Attention: See IRS Publications 1141, 1167, 1179 and other IRS resources for information about printing these tax forms.
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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 f $50 pr infrmatin rturn may b imps fr filing frms that cannt b scann. 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 2011 py A Fr Scial Scurity Aministratin Sn this ntir pag with Frm W-3 t th Scial Scurity Aministratin; phtcpis ar nt accptabl. Dpartmnt f th Trasury Intrnal Rvnu Srvic Fr Privacy Act an Paprwrk Ructin Act Ntic, s back f py D. at. N D D Nt ut, Fl, r Stapl Frms n This Pag D Nt ut, Fl, r Stapl Frms n This Pag
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 2011 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 2011 Dpartmnt f th Trasury Intrnal Rvnu Srvic
5 Ntic t Emply Rfun. Evn if yu nt hav t fil a tax rturn, yu shul fil t gt a rfun if bx 2 shws fral incm tax withhl r if yu can tak th arn incm crit. Earn incm crit (EI). Yu may b abl t tak th EI fr 2011 if (a) yu nt hav a qualifying chil an yu arn lss than $13,660 ($18,740 if marri filing jintly), (b) yu hav n qualifying chil an yu arn lss than $36,052 ($41,132 if marri filing jintly), (c) yu hav tw qualifying chilrn an yu arn lss than $40,964 ($46,044 if marri filing jintly), r () yu hav thr r mr qualifying chilrn an yu arn lss than $43,998 ($49,078 if marri filing jintly). Yu an any qualifying chilrn must hav vali scial scurity numbrs (SSNs). Yu cannt tak th EI if yur invstmnt incm is mr than $3,150. 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. 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 DD, f th cst f mplyr-spnsr halth cvrag is fr yur infrmatin nly. Th amunt rprt with DD is nt taxabl. rit fr xcss taxs. If yu ha mr than n mplyr in 2011 an mr than $4, in scial scurity an/r Tir I 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 $3, in Tir II 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 ar rquir t fil a tax rturn, a nglignc pnalty r thr sanctin OMB N 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 2011 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 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. Unlss yu hav rcrs that shw yu i nt rciv th amunt rprt in bx 8 as allcat tips, yu must fil Frm 4137, Scial Scurity an Micar Tax n Unrprt Tip Incm, with yur incm tax rturn t rprt th allcat tip amunt. On Frm 4137 yu will figur 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 is 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. 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 $16,500 ($11,500 if yu nly hav SIMPLE s; $19,500 fr sctin 403(b) s if yu qualify fr th 15-yar rul xplain in Pub. 571). Dfrrals unr c G ar limit t $16,500. Dfrrals unr c H ar limit t $7,000. Hwvr, if yu wr at last ag 50 in 2011, yur mplyr may hav allw an aitinal frral f up t $5,500 ($2,500 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 Ttal Tax in th Frm 1040 instructins. B Uncllct Micar tax n tips. Inclu this tax n Frm S Ttal Tax 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 2011 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 Ttal Tax 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 Ttal Tax in th Frm 1040 instructins. N Uncllct Micar tax n taxabl cst f grup-trm lif insuranc vr $50,000 (frmr mplys nly). S Ttal Tax 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 sctin 409A n a nnqualifi frr cmpnsatin. This amunt is als inclu in bx 1. It is subjct t an aitinal 20% tax plus intrst. S Ttal Tax 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. 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. mpar th Scial Scurity wags an th Micar wags t th infrmatin shwn n yur annual (fr wrkrs vr 25) Scial Scurity Statmnt.
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 2011 Dpartmnt f th Trasury Intrnal Rvnu Srvic Fr Privacy Act an Paprwrk Ructin Act Ntic, s back f py D.
11 Emplyrs, Plas Nt Spcific infrmatin n t cmplt Frm W-2 is availabl in a sparat bklt titl 2011 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. Yu cannt fil Frms W-2/W-2c an W-3/W-3c that yu print frm IRS.gv with SSA. Th SSA's quipmnt is nt abl t prcss ths frms. Insta, yu can us nlin fill-in frms t crat an submit Frms W-2/W-2c an W-3/W-3c t th SSA lctrnically. Fr mr infrmatin, visit th SSA's Emplyr W-2 Filing Instructins & Infrmatin pag at an click n "Hw t Fil W-2s." Du ats. Furnish pis B,, an 2 t th mply gnrally by January 31, Fil py A with th SSA by Fbruary 29, Sn all pis A with Frm W-3, Transmittal f Wag an Tax Statmnts. If yu fil lctrnically (rquir if submitting 250 r mr Frms W-2), th u at is April 2, 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, call (nt tll fr). Th hurs f pratin ar 8:30 a.m. t 4:30 p.m., Eastrn tim. Privacy Act an Paprwrk Ructin Act Ntic. W ask fr th infrmatin n Frms W-2 an W-3 t carry ut th Intrnal Rvnu laws f th Unit Stats. W n it t figur an cllct th right amunt f tax. Sctin 6051 an its rgulatins rquir yu t furnish wag an tax statmnts t mplys, th Scial Scurity Aministratin, an th Intrnal Rvnu Srvic. Sctin 6109 rquirs yu t prvi yur mplyr intificatin numbr (EIN). If yu fail t prvi this infrmatin in a timly mannr, yu may b subjct t pnaltis. Failur t prvi this infrmatin, r prviing fals r frauulnt infrmatin, may subjct yu t pnaltis. Yu ar nt rquir t prvi th infrmatin rqust n a frm that is subjct t th Paprwrk Ructin Act unlss th frm isplays a vali OMB cntrl numbr. Bks r rcrs rlating t a frm r its instructins must b rtain as lng as thir cntnts may bcm matrial in th aministratin f any Intrnal Rvnu law. Gnrally, tax rturns an rturn infrmatin ar cnfintial, as rquir by sctin Hwvr, sctin 6103 allws r rquirs th Intrnal Rvnu Srvic t iscls r giv th infrmatin shwn n yur rturn t thrs as scrib in th. Fr xampl, w may iscls yur tax infrmatin t th Dpartmnt f Justic fr civil an/r criminal litigatin, an t citis, stats, th District f lumbia, an U.S. cmmnwalths an pssssins fr us in aministring thir tax laws. W may als iscls this infrmatin t thr cuntris unr a tax traty, t fral an stat agncis t nfrc fral nntax criminal laws, r t fral law nfrcmnt an intllignc agncis t cmbat trrrism. Th tim n t cmplt an fil ths frms will vary pning n iniviual circumstancs. Th stimat avrag tims ar: Frm W-2 30 minuts, an Frm W-3 28 minuts. If yu hav cmmnts cncrning th accuracy f ths tim stimats r suggstins fr making ths frms simplr, w wul b happy t har frm yu. Yu can writ t th Intrnal Rvnu Srvic, Tax Pructs rinating mmitt, SE:W:AR:MP:T:T:SP, 1111 nstitutin Av. NW, IR-6526, Washingtn, D D nt sn Frms W-2 an W-3 t this arss. Insta, s Whr t fil papr frms in th Instructins fr Frms W-2 an W-3.
Attention: See IRS Publications 1141, 1167, 1179 and other IRS resources for information about printing these tax forms.
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
For Official Use Only OMB No. 1545-0008 1 Wages, tips, other compensation 2 Federal income tax withheld
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
7.1. Nicole s W-2 Wage and Tax Statement W-2 VISUAL. THEME 2 Lesson 7: Uncle Sam Takes a Bite 123-45-6789 1,822.00 00000000 24,050.
VISUA. THM 2 ssn : Uncl Sam Taks a Bit Nicl s W-2 Wag an Tax Statmnt b mplyr intificatin numbr (IN) c mplyr s nam, arss, an ZIP c a mply s scial scurity numbr 00000000 2,00.00 Yurtwn Supprt Srvics Braway
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22222 Vi b Emplyr intificatin numbr (EIN) a Emply s scial scurity numbr Fr Official Us Only OMB N. 1545-0008 1 Wags, tips, thr cmpnsatin 2 Fral incm tax withhl c Emplyr s nam, arss, an ZIP c 3 Scial scurity
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