2008 Department of the Treasury
Internal Revenue Service
Instructions for Forms
W-2AS, W-2GU, W-2VI, and
Form W-3SS
Section references are to the Internal Revenue Code unless Note. If you use “Certified Mail” to file, change the ZIP code to
otherwise noted. “18769-0002.” If you use an IRS-approved private delivery
Contents Page service, add “ATTN: W-2 Process, 1150 E. Mountain Dr.” to the
Reminders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 address and change the ZIP code to “18702-7997.” See Pub.
15 (Circular E), Employer’s Tax Guide, for a list of
When To File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
IRS-approved private delivery services.
Where To File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
General Instructions for Form W-3SS . . . . . . . . . . . . . . . . 1 Also see Where to file Copy 1 and Shipping and mailing on
General Instructions for Forms W-2AS, W-2CM, pages 1 and 2.
W-2GU, and Form W-2VI . . . . . . . . . . . . . . . . . . . . . . . . 2
Special Reporting Situations . . . . . . . . . . . . . . . . . . . . . . 2 General Instructions for Form W-3SS
Specific Instructions for Forms W-2AS, W-2GU,
Purpose of forms. Use Copy A of Form W-3SS to transmit
and Form W-2VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Copy A of Form W-2AS, W-2CM, W-2GU, or Form W-2VI to the
Specific Instructions for Form W-3SS . . . . . . . . . . . . . . . . 5 Social Security Administration. File Copy 1 of Form W-3SS and
Copy 1 of Form W-2AS, W-2CM, W-2GU, or W-2VI with your
local tax department. Form W-2AS is used to report American
Reminders Samoa wages, Form W-2CM is used to report the
Form 944-SS. If you file Form 944-SS, Employer’s ANNUAL Commonwealth of the Northern Mariana Islands wages, Form
Federal Tax Return, use the “944-SS” checkbox in box b on W-2GU is used to report Guam wages, and Form W-2VI is used
Form W-3SS. to report U.S. Virgin Islands wages. Do not use these forms to
report wages subject to U.S. income tax withholding.
Notice to employers in the Commonwealth of the Northern Instead, use Form W-2 to show U.S. income tax withheld.
Mariana Islands. If you are an employer in the
Commonwealth of the Northern Mariana Islands, you must Who must file. Employers and other payers in American
contact the Department of Revenue and Taxation, Capitol Hill, Samoa, the Commonwealth of the Northern Mariana Islands,
Saipan, MP 96959, to get Form W-2CM, Wage and Tax Guam, and the U.S. Virgin Islands must report wages and
Statement, and the instructions for completing and filing that withheld income tax, U.S. social security, and U.S. Medicare
form. taxes to their local tax department and to the U.S. Social
Security Administration (SSA).
When To File Household employers, even those with only one household
File Copy A of Form W-3SS with Copy A of Form W-2AS, employee, must file Form W-3SS with Form W-2AS, W-2CM,
W-2CM, W-2GU, or W-2VI by March 2, 2009. W-2GU, or Form W-2VI. On Form W-3SS, check the “Hshld.
emp.” checkbox in box b.
However, if you file electronically, you may file by March 31,
2009. Visit SSA’s Employer W-2 Filing Instructions & Where to file Copy 1. File Copy 1 of Forms W-2AS and
Information website at www.socialsecurity.gov/employer for W-3SS with the American Samoa Tax Office, Government of
electronic filing options. American Samoa, Pago Pago, AS 96799.
File Copy 1 of Forms W-2GU and W-3SS with the
Extension to file. You may request an automatic extension of
Department of Revenue and Taxation, Government of Guam,
time to file Forms W-2AS, W-2CM, W-2GU, or Form W-2VI by
P.O. Box 23607, GMF, GU 96921.
sending Form 8809, Application for Extension of Time To File
Information Returns, to the address shown on that form. You File Copy 1 of Forms W-2VI and W-3SS with the V.I. Bureau
must request the extension by the due date of Forms W-2. You of Internal Revenue, 9601 Estate Thomas, Charlotte Amalie, St.
will have an additional 30 days to file. See Form 8809 for Thomas, VI 00802.
details. Contact the Division of Revenue and Taxation,
Even if you receive an extension of time to file Forms Commonwealth of the Northern Mariana Islands at
(670) 664-1000, for the address to send Copy 1 of Forms
! W-2AS, W-2CM, W-2GU, or Form W-2VI, you must still
CAUTION furnish the forms to your employees by February 2, W-2CM and W-3SS.
2009. But see Extension to furnish Forms W-2 to employees on Shipping and mailing. If you file more than one type of form,
page 2. please group forms of the same type with a separate Form
W-3SS for each type. For example, send Forms W-2GU with
Where To File one Form W-3SS and Forms W-2AS with a second Form
W-3SS. Forms W-2AS, W-2CM, W-2GU, or W-2VI are printed
Send the entire first page of Form W-3SS (Copy A) with the
two forms to a page. Send the whole page of Copies A and 1
entire Copy A page of Form W-2AS, W-2CM, W-2GU, or W-2VI
even if one of the forms is blank or “Void.” Prepare and file
to:
Forms W-2 either alphabetically by employees’ last names or
Social Security Administration numerically by employees’ social security numbers. Do not
Data Operations Center staple or tape the forms together and do not fold them. Send
Wilkes-Barre, PA 18769-0001 the forms in a flat mailing.
Cat. No. 48440A
“9” with either a “7” or “8” as the fourth digit and is formatted like
General Instructions for Forms W-2AS, an SSN (for example, (9NN-7N-NNNN). For more information
W-2CM, W-2GU, and W-2VI about EINs and SSNs, see Pub. 80 (Circular SS).
Furnishing Copies B and C to employees. Furnish Copies B Social security numbers are used to record employee
and C of Forms W-2AS, W-2CM, W-2GU, and W-2VI to your earnings for future social security and Medicare benefits. You
employees by February 2, 2009. If employment ends before must show the correct social security number on the Form
December 31, 2008, you may furnish the copies any time after W-2AS, W-2CM, W-2GU, or W-2VI.
employment ends but not later than February 2, 2009. If the
employee asks for the form, furnish him or her the completed Special Reporting Situations
copies within 30 days of the request or within 30 days of the last Corrections. Use the current version of Form W-2c, Corrected
wage payment, whichever is later. If an employee loses a form, Wage and Tax Statement, to correct errors on previously filed
write “REISSUED STATEMENT” on the new copy (unless it Forms W-2AS, W-2CM, W-2GU, or W-2VI. Always send Form
was furnished electronically), but do not send Copy A of the W-3c, Transmittal of Corrected Wage and Tax Statements, with
reissued statement to the SSA. Employers are not prohibited Forms W-2c to the SSA. See the separate Instructions for
(by the Internal Revenue Code) from charging a fee for the Forms W-2c and W-3c. Also, see below for information on
issuance of a duplicate Form W-2AS, W-2CM, W-2GU, or correcting an employee’s address.
W-2VI.
Extension to furnish Forms W-2 to employees. You may If you are making an adjustment in 2008 to correct social
request an extension of time to furnish Forms W-2 to security and Medicare taxes for a prior year, you must file Form
employees by sending a letter to: 941c, Supporting Statement To Correct Information, with your
Form 941-SS, Employer’s QUARTERLY Federal Tax Return
IRS Enterprise Computing Center – Martinsburg (Form 941, Employer’s QUARTERLY Federal Tax Return);
Information Reporting Program Form 944-SS, Employer’s ANNUAL Federal Tax Return, (Form
Attn: Extension of Time Coordinator 944, Employer’s ANNUAL Federal Tax Return); or Form 943,
240 Murall Drive Employer’s Annual Federal Tax Return for Agricultural
Kearneysville, WV 25430 Employees, in the return period that you find the error. File
Mail your letter on or before the due date for furnishing Copy A of Forms W-2c and W-3c with the SSA and give the
Forms W-2 to employees. It must include: employee a copy of Form W-2c for the prior year.
• Your name and address, Incorrect address on employee’s Form W-2. If you filed a
• Your employer identification number (EIN), Form W-2AS, W-2CM, W-2GU, or Form W-2VI with the SSA
• A statement that you are requesting an extension to furnish showing an incorrect address for the employee but all other
“Forms W-2” to employees, information on the form is correct, do not file Form W-2c with
• Reason for delay, and the SSA merely to correct the address.
• Your signature or that of your authorized agent. However, if the address was incorrect on the Form W-2
Undeliverable forms. Keep for 4 years any employee furnished to the employee, you must do one of the following:
copies of Forms W-2AS, W-2CM, W-2GU, or W-2VI that you • Issue a new, corrected Form W-2 to the employee, including
tried to deliver but could not. However, if undelivered Forms the new address. Indicate “REISSUED STATEMENT” on the
W-2 can be produced electronically through April 15th of the new copies. Do not send Copy A to the SSA.
fourth year after the year of issue, you do not need to keep • Issue a Form W-2c to the employee showing the correct
undeliverable copies. Do not send undeliverable employee address in box f and all other correct information. Do not send
copies of Forms W-2 to the SSA. See Rev. Proc. 97-22, Copy A to the SSA.
1997-1, C.B. 652, for more information on electronic • Mail the Form W-2 with the incorrect address to the
recordkeeping. employee in an envelope showing the correct address or
Calendar year basis. Base all entries on Forms W-2AS, otherwise deliver it to the employee.
W-2CM, W-2GU, W-2VI, and W-3SS on a calendar year. Use Educational assistance programs. A $5,250 exclusion for
the correct year form. employer-provided educational assistance applies to benefits
Electronic reporting. If you are required to file 250 or more provided to your employees under an educational assistance
Forms W-2AS, W-2CM, W-2GU, or W-2VI, you must file them program. However, educational assistance that exceeds $5,250
electronically. You can get specifications for filing this may be excludable from an employee’s wages if it qualifies as a
information electronically by visiting Social Security’s Employer working condition benefit. See Pub. 970, Tax Benefits for
W-2 Filing Instructions & Information website at Education, and section 2 of Pub. 15-B, Employer’s Tax Guide to
www.socialsecurity.gov/employer or by contacting an SSA Fringe Benefits, for more information.
Employer Services Liaison Officer (ESLO) at 212-264-1117 for
the U.S. Virgin Islands or 510-970-8247 for Guam and Election workers. Report on Form W-2AS, W-2CM, W-2GU,
American Samoa. SSA will no longer accept any type of or W-2VI payments of $600 or more to election workers for
physical media (magnetic tape, cartridge, diskette, etc.) services performed in territorial, county, and municipal
submissions of Form W-2 reports. elections. File Form W-2AS, W-2CM, W-2GU, or W-2VI for
payments of less than $600 paid to election workers if social
If you file electronically, do not file the same returns on security and Medicare taxes were withheld under a section 218
paper. (Social Security Act) agreement. Do not report election worker
Note. You are encouraged to file electronically even if you payments on Form 1099-MISC.
file fewer than 250 Forms W-2. Group-term life insurance. If you paid for group-term life
You may request a waiver on Form 8508, Request for insurance coverage over $50,000 for an employee or a former
Waiver From Filing Information Returns Electronically/ employee, you must report the taxable cost of excess coverage
Magnetically. Submit Form 8508 to the IRS at least 45 days determined by using the table in section 2 of Pub. 15-B,
before the due date of Form W-2. See Form 8508 for filing Employer’s Tax Guide to Fringe Benefits, in boxes 1, 3, and 5
information. of Form W-2AS, W-2CM, W-2GU, or W-2VI. Also, show the
Taxpayer identification numbers (TINs). Employers use an amount in box 12 with code C. For employees, you must
employer identification number (EIN) (00-0000000). Employees withhold social security and Medicare taxes, but not income tax.
use a social security number (SSN) (000-00-0000). When you Former employees must pay the employee part of social
list a number, separate the nine digits properly to show the kind security and Medicare taxes on the taxable cost of group-term
of number. Do not accept an individual taxpayer identification life insurance coverage over $50,000 on Form 1040. You are
number (ITIN) for employment purposes. You can identify an not required to collect those taxes. However, you must report
ITIN because it is a 9-digit number, beginning with the number the uncollected social security tax with code M and the
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uncollected Medicare tax with code N in box 12 of Form Box c — Employer’s name, address, and ZIP code. This
W-2AS, W-2CM, W-2GU, or W-2VI. entry should generally be the same as shown on your Form
941-SS (Form 941), Form 944-SS (Form 944), or Form 943.
Moving expenses. Report moving expenses as follows:
• Qualified moving expenses that an employer paid to a third Box d — Control number. You may use this box to identify
party on behalf of the employee (for example, to a moving individual forms. You do not have to use this box.
company) and services that an employer furnished in kind to an Boxes e and f — Employee’s name and address. Enter the
employee are not reported on Form W-2AS, W-2CM, W-2GU, name as shown on the employee’s social security card (first,
or W-2VI. middle initial, last). Generally, do not enter “Jr.”, “Sr.”, etc.
• Qualified moving expense reimbursements paid directly to an on Copy A unless the suffix appears on the card. (You may
employee by an employer are reported only in box 12 of Form enter an employee’s name suffix in the designated area of box
W-2AS, W-2CM, W-2GU, or W-2VI with code P. e. However, SSA prefers that you do not enter the suffix on
• Nonqualified moving expense reimbursements are reported Copy A.) If the name does not fit, you may show first name
in boxes 1, 3, and 5 of Form W-2AS, W-2GU, or W-2VI. These initial, middle initial, and last name (and ignore the vertical
amounts are subject to income tax withholding and social lines). If the name has changed, the employee must get a
security and Medicare taxes. corrected card from any SSA office. Use the name on the
original card until you see the corrected one. Do not show
Sick pay. Sick pay paid to an employee by a third party, such titles or academic degrees, such as “Dr.”, “RN”, or “Esq.”,
as an insurance company or trust, requires special treatment at the beginning or end of the employee’s name.
because the IRS reconciles Forms 941-SS with the Forms
W-2AS, W-2CM, W-2GU, or Form W-2VI and Form W-3SS. Include in the address the number, street, apartment or suite
See Sick Pay Reporting in section 6 of Pub. 15-A, Employer’s number (or P.O. box number if mail is not delivered to a street
Supplemental Tax Guide, for specific reporting instructions. address).
Third-party payers of sick pay filing third-party sick pay
Terminating a business. If you terminate your business, you recap Forms W-2AS, W-2CM, W-2GU, or W-2VI must enter
must provide Forms W-2AS, W-2CM, W-2GU, or Form W-2VI “Third-Party Sick Pay Recap” in place of the employee’s name
to your employees for the calendar year of termination by the in box e. See Sick Pay Reporting in Pub. 15-A.
due date of your final Form 941-SS (Form 941) or Form 944-SS
(Form 944). You must also file Forms W-2AS, W-2CM, W-2GU, Box 1 — Wages, tips, other compensation. Show, before
or W-2VI with the SSA by the last day of the month that follows any payroll deductions, the total taxable wages, tips, and other
the due date of your final Form 941-SS (Form 941), or Form compensation such as: (a) wages, bonuses, prizes, and
944-SS (Form 944). However, if any of your employees are awards, (b) noncash payments, including certain fringe benefits,
immediately employed by a successor employer, see Rev. (c) tips reported, (d) taxable cost of group-term life insurance
Proc. 2004-53. You can find Rev. Proc. 2004-53 on page 320 of over $50,000, (e) distributions from a nonqualified or
Internal Revenue Bulletin 2004-34 at nongovernmental section 457(b) plan, and (f) cost of current
www.irs.gov/pub/irs-irbs/irb04-34.pdf. Also see Rev. Proc. insurance protection under a compensatory split-dollar life
96-57, 1996-2 C.B. 389, for information on automatic insurance arrangement. Other compensation is amounts you
extensions for furnishing Forms W-2AS, W-2CM, W-2GU, or pay the employee from which income tax is not withheld. You
W-2VI to employees and filing them with the SSA. You can find may show other compensation on a separate Form W-2AS,
Rev. Proc. 96-57 on page 14 of Internal Revenue Bulletin W-2GU, or W-2VI.
1996-53 at www.irs.gov/pub/irs-irbs/irb96-53.pdf. Note. Show payments to statutory employees that are subject
to social security and Medicare taxes but not subject to income
tax withholding in box 1 as other compensation. See Pub. 80
Specific Instructions for Forms W-2AS, (Circular SS), Federal Tax Guide for Employers in the U.S.
W-2GU, and W-2VI Virgin Islands, Guam, American Samoa, and the
For specific instructions for the 2008 Form W-2CM, see the Commonwealth of the Northern Mariana Islands, for the
2008 Instructions for Forms W-2CM and OS-3710, published by definition of a statutory employee.
the Division of Revenue and Taxation, Commonwealth of the Box 2 — Income tax withheld. Show the total American
Northern Mariana Islands. Samoa, Guam, or U.S. Virgin Islands income tax withheld. Do
not reduce this amount by any advance EIC payments.
Because Copy A of Forms W-2AS, W-2GU, and W-2VI is
read by machine, please type entries, if possible, using Box 3 — Social security wages. Show the total wages paid
12-point Courier font. Make all dollar entries without the (before payroll deductions) subject to employee social security
dollar sign and comma but with the decimal point tax. Do not include tips. The total of boxes 3 and 7 cannot be
(00000.00). If a box does not apply, leave it blank. Keep Copy more than $102,000 (2008 maximum social security wage
D, and a copy of Form W-3SS, with your records for 4 years. base). Generally, noncash payments are considered wages.
See Pub. 80 (Circular SS) for more information.
Void. Check this box when an error is made on a Form Box 4 — Social security tax withheld. Show the total
W-2AS, W-2GU, or W-2VI and you are voiding it because you employee social security tax (not your share) withheld or paid
will complete a new form. Be careful not to include any by you for the employee, including social security tax on tips.
amounts shown on “Void” forms in the totals you enter on Include only tax withheld (or paid by you for the employee) for
Form W-3SS. 2008 wages and tips. The amount shown should not exceed
Box a — Employee’s social security number. Enter the $6,324.00 ($102,000 x 6.2%).
number shown on the employee’s social security card. If the Box 5 — Medicare wages and tips. Show the total wages
employee does not have a card, he or she should apply for one paid and tips reported subject to employee Medicare tax. There
by completing Form SS-5, Application for a Social Security is no wage base limit for Medicare tax.
Card. If the employee has applied for a card, enter “Applied Box 6 — Medicare tax withheld. Show the total employee
For” in box a. Medicare tax (not the employer’s share) withheld or paid by you
Box b — Employer identification number (EIN). Show the for the employee. Include only tax withheld for 2008 wages and
employer identification number (EIN) assigned to you by the tips. The rate is 1.45% of all wages and tips.
IRS (00-0000000). This should be the same number that you Box 7 — Social security tips. Show the tips that the employee
used on your Form 941-SS (Form 941), Form 944-SS (Form reported to you even if you did not have enough employee
944), or Form 943. Do not use a prior owner’s EIN. If you do not funds to collect the social security tax for the tips. The total of
have an EIN, enter “Applied For” in box b; do not use your boxes 3 and 7 should not be more than $102,000 for 2008.
SSN. File Form SS-4, Application for Employer Identification Report all tips in box 1 along with wages and other
Number, to get an EIN. See Terminating a business, above. compensation.
-3-
Box 9 — Advance EIC payment. (Forms W-2GU and W-2VI For employees who were 50 years of age or older at any
only.) Show the total advance earned income credit (EIC) paid time during the year and made elective deferral and/or
to the employee. designated Roth “catch-up” contributions, report the elective
Box 11 — Nonqualified plans. The purpose of box 11 is for deferrals and the elective deferral “catch-up” contributions as a
the SSA to determine if any part of the amount reported in box single sum in box 12 using the appropriate code, and the
1 or boxes 3 and/or 5 was earned in a prior year. The SSA uses designated Roth contributions and the designated Roth
this information to verify that they have properly applied the “catch-up” contributions as a single sum in box 12 using the
social security earnings test and paid the correct amount of appropriate code.
benefits. The following are not elective deferrals and may be
Show distributions to an employee from a nonqualified or reported in box 14, but not in box 12: (a) nonelective
nongovernmental section 457(b) plan. Also report the employer contributions on behalf of an employee; (b) after-tax
distributions in box 1. Make only one entry in this box. contributions that are not designated Roth contributions, such
Distributions from governmental section 457(b) plans must be as voluntary contributions to a pension plan that are deducted
reported on Form 1099-R, not in box 1 of Forms W-2AS, from an employee’s pay; and (c) required employee and
W-2GU, or W-2VI. employer matching contributions. See the instructions below in
codes AA and BB for reporting designated Roth contributions.
If you did not make distributions this year, show
deferrals (plus earnings) under a nonqualified or any Code D — Elective deferrals to a section 401(k) cash or
section 457(b) plan that became taxable for social security deferred arrangement (plan). Also show deferrals under a
and Medicare taxes during the year (but were for prior year SIMPLE retirement account that is part of a section 401(k)
services) because the deferred amounts were no longer arrangement.
subject to a substantial risk of forfeiture. Also report these Example of reporting elective deferrals and designated
amounts in boxes 3 (up to the social security wage base) and 5. Roth contributions to a section 401(k) plan. For 2008,
Do not report in box 11 deferrals that are included in boxes Employee A (age 45) elected to defer $16,000 to a section
3 and/or 5 and that are for current year services (such as, 401(k) plan, made a designated Roth contribution of $1,000 to
those that have no risk of forfeiture). the plan, and made a voluntary (non-Roth) after-tax contribution
If you made distributions and you are also reporting any of $600. In addition, the employer, on A’s behalf, made a
qualified nonelective contribution of $2,000 to the plan and a
! deferrals in boxes 3 and/or 5, do not complete box 11.
CAUTION See Pub. 957, Reporting Back Pay and Special Wage nonelective profit-sharing employer contribution of $3,000.
Payments to the Social Security Administration, and Form The total elective deferral of $16,000 is reported in box 12
SSA-131, Employer Report of Special Wage Payments, for with code D (D 16000.00), and the designated Roth contribution
special reporting instructions for these and other kinds of is reported in box 12 with code AA (AA 1000.00). Even though
compensation earned in prior years. However, do not file Form the 2008 limit for elective deferrals and designated Roth
SSA-131 if this situation applies but the employee will not be contributions is $15,500, the employer must separately report
age 62 or older by the end of that year. the actual amounts of 16,000 and $1,000 in box 12. The return
Note. Do not report special wage payments, such as of excess salary deferrals and excess designated Roth
accumulated sick or vacation pay, in box 11. For more contributions, including earnings on both, is reported on Form
information or reporting special wage payments, see Pub. 957. 1099-R.
Box 12 — Codes. Complete and code this box for all items The $600 voluntary after-tax contribution may be reported in
described below. On Copy A, do not enter more than four items box 14 (this is optional) but not in box 12. The $2,000
in box 12. If more than four items need to be reported in box 12, nonelective contribution and the $3,000 nonelective
use a separate Form W-2AS, W-2GU, or W-2VI for additional profit-sharing employer contribution are not required to be
items. You may enter more than four items on all other copies reported on Form W-2AS, W-2GU, or W-2VI, but may be
when using an approved substitute form. reported in box 14.
Show the IRS code (using a capital letter or letters) to Check the “Retirement plan” box in box 13.
the left of the vertical line in boxes 12a – 12d and the Code E — Elective deferrals under a section 403(b)
money amount to the right of the vertical line using decimal salary reduction agreement.
points but no dollar signs or commas, (for example, D 5300.00).
Code A — Uncollected social security tax on tips. Show Code F — Elective deferrals under a section 408(k)(6)
the employee social security tax on tips that you could not salary reduction SEP.
collect because the employee did not have enough funds from Code G — Elective deferrals and employer contributions
which to deduct it. Do not include this amount in box 4. (including nonelective deferrals) to any governmental or
Code B — Uncollected Medicare tax on tips. Show the nongovernmental section 457(b) deferred compensation
employee Medicare tax on tips that you could not collect plan. Do not report either section 457(b) or section 457(f)
because the employee did not have enough funds from which amounts that are subject to a substantial risk of forfeiture.
to deduct it. Do not include this amount in box 6. Code H — Elective deferrals to a section 501(c)(18)(D)
Code C — Taxable cost of group-term life insurance over tax-exempt organization plan. Be sure to include this amount
$50,000. Show the taxable cost of group-term life insurance in box 1 as wages. The employee will deduct the amount on his
coverage over $50,000 provided to your employee (including a or her income tax return.
former employee). Also include this amount in boxes 1, 3 (up to Code J — Nontaxable sick pay. Show any sick pay that
the social security wage base), and 5. was paid by a third-party and was not includible in income (and
Codes D through H, S, Y, AA, and BB. Use these codes not shown in boxes 1, 3, and 5) because the employee
to show pre-tax elective deferrals and designated Roth contributed to the sick pay plan.
contributions made to the plans listed. Do not report amounts Code M — Uncollected social security tax on taxable
for other types of plans. The Example following code D shows cost of group-term life insurance over $50,000 (for former
how to report elective deferrals to a section 401(k) plan. employees). If you provided your former employees (including
Report as elective deferrals and designated Roth retirees) more than $50,000 of group-term life insurance
contributions only the part of the employee’s salary (or other coverage for periods during which an employment relationship
compensation) that he or she did not receive because of the no longer exists, enter the amount of uncollected social security
deferrals or designated Roth contributions. For section 457(b) tax on the coverage in box 12. See Group-term life insurance
plans, report both elective and nonelective deferrals on page 2.
using code G.
-4-
Code N — Uncollected Medicare tax on taxable cost of Box 13 — Checkboxes. Check all boxes that apply.
group-term life insurance over $50,000 (for former • Statutory employee. Check this box for statutory employees
employees). Enter any uncollected Medicare tax on the cost whose earnings are subject to social security and Medicare
of group-term life insurance coverage over $50,000 for your taxes but not subject to income tax withholding. Do not check
former employees. See code M above. this box for common law employees. See Pub. 80 (Circular SS)
Code P — Excludable moving expense reimbursements for more information on statutory employees.
paid directly to employee. Show the total moving expense • Retirement plan. Check this box if the employee was an
reimbursements that you paid directly to your employee for “active participant” (for any part of the year) in any of the
qualified (deductible) moving expenses. See Moving expenses following:
on page 3. 1. A qualified pension, profit-sharing, or stock bonus plan
described in section 401(a) (including a 401(k) plan).
Code Q — Nontaxable combat pay. If you are a military
2. An annuity plan described in section 403(a).
employer, report any nontaxable combat pay in box 12.
3. An annuity contract or custodial account described in
Code R — Employer contributions to an Archer MSA. section 403(b).
Show any employer contributions to an Archer MSA. 4. A simplified employee pension (SEP) plan described in
Code S — Employee salary reduction contributions section 408(k).
under a section 408(p) SIMPLE. Show deferrals under a 5. A SIMPLE retirement account described in section
section 408(p) salary reduction SIMPLE retirement account. 408(p).
However, if the SIMPLE is part of a section 401(k) 6. A trust described in section 501(c)(18).
arrangement, use code D. 7. A plan for federal, state, or local government employees
or by an agency or instrumentality thereof (other than a section
Code T — Adoption benefits. Show the total that you paid 457(b) plan).
or reimbursed for qualified adoption expenses furnished to your
employee under an adoption assistance program. Also include Generally, an employee is an active participant if covered
adoption benefits paid or reimbursed from the pre-tax by (a) a defined benefit plan for any tax year that he or she is
contributions made by the employee to a section 125 (cafeteria) eligible to participate or (b) a defined contribution plan (for
plan. However, do not include adoption benefits forfeited from a example, a section 401(k) plan) for any tax year that employer
section 125 (cafeteria) plan. Report all amounts including those or employee contributions (or forfeitures) are added to his or
in excess of the $11,650 exclusion. her account. For additional information on employees who are
eligible to participate in a plan, contact your plan administrator.
Code V — Income from the exercise of nonstatutory
For details on the active participant rules, see Notice 87-16,
stock option(s). Show the spread (that is, fair market value of
1987-1 C.B. 446; Notice 98-49, 1998-2 C.B. 365; section
stock over the exercise price of option(s) granted to your
219(g)(5); and Pub. 590, Individual Retirement Arrangements
employee with respect to that stock) from your employee’s (or
(IRAs). You can find Notice 98-49 on page 5 of Internal
former employee’s) exercise of nonstatutory stock option(s).
Revenue Bulletin 1998-38 at
Include this amount in boxes 1, 3 (up to social security wage
www.irs.gov/pub/irs-irbs/irb98-38.pdf.
base), and 5.
Do not check this box for contributions made to a
This reporting requirement does not apply to the exercise of nonqualified or section 457(b) plan.
a statutory stock option, or the sale or disposition of stock • Third-party sick pay. Check this box only if you are a
acquired pursuant to the exercise of a statutory stock option. third-party sick pay payer filing a Form W-2AS, W-2GU, or
For more information about the taxability of employee stock Form W-2VI for an insured’s employee or are an employer
options, see Pub. 15-B. reporting sick pay payments made by a third party. See Sick
Code W — Employer contributions to an employee’s Pay Reporting in section 6 of Pub. 15-A.
Health Savings Account (HSA). Show any employer Box 14 — Other. The lease value of a vehicle provided to your
contributions (including amounts the employee elected to pay employee and reported in box 1 must be reported here or on a
under a section 125 (cafeteria) plan) to your employee’s Health separate statement to your employee. You may use this box for
Savings Account (HSA). any other information that you want to give to your employee,
See Notice 2004-2 and Notice 2004-50 for more information such as health insurance premiums deducted, union dues,
about HSAs. You can find Notice 2004-2 on page 269 of voluntary after-tax contributions (but not designated Roth
Internal Revenue Bulletin 2004-2 at contributions) to a pension plan, or nontaxable income. Clearly
www.irs.gov/pub/irs-irbs/irb04-02.pdf. You can find Notice label each entry.
2004-50 on page 196 of Internal Revenue Bulletin 2004-33 at
www.irs.gov/pub/irs-irbs/irb04-33.pdf. See also Form 8889, Specific Instructions for Form W-3SS
Health Savings Accounts (HSAs), and Pub. 969, Health How to complete Form W-3SS. Please type or print entries.
Savings Accounts and Other Tax-Favored Health Plans. Make all entries without the dollar sign and comma but with the
Code Y — Deferrals under a section 409A, nonqualified decimal point (00000.00). If a box does not apply, leave it blank.
deferred compensation plan. Include current year deferrals Box a — Control number. This is an optional box that you
under a section 409A deferred compensation plan. Any may use for numbering the whole transmittal.
earnings during the year on current year and prior year Box b — Kind of Payer. Check only one box unless the
deferrals must also be reported here. second, marked checkbox is “Third-party sick pay.” If you have
Code Z — Income under section 409A on a nonqualified more than one type of Form W-2AS, W-2CM, W-2GU, or
deferred compensation plan. Show any income under W-2VI, send each type with a separate Form W-3SS.
section 409A on a nonqualified deferred compensation plan that 941-SS. Check this box if you file Form 941-SS and no
was included in box 1. This income is subject to an additional other category (except “Third-party sick pay”) applies. A church
tax reported on the employee’s tax return. or church organization should check this box even if it is not
Code AA — Designated Roth contributions under a required to file Form 941-SS or Form 944-SS.
section 401(k) plan. Use this code to report designated Roth Military. Check this box if you are a military employer
contributions under a section 401(k) plan. Do not use this code sending Forms W-2AS, W-2CM, W-2GU, or W-2VI for members
to report elective deferrals under code D. of the uniformed services.
Code BB — Designated Roth contributions under a 943. Check this box if you file Form 943 and are sending
section 403(b) plan. Use this code to report designated Roth forms for agricultural employees. For nonagricultural
contributions under a section 403(b) plan. Do not use this code employees, send their Forms W-2AS, W-2CM, W-2GU, or
to report elective deferrals under code E. W-2VI with a separate Form W-3SS.
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944-SS. Check this box if you file Form 944-SS and no Form W-2 described in section 6 of Pub. 15-A) filing third-party
other category applies. sick pay recap Forms W-2 and W-3SS must enter “Third-Party
Hshld. emp. Check this box if you are a household Sick Pay Recap” in this box. See Sick Pay Reporting in Pub.
employer sending Form W-2AS, W-2CM, W-2GU, or W-2VI for 15-A for details.
household employees, and you did not include the household Box 14 — Income tax withheld by payer of third-party sick
employee’s taxes on Form 941-SS, Form 944-SS or Form 943. pay. Complete this box only if you are the employer and have
Medicare government employee. Check this box if you employees who had income tax withheld on third-party
are a U.S. or a U.S. Virgin Islands government employer with payments of sick pay. Show the total income tax withheld by
employees subject only to the 1.45% Medicare tax. third-party payers on payments to all of your employees.
Third-party sick pay. Check this box (and one other Although this tax is included in the box 2 total, it must be shown
checkbox) if you are a third-party sick pay payer (or are separately here.
reporting payments made by a third party) filing Form(s) Box 15 — Type of form. Check this box for the type of forms
W-2AS, W-2CM, W-2GU, or W-2VI with the “Third-party sick you are submitting with this Form W-3SS.
pay” box in box 13 checked. Signature. The signature on Copies A and 1 of Form W-3SS
Box c — Total number of Forms W-2. Show the number of must be an original (not a copy).
completed individual Forms W-2AS, W-2CM, W-2GU, or W-2VI
filed with this Form W-3SS. Do not count “Void” forms. Privacy Act and Paperwork Reduction Act Notice. We ask
Box d — Establishment number. You may use this box to for the information on Forms W-2AS, W-2CM, W-2GU, W-2VI,
identify separate establishments in your business. You may file and W-3SS to carry out the Internal Revenue laws of the United
a separate Form W-3SS, with Forms W-2AS, W-2CM, W-2GU, States. We need it to figure and collect the right amount of tax.
or W-2VI, for each establishment even if they all have the same Section 6051 and its regulations require you to furnish wage
EIN, or you may use a single Form W-3SS for all Forms W-2 of and tax statements to employees and to the Social Security
the same type. Administration. Section 6109 requires you to provide your
employer identification number. If you fail to provide this
Box e — Employer identification number (EIN). If you information in a timely manner, you may be subject to penalties.
received a preprinted Form W-3SS from the IRS with Pub. 80
(Circular SS), make any necessary corrections on the form. If You are not required to provide the information requested on
you are not using a preprinted IRS Form W-3SS, enter the a form that is subject to the Paperwork Reduction Act unless
nine-digit EIN assigned to you by the IRS. The EIN should be the form displays a valid OMB control number. Books or
the same as shown on your Form 941-SS, Form 944-SS, or records relating to a form or its instructions must be retained as
Form 943 and in the following format: 00-0000000. Do not use long as their contents may become material in the
a prior owner’s EIN. If you do not have an EIN, see Box b on administration of any Internal Revenue law.
page 3. See also Box h below. Generally, tax returns and return information are confidential,
Boxes f and g — Employer’s name and address. If you are as required by section 6103. However, section 6103 allows or
not using a preprinted Form W-3SS, enter your name and requires the Internal Revenue Service to disclose or give the
address as shown on your Form 941-SS, Form 944-SS, or information shown on your return to others as described in the
Form 943. Make any necessary corrections on your preprinted Code. For example, we may disclose your tax information to the
Form W-3SS. Department of Justice for civil and criminal litigation, and to
cities, states, and the District of Columbia for use in
Box h — Other EIN used this year. If you have used an EIN administering their tax laws. We may also disclose this
(including a prior owner’s EIN) on Form 941-SS, Form 944-SS, information to other countries under a tax treaty, to federal and
or Form 943 submitted for 2008 that is different from the EIN state agencies to enforce federal nontax criminal laws, or to
reported in box e on this form, enter the other EIN used. federal law enforcement and intelligence agencies to combat
Contact person, telephone number, fax number, and email terrorism.
address. Please enter this information for use by the SSA if
The time needed to complete and file these forms will vary
questions arise during processing.
depending on individual circumstances. The estimated average
Boxes 1 through 7. Enter the totals reported in boxes 1 times are: Form W-2AS — 23 minutes; Form W-2GU — 24
through 7 of Forms W-2AS, W-2CM, W-2GU, or Form W-2VI minutes; Form W-2VI — 24 minutes; Form W-3SS — 24
being filed with this Form W-3SS. minutes.
Box 9 — Advance EIC payments. Enter the total advance EIC If you have comments concerning the accuracy of these
payments shown on Form W-2GU or Form W-2VI only. time estimates or suggestions for making these forms simpler,
Box 11 — Nonqualified plans. Enter the total reported in box we would be happy to hear from you. You can write to the
11 on Forms W-2AS, W-2CM, W-2GU, or W-2VI being filed with Internal Revenue Service, Tax Products Coordinating
this Form W-3SS. Committee, SE:W:CAR:MP:T:B:C, 1111 Constitution Ave. NW,
Box 12 — Deferred compensation. Enter one total for all IR-6526, Washington, DC 20224. Do not send Forms W-2AS,
amounts reported with codes D-H, S, Y, AA, and BB in box 12 W-2GU, W-2VI, or W-3SS to this address. Instead, see Where
of Forms W-2AS, W-2GU, or W-2VI. Do not enter a code. To File on page 1.
Box 13 — For third-party sick pay use only. Third-party
payers of sick pay (or employers using the optional rule for
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