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 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 of $50 per information return may be
imposed for filing forms that cannot be scanned.
To order official IRS forms, call 1-800-TAX-FORM (1-800-829-3676) or Order
Information Returns and Employer Returns Online, 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 Reporting Instructions & 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 CUT, FOLD, OR STAPLE
a Tax year/Form corrected

55555

/ W-

For Official Use Only

©

OMB No. 1545-0008
c

b Employer’s name, address, and ZIP code

Kind
of
Payer

941/941-SS

Military

943

944/944-SS

CT-1

Hshld.
emp.

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.

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

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

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

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 3rd party sick pay payer

14 Inc. tax W/H by 3rd 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

Telephone number

Email address

Fax number

Form

W-3c

(Rev. 4-2010)

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
separate Instructions for Forms W-2c and W-3c 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.

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

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

Cat. No. 10164R