Form W-3 - Transmittal Of Wage And Tax Statements - 2012
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1DO NOT STAPLE
a Control number
For Official Use Only
33333
OMB No. 1545-0008
b
941
Military
943
944
None apply
501c non-govt.
Third-party
sick pay
Kind
Kind
of
of
(Check if
Hshld.
Medicare
State/local
Payer
Employer
applicable)
CT-1
emp.
govt. emp.
non-501c
State/local 501c
Federal govt.
(Check one)
(Check one)
c Total number of Forms W-2
d Establishment number
1 Wages, tips, other compensation
2 Federal income tax withheld
e Employer identification number (EIN)
3 Social security wages
4 Social security tax withheld
6 Medicare tax withheld
f Employer’s name
5 Medicare wages and tips
7 Social security tips
8 Allocated tips
10 Dependent care benefits
9
11 Nonqualified plans
12a Deferred compensation
g Employer’s address and ZIP code
h Other EIN used this year
13 For third-party sick pay use only
12b
15 State
Employer’s state ID number
14 Income tax withheld by payer of third-party sick pay
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
Contact person
Telephone number
For Official Use Only
Email address
Fax number
Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and
complete.
Signature
Date
Title
2012
W-3
Transmittal of Wage and Tax Statements
Department of the Treasury
Form
Internal Revenue Service
Send this entire page with the entire Copy A page of Form(s) W-2 to the Social Security Administration (SSA).
Photocopies are not acceptable. Do not send Form W-3 if you filed electronically with the SSA.
Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3.
Reminder
Separate instructions. See the 2012 General Instructions for Forms
W-2 and W-3 for information on completing this form.
Purpose of Form
A Form W-3 Transmittal is completed only when paper Copy A of
Form(s) W-2, Wage and Tax Statement, is being filed. Do not file Form
W-3 alone. Do not file Form W-3 for Form(s) W-2 that were submitted
electronically to the SSA (see below). All paper forms must comply
with IRS standards and be machine readable. Photocopies are not
acceptable. Use a Form W-3 even if only one paper Form W-2 is being
filed. Make sure both the Form W-3 and Form(s) W-2 show the correct
When To File
tax year and Employer Identification Number (EIN). Make a copy of this
form and keep it with Copy D (For Employer) of Form(s) W-2 for your
Mail Copy A of Form W-3 with Form(s) W-2 by February 28, 2013.
records. The IRS recommends retaining copies of these forms for four
Where To File Paper Forms
years.
Send this entire page with the entire Copy A page of Form(s) W-2 to:
E-Filing
Social Security Administration
The SSA strongly suggests employers report Form W-3 and Forms W-2
Data Operations Center
Copy A electronically instead of on paper. The SSA provides two free e-
filing options on its Business Services Online (BSO) website:
Wilkes-Barre, PA 18769-0001
• W-2 Online. Use fill-in forms to create, save, print, and submit up to
Note. If you use “Certified Mail” to file, change the ZIP code to
50 Forms W-2 at a time to the SSA.
“18769-0002.” If you use an IRS-approved private delivery service, add
“ATTN: W-2 Process, 1150 E. Mountain Dr.” to the address and change
• File Upload. Upload wage files to the SSA you have created using
the ZIP code to “18702-7997.” See Publication 15 (Circular E),
payroll or tax software that formats the files according to the SSA’s
Specifications for Filing Forms W-2 Electronically (EFW2).
Employer’s Tax Guide, for a list of IRS-approved private delivery
services.
W-2 Online fill-in forms or file uploads will be on time if submitted by
April 1, 2013. For more information, go to
employer and select “First Time Filers” or “Returning Filers” under
“BEFORE YOU FILE.”
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10159Y
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