachusetts, Michigan, Minnesota,
Montana, Nebraska, New Hampshire,
New Jersey, New York, North Carolina,
North Dakota, Ohio, Oregon,
Pennsylvania, Rhode Island, South
Carolina, South Dakota, Vermont, Virginia,
West Virginia, Wisconsin, Wyoming

Internal Revenue Service
IRS SSA CAWR
Philadelphia, PA 19255-0533

Form

8922

Cat. No. 37734T

If your principal place of business is outside the United States, file
with the Internal Revenue Service, IRS SSA CAWR, Philadelphia, PA
19255-0533.
Private delivery services. Private delivery services can’t deliver to the
addresses shown above. If you choose to use a private delivery
service, send Form 8922 to the address shown below based on the
location of your principal business, office, or agency.
Internal Revenue Service
5333 Getwell Rd Stop 814 D6
Memphis, TN 38118
Internal Revenue Service
Mail Stop 4-G08 151
2970 Market St
Philadelphia, PA 19104
Go to www.irs.gov/PDS for the current list of designated services.

Substitute Forms

The IRS accepts quality substitute tax forms that are consistent with
the official forms and have no adverse impact on our processing. The
official Form 8922 is the standard for substitute forms. Because a
substitute form is a variation from the official form, you should know
the requirements of the official form for the year of use before you
create a substitute version. For details on the requirements for
substitute forms, see Pub. 1167.

Specific Instructions
Check box for employer or insurer/agent. Check the appropriate
box to state whether you’re the employer or the insurer/agent filing
Form 8922.
Filer’s name. If the Employer box is checked, the employer for whom
the sick pay was paid by the insurer or agent will complete the
information with the employer’s name, address, and phone number.
If the Insurer/Agent box is checked, the insurer or agent who paid
the sick pay will complete the information with the insurer/agent’s
name, address, and phone number.
Filer’s EIN. If the Employer box is checked, enter the EIN of the
employer.
If the Insurer/Agent box is checked, enter the EIN of the insurer or
agent.
Other party’s name and EIN. If the Employer box is checked, the
employer must provide the name and EIN of the insurer or agent. If the
employer has contracts with more than one insurer or agent, the
employer must file a separate Form 8922 for the wages and taxes
related to each contract.
If the Insurer/Agent box is checked, the insurer or agent may, but
isn’t required to, provide the name and EIN of the employer. If it is
providing this information, and if it has contracts with more than one
employer, it must file a separate Form 8922 for the wages and taxes
related to each employer. Alternatively, it may file a separate Form
8922 for the wages and taxes related to each employer for which it is

www.irs.gov/Form8922

Department of the Treasury - Internal Revenue Service

Page 2

Form 8922 (2023)

supplying the name and EIN, and then file one Form 8922 for the
wages and taxes related to the employers for which it isn’t supplying
the name and EIN.
Box 1. Enter the total amount of sick pay subject to federal income
tax.
Box 2. Enter the total amount of federal income tax withheld from the
sick pay.
Box 3. Enter the total amount of sick pay subject to social security
tax. If a third-party payer of sick pay is also paying qualified sick leave
wages on behalf of an employer, the third party would be making the
payments as an agent of the employer. The employer is required to do
the reporting and payment of employment taxes with respect to the
qualified sick leave wages, unless the employer has an agency
agreement with the third-party payer that requires the third-party
payer to do the collecting, reporting, and/or paying or depositing
employment taxes on the qualified sick leave wages. If the employer
has that type of agency agreement with the third-party payer, the
third-party payer includes the qualified sick leave wages in box 3. The
third-party payer must also attach a statement to Form 8922 that
specifies the amount of qualified sick leave wages included in box 3.
See the instructions for your employment tax return for more
information about qualified sick leave wages.
Box 4. Enter the total amount of social security tax withheld from the
sick pay.
Box 5. Enter the total amount of sick pay subject to Medicare tax.
Box 6. Enter the total amount of the Medicare tax (including Additional
Medicare Tax) withheld from the sick pay.
Corrected Form 8922. If you filed Form 8922 with the IRS and later
discover that you made an error on it, you must correct it as soon as
possible. Complete all entries on Form 8922 when making a
correction. Enter an “X” in the “CORRECTED” checkbox only when
correcting a Form 8922 previously filed with the IRS.
Recordkeeping. Keep all records of employment taxes for at least 6
years. These should be available for IRS review.

Privacy Act and Paperwork Reduction Act Notice. We ask for the
information on this form to carry out the Internal Revenue laws of the
United States. We need it to figure and collect the right amount of tax.
Section 6051 and its regulations require you to furnish wage and tax
statements to employees, the Social Security Administration, and the
Internal Revenue Service. Section 6109 requires you to provide your
identification number. Failure to provide this information in a timely
manner or providing false or fraudulent information may subject you to
penalties.
Generally, tax returns and return information are confidential, as
required by section 6103. However, section 6103 allows or requires
the Internal Revenue Service to disclose or give the information shown
on your return to others as described in the Code. For example, we
may disclose your tax information to the Department of Justice for
civil and/or criminal litigation, and to cities, states, the District of
Columbia, and U.S. commonwealths and possessions for use in
administering their tax laws. We may also disclose this information to
other countries under a tax treaty, to federal and state agencies to
enforce federal nontax criminal laws, or to federal law enforcement
and intelligence agencies to combat terrorism.
You’re not required to provide the information requested on a form
that is subject to the Paperwork Reduction Act unless the form
displays a valid OMB control number. Books or records relating to a
form or its instructions must be retained as long as their contents may
become material in the administration of any Internal Revenue law.
The time needed to complete and file this form will vary depending
on individual circumstances. The estimated burden for business
taxpayers filing this form is approved under OMB control number
1545-0123 and is included in the estimates shown in the instructions
for their business income tax return.
If you have comments concerning the accuracy of these time
estimates or suggestions for making Form 8922 simpler, we would be
happy to hear from you. You can send us comments from
www.irs.gov/FormComments. Or you can send your comments to
Internal Revenue Service, Tax Forms and Publications Division, 1111
Constitution Ave. NW, IR-6526, Washington, DC 20224. Don’t send
Form 8922 to this address. Instead, see Where To File, earlier.

TREASURY/IRS
AND OMB USE
ONLY DRAFT
July 20, 2023
DO NOT FILE