Form Ssa-L-93-Sm (04-11) - Retirement, Survivors And Disability Insurance Form (Page 5 of 7) in pdf

Form Ssa-L-93-Sm (04-11) - Retirement, Survivors And Disability Insurance Form Page 5

Page 5 of 7

Caution: You must identify this as a reconciliation file when you submit it! Enclose the

electronic receipt showing the Wage File ID (WFID) as proof of filing.

3. ( ) I filed Forms W-2 under EIN __________, rather than the EIN shown above. Attach legible

copies if on paper. Enter the Wage File ID (WFID) if electronic (or other proof of filing if a third-party,

such as a payroll service e-filed for you).

4. ( ) I filed but cannot locate my copies of Forms W-2 and W-3. I am now taking the following action

(check one):

( ) Enclosing duplicate copies of paper Forms W-2 and W-3, or

( ) Sending SSA an electronic file.

Caution: You must identify this as a reconciliation file when you submit it! Enclose the

electronic receipt showing the Wage ID (WFID) as proof of filing.

5. ( ) I was not required to file Forms W-2 with SSA, as I was self-employed. (Attach a legible copy of

Form 1099 or 1040 with a Schedule SE or Schedule C that shows SE tax.)

6. ( ) Other ________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

________________________________________

(

) ______________________

Your Name and Title

Daytime Phone, with area code

INFORMATION ABOUT THE DATA YOU SEND SSA

The name, Social Security number, and wage amounts on the Forms W-2 must be readable and complete.

If we cannot read all information on the documents you submit, or if any of these items are missing, we

cannot add the wages to the employee's wage record. If you need blank copies of the Forms W-2 or W-3,

call the IRS at 1-800-829-3676. If your copies of the Forms W-2 are illegible, please prepare duplicates

on blank copies of the Forms W-2. Make sure the Forms W-2 show the correct year for the wages you

report.

Note: If you send 250 or more wage items to us, you must file your wage reports electronically in

accordance with Publication 42-007: Specifications for Filing Forms W-2 Electronically (EFW2). For

more information, please go to our website at or call SSA's Employer

Reporting Branch at 1-800-772-6270 from 7:00 A.M. to 7:00 P.M., Eastern time, Monday through Friday.

999999999-99-MMDDYY

SSA-95-SM (04-11)

Form Ssa-L-93-Sm (04-11) - Retirement, Survivors And Disability Insurance Form Page 5