8922 Third-Party Sick Pay Recap

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. 1545-0029

Employer

Form
(Rev. October 2024)

8922

For calendar year

Insurer/Agent

FILER’S employer identification number

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.

What’s New
Continuous-use form and instructions. Form 8922 and these
instructions have been converted from an annual revision to
continuous use. Both the form and these instructions will be updated
only as needed.

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.

Third-Party
Sick Pay
Recap
For Privacy Act
and Paperwork
Reduction Act
Notice, see
page 2.

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

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.

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.

Who Must File

Specific Instructions

CAUTION

Purpose of Form

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 the last day of February. If the due date falls on a
Saturday, Sunday, or legal holiday, the due date is the next business
day.

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 (Rev. 10-2024)

Cat. No. 37734T

Calendar year. Enter the four-digit calendar year (for example, 2024)
for which you’re filing Form 8922.
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

Form 8922 (Rev. 10-2024)

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.
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 4
years. These should be available for IRS review.

Page 2

Privacy Act and Paperwork Reduction Act Notice. We ask for the
information on Form 8922 to carry out the Internal Revenue laws of
the United States. You’re required to give us the information. We need
it to ensure that you're complying with these laws and to allow us to
figure and collect the right amount of tax. Section 6011 requires you
to provide the requested information if the tax is applicable to you.
Section 6109 requires you to provide your identification number.
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.
Generally, tax returns and return information are confidential, as
required by section 6103. However, section 6103 allows or requires
the IRS to disclose or give the information shown on your tax return to
others as described in the Code. For example, we may disclose your
tax information to the Department of Justice for civil and criminal
litigation, and to cities, states, the District of Columbia, and U.S.
commonwealths and territories 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.
The time needed to complete and file Form 8922 will vary
depending on individual circumstances. The estimated burden for
filing Form 8922 is approved under OMB control number 1545-0029
and is included in the estimates shown in the instructions for the
employment tax return that you file.