a Employer's name, address, and ZIP code.
b Employer's Federal EIN
Note: Only complete money fields that are being corrected (exception: for corrections involving MQGE, see the instructions for Forms W-2c and W-3c, boxes 5 and 6).
c Tax year/Form corrected
d Employee's correct SSN
For Official Use Only ►
e Corrected SSN and/or name (Check this box and complete boxes f
and/or g if incorrect on form previously filed.)
Complete boxes f and/or g only if incorrect on form previously filed ►
f Employee's previously reported SSN
g Employee's previously reported name
h Employee's first name and initial
i Employee's address and ZIP code
1 Wages, tips, other compensation
3 Social security wages
5 Medicare wages and tips
7 Social security tips
9 Advance EIC payment
11 Nonqualified plans
11 Nonqualified plans
9 Advance EIC payment
7 Social security tips
5 Medicare wages and tips
3 Social security wages
1 Wages, tips, other compensation
14 Other (see instructions)
14 Other (see instructions)
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
10 Dependent care benefits
12a See instructions for box 12
12a See instructions for box 12
10 Dependent care benefits
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
a Employer's name, address, and ZIP code.
b Employer's Federal EIN
Note: Only complete money fields that are being corrected (exception: for corrections involving MQGE, see the instructions for Forms W-2c and W-3c, boxes 5 and 6).
c Tax year/Form corrected
d Employee's correct SSN
For Official Use Only ►
e Corrected SSN and/or name (Check this box and complete boxes f
and/or g if incorrect on form previously filed.)
Complete boxes f and/or g only if incorrect on form previously filed ►
f Employee's previously reported SSN
g Employee's previously reported name
h Employee's first name and initial
i Employee's address and ZIP code
1 Wages, tips, other compensation
3 Social security wages
5 Medicare wages and tips
7 Social security tips
9 Advance EIC payment
11 Nonqualified plans
11 Nonqualified plans
9 Advance EIC payment
7 Social security tips
5 Medicare wages and tips
3 Social security wages
1 Wages, tips, other compensation
14 Other (see instructions)
14 Other (see instructions)
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
10 Dependent care benefits
12a See instructions for box 12
12a See instructions for box 12
10 Dependent care benefits
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
a Employer's name, address, and ZIP code.
b Employer's Federal EIN
Note: Only complete money fields that are being corrected (exception: for corrections involving MQGE, see the instructions for Forms W-2c and W-3c, boxes 5 and 6).
c Tax year/Form corrected
d Employee's correct SSN
For Official Use Only ►
e Corrected SSN and/or name (Check this box and complete boxes f
and/or g if incorrect on form previously filed.)
Complete boxes f and/or g only if incorrect on form previously filed ►
f Employee's previously reported SSN
g Employee's previously reported name
h Employee's first name and initial
i Employee's address and ZIP code
1 Wages, tips, other compensation
3 Social security wages
5 Medicare wages and tips
7 Social security tips
9 Advance EIC payment
11 Nonqualified plans
11 Nonqualified plans
9 Advance EIC payment
7 Social security tips
5 Medicare wages and tips
3 Social security wages
1 Wages, tips, other compensation
14 Other (see instructions)
14 Other (see instructions)
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
10 Dependent care benefits
12a See instructions for box 12
12a See instructions for box 12
10 Dependent care benefits
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
a Employer's name, address, and ZIP code.
b Employer's Federal EIN
Note: Only complete money fields that are being corrected (exception: for corrections involving MQGE, see the instructions for Forms W-2c and W-3c, boxes 5 and 6).
c Tax year/Form corrected
d Employee's correct SSN
For Official Use Only ►
e Corrected SSN and/or name (Check this box and complete boxes f
and/or g if incorrect on form previously filed.)
Complete boxes f and/or g only if incorrect on form previously filed ►
f Employee's previously reported SSN
g Employee's previously reported name
h Employee's first name and initial
i Employee's address and ZIP code
1 Wages, tips, other compensation
3 Social security wages
5 Medicare wages and tips
7 Social security tips
9 Advance EIC payment
11 Nonqualified plans
11 Nonqualified plans
9 Advance EIC payment
7 Social security tips
5 Medicare wages and tips
3 Social security wages
1 Wages, tips, other compensation
14 Other (see instructions)
14 Other (see instructions)
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
10 Dependent care benefits
12a See instructions for box 12
12a See instructions for box 12
10 Dependent care benefits
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
a Employer's name, address, and ZIP code.
b Employer's Federal EIN
Note: Only complete money fields that are being corrected (exception: for corrections involving MQGE, see the instructions for Forms W-2c and W-3c, boxes 5 and 6).
c Tax year/Form corrected
d Employee's correct SSN
For Official Use Only ►
e Corrected SSN and/or name (Check this box and complete boxes f
and/or g if incorrect on form previously filed.)
Complete boxes f and/or g only if incorrect on form previously filed ►
f Employee's previously reported SSN
g Employee's previously reported name
h Employee's first name and initial
i Employee's address and ZIP code
1 Wages, tips, other compensation
3 Social security wages
5 Medicare wages and tips
7 Social security tips
9 Advance EIC payment
11 Nonqualified plans
11 Nonqualified plans
9 Advance EIC payment
7 Social security tips
5 Medicare wages and tips
3 Social security wages
1 Wages, tips, other compensation
14 Other (see instructions)
14 Other (see instructions)
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
10 Dependent care benefits
12a See instructions for box 12
12a See instructions for box 12
10 Dependent care benefits
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
a Employer's name, address, and ZIP code.
b Employer's Federal EIN
Note: Only complete money fields that are being corrected (exception: for corrections involving MQGE, see the instructions for Forms W-2c and W-3c, boxes 5 and 6).
c Tax year/Form corrected
d Employee's correct SSN
For Official Use Only ►
e Corrected SSN and/or name (Check this box and complete boxes f
and/or g if incorrect on form previously filed.)
Complete boxes f and/or g only if incorrect on form previously filed ►
f Employee's previously reported SSN
g Employee's previously reported name
h Employee's first name and initial
i Employee's address and ZIP code
1 Wages, tips, other compensation
3 Social security wages
5 Medicare wages and tips
7 Social security tips
9 Advance EIC payment
11 Nonqualified plans
11 Nonqualified plans
9 Advance EIC payment
7 Social security tips
5 Medicare wages and tips
3 Social security wages
1 Wages, tips, other compensation
14 Other (see instructions)
14 Other (see instructions)
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
10 Dependent care benefits
12a See instructions for box 12
12a See instructions for box 12
10 Dependent care benefits
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
15 State
16 State wages, tips, etc.
17 State income tax.
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
20 Locality name
19 Local income tax
18 Local wages, tips, etc.
Specific information needed to complete Form W-2c is
given in the separate Instructions for Forms W-2c and W-3c. You can order those instructions and additional forms by calling 1-800-TAX-FORM (1-800-829-3676).
You can also get forms and instructions from the IRS website at www.irs.gov. Electronic filing of Form W-2c is preferred. For information on how to file electronically, go to the Social Security Administration website at www.socialsecurity.gov/employer.