REQUEST FOR DUPLICATE W-2
Date Department Employed
City / State / Zip Code
Payroll Number Social Security No.
Tax Year(s) Requested
The undersigned requests a duplicate W-2 Wage and Tax Statement be issued by
the Iowa Department of Administrative Services at a fee of $5.00 for each tax year
Cash Check Make checks payable to: Treasurer, State of Iowa
Mail this request to: Iowa Department of Administrative Services
State Accounting Enterprise, Centralized Payroll
1305 East Walnut, Hoover Building, 3rd Floor
Des Moines, IA 50319
Duplicate W-2 Request forms received by email will not be accepted.
Reissuance of a Duplicate W-2 may require up to 30 days.
TO BE COMPLETED BY CENTRALIZED PAYROLL STAFF:
1. Federal Wages 9. Advance EIC Pymt
2. Fed Tax Withheld 10. Dep. Care Benefits
3. Social Sec Wages 12. Annuities / Code / Amount
4. SS Tax Withheld 14. Retirement Type / Amount
5. Medicare Wages 16. State Wages
6. Medicare Tax WH 17. State Withholding