For Official Use Only OMB No Wages, tips, other compensation 2 Federal income tax withheld

Transcription

1 Attntin: This frm is prvi fr infrmatinal purpss nly. py A appars in r, similar t th fficial IRS frm. D nt fil cpy A wnla frm this wbsit with th SSA. Th fficial print vrsin f this IRS frm is scannabl, but th nlin vrsin f it, print frm this wbsit, is nt. A pnalty may b imps fr filing frms that can t b scann. S th pnaltis sctin in th currnt Gnral Instructins fr Frms W-2 an W-3 fr mr infrmatin. T rr fficial IRS frms, call TAX-FORM ( ) r Orr Infrmatin Rturns an Emplyr Rturns Onlin, an w ll mail yu th scannabl frms an thr pructs. Yu may fil Frms W-2 an W-3 lctrnically n th SSA s wbsit at Emplyr Rprting Instructins & Infrmatin. Yu can crat fill-in vrsins f Frms W-2 an W-3 fr filing with SSA. Yu may als print ut cpis fr filing with stat r lcal gvrnmnts, istributin t yur mplys, an fr yur rcrs. S IRS Publicatins 1141, 1167, 1179 an thr IRS rsurcs fr infrmatin abut printing ths tax frms.

2 22222 Vi b Emplyr intificatin numbr (EIN) a Emply s scial scurity numbr Fr Official Us Only OMB N Wags, tips, thr cmpnsatin 2 Fral incm tax withhl c Emplyr s nam, arss, an ZIP c 3 Scial scurity wags 4 Scial scurity tax withhl 5 Micar wags an tips 6 Micar tax withhl 7 Scial scurity tips 8 Allcat tips ntrl numbr 9 10 Dpnnt car bnfits Emply s first nam an initial Last nam Suff. 11 Nnqualifi s 12a S instructins fr bx Statutry mply 14 Othr f Emply s arss an ZIP c 15 Stat Emplyr s stat ID numbr 16 Stat wags, tips, tc. 17 Stat incm tax 18 Lcal wags, tips, tc. 19 Lcal incm tax 20 Lcality nam Rtirmnt Thir-party 12 Frm W-2 Wag an Tax Statmnt 2015 py A Fr Scial Scurity Aministratin Sn this ntir pag with Frm W-3 t th Scial Scurity Aministratin; phtcpis ar nt accptabl. D Nt ut, Fl, r Stapl Frms n This Pag Dpartmnt f th Trasury Intrnal Rvnu Srvic Fr Privacy Act an Paprwrk Ructin Act Ntic, s th sparat instructins. at. N D

3 22222 b Emplyr intificatin numbr (EIN) a Emply s scial scurity numbr OMB N Wags, tips, thr cmpnsatin 2 Fral incm tax withhl c Emplyr s nam, arss, an ZIP c 3 Scial scurity wags 4 Scial scurity tax withhl 5 Micar wags an tips 6 Micar tax withhl 7 Scial scurity tips 8 Allcat tips ntrl numbr 9 10 Dpnnt car bnfits Emply s first nam an initial Last nam Suff. 11 Nnqualifi s 12a 13 Statutry mply 14 Othr f Emply s arss an ZIP c 15 Stat Emplyr s stat ID numbr 16 Stat wags, tips, tc. 17 Stat incm tax 18 Lcal wags, tips, tc. 19 Lcal incm tax 20 Lcality nam Rtirmnt Thir-party 12 Wag an Tax Frm W-2 py 1 Fr Stat, ity, r Lcal Tax Dpartmnt Statmnt 2015 Dpartmnt f th Trasury Intrnal Rvnu Srvic

4 b Emplyr intificatin numbr (EIN) a Emply s scial scurity numbr OMB N Saf, accurat, FAST! Us Visit th IRS wbsit at 1 Wags, tips, thr cmpnsatin 2 Fral incm tax withhl c Emplyr s nam, arss, an ZIP c 3 Scial scurity wags 4 Scial scurity tax withhl 5 Micar wags an tips 6 Micar tax withhl 7 Scial scurity tips 8 Allcat tips ntrl numbr 9 10 Dpnnt car bnfits Emply s first nam an initial Last nam Suff. 11 Nnqualifi s 12a S instructins fr bx Statutry mply 14 Othr f Emply s arss an ZIP c 15 Stat Emplyr s stat ID numbr 16 Stat wags, tips, tc. 17 Stat incm tax 18 Lcal wags, tips, tc. 19 Lcal incm tax 20 Lcality nam Rtirmnt Thir-party 12 Wag an Tax Frm W-2 py B T B Fil With Emply s FEDERAL Tax Rturn. This infrmatin is bing furnish t th Intrnal Rvnu Srvic. Statmnt 2015 Dpartmnt f th Trasury Intrnal Rvnu Srvic

5 Ntic t Emply D yu hav t fil? Rfr t th Frm 1040 Instructins t trmin if yu ar rquir t fil a tax rturn. Evn if yu nt hav t fil a tax rturn, yu may b ligibl fr a rfun if bx 2 shws an amunt r if yu ar ligibl fr any crit. Earn incm crit (EI). Yu may b abl t tak th EI fr 2015 if yur ajust grss incm (AGI) is lss than a crtain amunt. Th amunt f th crit is bas n incm an family siz. Wrkrs withut chilrn cul qualify fr a smallr crit. Yu an any qualifying chilrn must hav vali scial scurity numbrs (SSNs). Yu cannt tak th EI if yur invstmnt incm is mr than th spcifi amunt fr 2015 r if incm is arn fr srvics prvi whil yu wr an inmat at a pnal institutin. Fr 2015 incm limits an mr infrmatin, visit Als s Pub. 596, Earn Incm rit. Any EI that is mr than yur tax liability is rfun t yu, but nly if yu fil a tax rturn. lrgy an rligius wrkrs. If yu ar nt subjct t scial scurity an Micar taxs, s Pub. 517, Scial Scurity an Othr Infrmatin fr Mmbrs f th lrgy an Rligius Wrkrs. rrctins. If yur nam, SSN, r arss is incrrct, crrct pis B,, an 2 an ask yur mplyr t crrct yur mplymnt rcr. B sur t ask th mplyr t fil Frm W-2c, rrct Wag an Tax Statmnt, with th Scial Scurity Aministratin (SSA) t crrct any nam, SSN, r mny amunt rrr rprt t th SSA n Frm W-2. B sur t gt yur cpis f Frm W-2c frm yur mplyr fr all crrctins ma s yu may fil thm with yur tax rturn. If yur nam an SSN ar crrct but ar nt th sam as shwn n yur scial scurity car, yu shul ask fr a nw car that isplays yur crrct nam at any SSA ffic r by calling Yu als may visit th SSA at st f mplyr-spnsr halth cvrag (if such cst is prvi by th mplyr). Th rprting in bx 12, using c DD, f th cst f mplyr-spnsr halth cvrag is fr yur infrmatin nly. Th amunt rprt with c DD is nt taxabl. rit fr xcss taxs. If yu ha mr than n mplyr in 2015 an mr than $7,347 in scial scurity an/r Tir 1 railra rtirmnt (RRTA) taxs wr withhl, yu may b abl t claim a crit fr th xcss against yur fral incm tax. If yu ha mr than n railra mplyr an mr than $4, in Tir 2 RRTA tax was withhl, yu als may b abl t claim a crit. S yur Frm 1040 r Frm 1040A instructins an Pub. 505, Tax Withhling an Estimat Tax. (Als s Instructins fr Emply n th back f py.)

6 b Emplyr intificatin numbr (EIN) a Emply s scial scurity numbr This infrmatin is bing furnish t th Intrnal Rvnu Srvic. If yu OMB N ar rquir t fil a tax rturn, a nglignc pnalty r thr sanctin may b imps n yu if this incm is taxabl an yu fail t rprt it. 1 Wags, tips, thr cmpnsatin 2 Fral incm tax withhl c Emplyr s nam, arss, an ZIP c 3 Scial scurity wags 4 Scial scurity tax withhl 5 Micar wags an tips 6 Micar tax withhl 7 Scial scurity tips 8 Allcat tips ntrl numbr 9 10 Dpnnt car bnfits Emply s first nam an initial Last nam Suff. 11 Nnqualifi s 12a S instructins fr bx Statutry mply 14 Othr f Emply s arss an ZIP c 15 Stat Emplyr s stat ID numbr 16 Stat wags, tips, tc. 17 Stat incm tax 18 Lcal wags, tips, tc. 19 Lcal incm tax 20 Lcality nam Rtirmnt Thir-party 12 Wag an Tax Frm W-2 py Fr EMPLOYEE S REORDS (S Ntic t Emply n th back f py B.) Statmnt 2015 Dpartmnt f th Trasury Intrnal Rvnu Srvic Saf, accurat, FAST! Us

7 Instructins fr Emply (Als s Ntic t Emply, n th back f py B.) Bx 1. Entr this amunt n th wags lin f yur tax rturn. Bx 2. Entr this amunt n th fral incm tax withhl lin f yur tax rturn. Bx 5. Yu may b rquir t rprt this amunt n Frm 8959, Aitinal Micar Tax. S th Frm 1040 instructins t trmin if yu ar rquir t cmplt Frm Bx 6. This amunt inclus th 1.45% Micar Tax withhl n all Micar wags an tips shwn in Bx 5, as wll as th 0.9% Aitinal Micar Tax n any f ths Micar wags an tips abv $200,000. Bx 8. This amunt is nt inclu in bxs 1, 3, 5, r 7. Fr infrmatin n hw t rprt tips n yur tax rturn, s yur Frm 1040 instructins. Yu must fil Frm 4137, Scial Scurity an Micar Tax n Unrprt Tip Incm, with yur incm tax rturn t rprt at last th allcat tip amunt unlss yu can prv that yu rciv a smallr amunt. If yu hav rcrs that shw th actual amunt f tips yu rciv, rprt that amunt vn if it is mr r lss than th allcat tips. On Frm 4137 yu will calculat th scial scurity an Micar tax w n th allcat tips shwn n yur Frm(s) W-2 that yu must rprt as incm an n thr tips yu i nt rprt t yur mplyr. By filing Frm 4137, yur scial scurity tips will b crit t yur scial scurity rcr (us t figur yur bnfits). Bx 10. This amunt inclus th ttal pnnt car bnfits that yur mplyr pai t yu r incurr n yur bhalf (incluing amunts frm a sctin 125 (caftria) ). Any amunt vr $5,000 is als inclu in bx 1. mplt Frm 2441, hil an Dpnnt ar Expnss, t cmput any taxabl an nntaxabl amunts. Bx 11. This amunt is (a) rprt in bx 1 if it is a istributin ma t yu frm a nnqualifi frr cmpnsatin r nngvrnmntal sctin 457(b) r (b) inclu in bx 3 an/r 5 if it is a prir yar frral unr a nnqualifi r sctin 457(b) that bcam taxabl fr scial scurity an Micar taxs this yar bcaus thr is n lngr a substantial risk f frfitur f yur right t th frr amunt. This bx shul nt b us if yu ha a frral an a istributin in th sam calnar yar. If yu ma a frral an rciv a istributin in th sam calnar yar, an yu ar r will b ag 62 by th n f th calnar yar, yur mplyr shul fil Frm SSA-131, Emplyr Rprt f Spcial Wag Paymnts, with th Scial Scurity Aministratin an giv yu a cpy. Bx 12. Th fllwing list xplains th cs shwn in bx 12. Yu may n this infrmatin t cmplt yur tax rturn. Elctiv frrals (cs D, E, F, an S) an signat Rth cntributins (cs AA, BB, an EE) unr all s ar gnrally limit t a ttal f $18,000 ($12,500 if yu nly hav SIMPLE s; $21,000 fr sctin 403(b) s if yu qualify fr th 15-yar rul xplain in Pub. 571). Dfrrals unr c G ar limit t $18,000. Dfrrals unr c H ar limit t $7,000. Hwvr, if yu wr at last ag 50 in 2015, yur mplyr may hav allw an aitinal frral f up t $6,000 ($3,000 fr sctin 401(k)(11) an 408(p) SIMPLE s). This aitinal frral amunt is nt subjct t th vrall limit n lctiv frrals. Fr c G, th limit n lctiv frrals may b highr fr th last 3 yars bfr yu rach rtirmnt ag. ntact yur aministratr fr mr infrmatin. Amunts in xcss f th vrall lctiv frral limit must b inclu in incm. S th Wags, Salaris, Tips, tc. lin instructins fr Frm Nt. If a yar fllws c D thrugh H, S, Y, AA, BB, r EE, yu ma a mak-up pnsin cntributin fr a prir yar(s) whn yu wr in military srvic. T figur whthr yu ma xcss frrals, cnsir ths amunts fr th yar shwn, nt th currnt yar. If n yar is shwn, th cntributins ar fr th currnt yar. A Uncllct scial scurity r RRTA tax n tips. Inclu this tax n Frm S Othr Taxs in th Frm 1040 instructins. B Uncllct Micar tax n tips. Inclu this tax n Frm S Othr Taxs in th Frm 1040 instructins. Taxabl cst f grup-trm lif insuranc vr $50,000 (inclu in bxs 1, 3 (up t scial scurity wag bas), an 5) D Elctiv frrals t a sctin 401(k) cash r frr arrangmnt. Als inclus frrals unr a SIMPLE rtirmnt accunt that is part f a sctin 401(k) arrangmnt. E Elctiv frrals unr a sctin 403(b) salary ructin agrmnt (cntinu n back f py 2)

8 b Emplyr intificatin numbr (EIN) a Emply s scial scurity numbr OMB N Wags, tips, thr cmpnsatin 2 Fral incm tax withhl c Emplyr s nam, arss, an ZIP c 3 Scial scurity wags 4 Scial scurity tax withhl 5 Micar wags an tips 6 Micar tax withhl 7 Scial scurity tips 8 Allcat tips ntrl numbr 9 10 Dpnnt car bnfits Emply s first nam an initial Last nam Suff. 11 Nnqualifi s 12a 13 Statutry mply 14 Othr f Emply s arss an ZIP c 15 Stat Emplyr s stat ID numbr 16 Stat wags, tips, tc. 17 Stat incm tax 18 Lcal wags, tips, tc. 19 Lcal incm tax 20 Lcality nam Rtirmnt Thir-party 12 Wag an Tax Frm W-2 py 2 T B Fil With Emply s Stat, ity, r Lcal Incm Tax Rturn Statmnt 2015 Dpartmnt f th Trasury Intrnal Rvnu Srvic

9 Instructins fr Emply (cntinu frm back f py ) F Elctiv frrals unr a sctin 408(k)(6) salary ructin SEP G Elctiv frrals an mplyr cntributins (incluing nnlctiv frrals) t a sctin 457(b) frr cmpnsatin H Elctiv frrals t a sctin 501(c)(18)(D) tax-xmpt rganizatin. S Ajust Grss Incm in th Frm 1040 instructins fr hw t uct. J Nntaxabl (infrmatin nly, nt inclu in bxs 1, 3, r 5) K 20% xcis tax n xcss gln parachut paymnts. S Othr Taxs in th Frm 1040 instructins. L Substantiat mply businss xpns rimbursmnts (nntaxabl) M Uncllct scial scurity r RRTA tax n taxabl cst f gruptrm lif insuranc vr $50,000 (frmr mplys nly). S Othr Taxs in th Frm 1040 instructins. N Uncllct Micar tax n taxabl cst f grup-trm lif insuranc vr $50,000 (frmr mplys nly). S Othr Taxs in th Frm 1040 instructins. P Excluabl mving xpns rimbursmnts pai irctly t mply (nt inclu in bxs 1, 3, r 5) Q Nntaxabl cmbat pay. S th instructins fr Frm 1040 r Frm 1040A fr tails n rprting this amunt. R Emplyr cntributins t yur Archr MSA. Rprt n Frm 8853, Archr MSAs an Lng-Trm ar Insuranc ntracts. S Emply salary ructin cntributins unr a sctin 408(p) SIMPLE (nt inclu in bx 1) T Aptin bnfits (nt inclu in bx 1). mplt Frm 8839, Qualifi Aptin Expnss, t cmput any taxabl an nntaxabl amunts. V Incm frm xrcis f nnstatutry stck ptin(s) (inclu in bxs 1, 3 (up t scial scurity wag bas), an 5). S Pub. 525 an instructins fr Schul D (Frm 1040) fr rprting rquirmnts. W Emplyr cntributins (incluing amunts th mply lct t cntribut using a sctin 125 (caftria) ) t yur halth savings accunt. Rprt n Frm 8889, Halth Savings Accunts (HSAs). Y Dfrrals unr a sctin 409A nnqualifi frr cmpnsatin Z Incm unr a nnqualifi frr cmpnsatin that fails t satisfy sctin 409A. This amunt is als inclu in bx 1. It is subjct t an aitinal 20% tax plus intrst. S Othr Taxs in th Frm 1040 instructins. AA Dsignat Rth cntributins unr a sctin 401(k) BB Dsignat Rth cntributins unr a sctin 403(b) DD st f mplyr-spnsr halth cvrag. Th amunt rprt with DD is nt taxabl. EE Dsignat Rth cntributins unr a gvrnmntal sctin 457(b). This amunt s nt apply t cntributins unr a taxxmpt rganizatin sctin 457(b). Bx 13. If th Rtirmnt bx is chck, spcial limits may apply t th amunt f traitinal IRA cntributins yu may uct. S Pub. 590, Iniviual Rtirmnt Arrangmnts (IRAs). Bx 14. Emplyrs may us this bx t rprt infrmatin such as stat isability insuranc taxs withhl, unin us, unifrm paymnts, halth insuranc prmiums uct, nntaxabl incm, ucatinal assistanc paymnts, r a mmbr f th clrgy's parsnag allwanc an utilitis. Railra mplyrs us this bx t rprt railra rtirmnt (RRTA) cmpnsatin, Tir 1 tax, Tir 2 tax, Micar tax an Aitinal Micar Tax. Inclu tips rprt by th mply t th mplyr in railra rtirmnt (RRTA) cmpnsatin. Nt. Kp py f Frm W-2 fr at last 3 yars aftr th u at fr filing yur incm tax rturn. Hwvr, t hlp prtct yur scial scurity bnfits, kp py until yu bgin rciving scial scurity bnfits, just in cas thr is a qustin abut yur wrk rcr an/r arnings in a particular yar.

10 Vi b Emplyr intificatin numbr (EIN) a Emply s scial scurity numbr OMB N Wags, tips, thr cmpnsatin 2 Fral incm tax withhl c Emplyr s nam, arss, an ZIP c 3 Scial scurity wags 4 Scial scurity tax withhl 5 Micar wags an tips 6 Micar tax withhl 7 Scial scurity tips 8 Allcat tips ntrl numbr 9 10 Dpnnt car bnfits Emply s first nam an initial Last nam Suff. 11 Nnqualifi s 12a S instructins fr bx Statutry mply 14 Othr f Emply s arss an ZIP c 15 Stat Emplyr s stat ID numbr 16 Stat wags, tips, tc. 17 Stat incm tax 18 Lcal wags, tips, tc. 19 Lcal incm tax 20 Lcality nam Rtirmnt Thir-party 12 Frm W-2 py D Fr Emplyr Wag an Tax Statmnt 2015 Dpartmnt f th Trasury Intrnal Rvnu Srvic Fr Privacy Act an Paprwrk Ructin Act Ntic, s sparat instructins.

11 Emplyrs, Plas Nt Spcific infrmatin n t cmplt Frm W-2 is availabl in a sparat bklt titl th 2015 Gnral Instructins fr Frms W-2 an W-3. Yu can rr ths instructins an aitinal frms by calling TAX-FORM ( ). Yu als can gt frms an instructins at IRS.gv. autin. D nt sn th SSA Frms W-2 an W-3 that yu hav print frm IRS.gv. Th SSA is unabl t prcss ths frms. Insta, yu can crat an submit thm nlin. S E-filing, latr. Du ats. By Fbruary 1, 2016, furnish pis B,, an 2 t ach prsn wh was yur mply uring By Fbruary 29, 2016, sn py A f Frm(s) W-2 an W-3 t th SSA. Hwvr, if yu fil lctrnically, th u at is March 31, S th sparat instructins. N hlp? If yu hav qustins abut rprting n Frm W-2, call th infrmatin rprting custmr srvic sit tll fr at r (nt tll fr). Fr TTY/TDD quipmnt fr prsns wh ar af, har f haring, r hav a spch isability, call (nt tll fr). Th hurs f pratin ar 8:30 a.m. t 4:30 p.m. Eastrn tim. E-filing. If yu fil 250 r mr Frm(s) W-2, yu must fil lctrnically. Evn if yu ar nt rquir t fil lctrnically, ing s can sav yu tim an ffrt. Emplyrs may nw us th SSA's W-2 Onlin srvic t crat, sav, print, an submit up t 50 Frm(s) W-2 at a tim vr th Intrnt. Whn yu -fil with th SSA, n sparat Frm W-3 filing is rquir. An lctrnic Frm W-3 will b crat fr yu by th W-2 Onlin srvic. Fr infrmatin, visit th SSA's Emplyr W-2 Filing Instructins & Infrmatin wbsit at mplyr. Futur vlpmnts. Infrmatin abut any futur vlpmnts affcting Frm W-2 an its instructins (such as lgislatin nact aftr w rlas thm) will b pst at