W-3C Transmittal of Corrected Wage and Tax Statements

Attention:
This form is provided for informational purposes only. Copy A
appears in red, similar to the official printed IRS form. But do
not file Copy A downloaded from this website with the SSA. A
penalty of $50 per information return may be imposed for filing
such forms that cannot be scanned.
To order official IRS forms, call 1-800-TAX-FORMS (1-800-8293676) or order online at Forms and Publications By U.S. Mail.
You may file Forms W-2 and W-3 electronically on the SSA’s
website at Employer Reporting Instructions & Information.
You can create fill-in versions of Forms W-2 and W-3 for filing
with the SSA. You may also print out copies for filing with state
or local governments, distribution to your employees, and for your
records.

W-2 / W-3 Cover page

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I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM W-3c, PAGE 1 OF 2 (Page 2 is blank)
MARGINS; TOP 13mm (1/2"), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (8-1/2") x 279mm (11")
PERFORATE: None
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Date

Action

Date

Signature

O.K. to print
Revised proofs
requested

Separation 1: Prints Red
Separation 2: Prints Black

DO NOT CUT, FOLD OR STAPLE
a

Tax year/Form corrected

/ W-

55555

For Official Use Only

䊳

OMB No. 1545-0008

b Employer’s name, address, and ZIP code

c

䊳

Kind
of
Payer

941/941-SS

Military

CT-1

943

Hshld.
emp.

944/944-SS

Medicare
govt. emp.

Third-party
sick pay

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

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 amounts previously reported
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

9

Advance EIC payments

9

Advance EIC payments

10

Nonqualified plans

12a-d (Coded items)

12a-d (Coded items)

11

Dependent care benefits

10

Dependent care benefits

11

Nonqualified plans

14

Inc. tax W/H by 3rd party sick pay payer 14

Inc. tax W/H by 3rd party sick pay payer

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:

Yes

Has an adjustment been made on an employment tax return filed with the Internal Revenue Service?
If “Yes,” give date the return was filed 䊳

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

䊳

Title

䊳

Contact person

Date
Telephone number

(
Email address

䊳

For Official Use Only

)

Fax number

(

)

Purpose of Form

Where To File

Use this form to transmit Copy A of Form(s) W-2c, Corrected Wage
and Tax Statement (Rev. 1-2006). 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 or
social security number (SSN). See the separate Instructions for Forms
W-2c and W-3c for information on completing this form.

If you use the U.S. Postal Service, send Forms W-2c and W-3c to the
following address:

When To File

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:

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.

Form

W-3c

(Rev. 1-2006)

Social Security Administration
Data Operations Center
Attn: W-2c Process
1150 E. Mountain Drive
Wilkes-Barre, PA 18702-7997

Transmittal of Corrected Wage and Tax Statements

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 10164R

Department of the Treasury
Internal Revenue Service