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Introduction

Part III. Administrative, Procedural, and Miscellaneous

Internal Revenue Bulletin 2014-28 · 2026-10-03 edition · updated 2026-10-04 · United States

NOTE. This revenue procedure will be reproduced as the next revision of IRS Publication 1223, General Rules and Specifications for Substitute Forms and Schedules

26 CFR 601.602: Tax forms and instructions. (Also Part I, Sections 6041, 6051, 6071, 6081, 6091; 1.6041–1, 1.6041–2, 31.6051–1, 31.6051–2, 31.6071(a)–1, 31.6081(a)–1, 31.6091–1.)

Rev. Proc. 2014–29

TABLE OF CONTENTS

Part 1 – SUBSTITUTE FORMS W–2C AND W–3C ..............................................................................................................105 SECTION 1.1 PURPOSE .............................................................................................................................................................105 SECTION 1.2 What’s New ..........................................................................................................................................................106 SECTION 1.3 Filing Forms W–2c and W–3c Electronically ..................................................................................................107 SECTION 1.4 Specifications for Red-Ink Substitute Forms W–2c (Copy A) and

W–3c Filed With the SSA ..................................................................................................................................107 SECTION 1.5 Specifications for Substitute Black-and-White Forms W–2c (Copy A) and

W–3c Filed With the SSA ..................................................................................................................................110 SECTION 1.6 Requirements for Substitute Privately-Printed Forms W–2c (Copies B, C, and 2)

Furnished to Employees .....................................................................................................................................111 SECTION 1.7 Instructions for Employers .................................................................................................................................113 SECTION 1.8 OMB Requirements for Both Red-Ink and Black-and-White Copy A

and W–3c Substitute Forms ...............................................................................................................................113 SECTION 1.9 Order Forms and Instructions ...........................................................................................................................114 SECTION 1.10 Effect on Other Documents ..............................................................................................................................114 SECTION 1.11 Exhibits ...............................................................................................................................................................115

Part 1

Substitute Forms W–2c and W–3c

SECTION 1.1 PURPOSE .01 The purpose of this revenue procedure is to state the requirements of the Internal Revenue Service (IRS) and the Social Security Administration (SSA) regarding the preparation and use of substitute forms for Form W–2c, Corrected Wage and Tax Statement, and Form W–3c, Transmittal of Corrected Wage and Tax Statements, for wages paid during the 2013 calendar year.

.02 The official IRS Form W–2c is a six-part form and the official IRS Form W–3c is a one-part form. Red-ink substitute forms that completely conform to the specifications contained in this document may be privately-printed without the prior approval of the IRS or the SSA. Only the substitute black-and-white Form (Copy A) and substitute black-and-white W–3c forms need to be submitted to the SSA for approval.

Note. Both paper substitute forms filed with the SSA, and those furnished to employees, that do not totally conform to these specifications are not acceptable. Forms W–2c (Copy A) and Forms W–3c that do not conform may be returned. In addition, penalties may be assessed by the IRS.

.03 Substitute red-ink forms should not be submitted to either the IRS or the SSA for specific approval. If you are uncertain of any specification and want clarification, do the following.

  1. Submit a letter to the appropriate address below citing the specification.
  2. State your understanding of the specification; enclose an example.
  3. Be sure to include your name, complete address, phone number, and, if applicable, your email address with your correspondence.

.04 Any questions about the red-ink Form W–2c (Copy A) and Form W–3c, should be emailed to substituteforms@irs.gov . Please enter “Substitute Forms” on the subject line. Or send your questions to:

Bulletin No. 2014–28 105 July 07, 2014

SECTION 1.2 WHAT’S NEW

Internal Revenue Service Attn: Substitute Forms Program SE:W:CAR:MP:P:TP 5000 Ellin Road, C7-263 Lanham, MD 20706

Any questions about the substitute black-and-white Form W–2c (Copy A) and W–3c should be emailed to copy.a.forms@ssa.gov or sent to:

Social Security Administration Data Operations Center Attn: Substitute Black-and-White Copy A Forms, Room 360 1150 E. Mountain Drive Wilkes-Barre, PA 18702-7997

Do not mail completed Forms W–2c (Copy A) employer reports to the Substitute Black-andWhite Copy A Forms address. Submitters should use the address shown on the Form W–3c.

Note. You should receive a response from either the IRS or the SSA within 30 days.

.05 The Internal Revenue Service/Information Returns Branch (IRS/IRB) maintains a centralized customer service call site to answer questions related to information returns (Forms W–2, W–3, W–2c, W–3c, 1099 series, 1096, etc.). You can reach the call site at 1-866-455-7438 (toll-free) or 304-263-8700 (not a toll-free number). The Telecommunication Device for the Deaf (TDD) number is 304-579-4827 (not a toll-free number). The hours of operation are Monday through Friday from 8:30 a.m. to 4:30 p.m. Eastern time. You may also send questions to the call site via the Internet at mccirp@irs.gov . IRS/IRB does not process information returns which are filed on paper forms.

Do not submit employee information via email, because electronic mail may be not be secure and the employee’s information may be compromised.

.06 The following form instructions and publications provide more detailed filing procedures for certain information returns.

  • General Instructions for Forms W–2 and W–3 (including Forms W–2AS, W–2GU, W–2VI, W–3SS, W–2c, and W–3c).

  • Publication 1141, General Rules and Specifications for Substitute Forms W–2 and W–3.

.01 The following changes have been made to Publication 1223 since the last revision (April 2012). The major changes include the following.

  • Form W–3c–Telephone number, email, and fax number. The word “Employer’s” was added to the telephone, fax, and email data entry box headings/caption located in the bottom section of the form.

  • Form W–3c–Information sequence. The signature fields at the bottom of the form have been rearranged.

  • Form W–3c “For Official Use Only”. The “For Official Use Only” field size has been reduced.

  • Form W–3c Instructions on e-file. E-file instructions were added at the bottom of the form under the Purpose of Form section of the instructions.

  • Section 6.02 (Revised). Logos, slogans, and advertising. Revised Section 6.02 to clarify that forms may include an embossment or watermark on the information return and employee copies that is a representation of the name, a primary trade name, trademark, service mark, or symbol of the employer or agent. In addition, the address for submitting comments regarding the prohibition against including slogans, advertising, and logos has changed.

  • IRS address change. The address for the Substitute Forms Unit has changed to: Internal Revenue Service, Attn: Substitute Forms Program, 5000 Ellin Road, C7–263, Lanham, MD

July 07, 2014 106 Bulletin No. 2014–28

SECTION 1.3 FILING FORMS W–2 AND W–3c ELECTRONICALLY

SECTION 1.4 SECIFICATIONS OF RED-INK SUBSTITUT FORMS W–2c (COPY A) AND WITH THE SSA

  • SSA address change. Inquiries about the substitute black-and-white Form Copy A and substitute black-and-white Form W–3c, should be sent to the SSA at: Social Security Administration Data Operation Center, Attn: Substitute Black-and-White Copy A Forms, Room 360, 1150 E. Mountain Drive, Wilkes-Barre, PA 18702-7997.

  • IRS DVD. The DVD containing IRS tax products will no longer be produced. Official IRS forms and information copies of federal tax materials can be obtained at local IRS offices, by calling the National Distribution Center, or by accessing IRS.gov. Further details are provided in Section 9 - Order Forms and Instructions.

  • Editorial changes. We made editorial changes. Redundancies were eliminated as much as possible.

.01 Employers must file electronically with the SSA if they file 250 or more Forms W–2c (Copy A) during a calendar year unless the IRS granted you a waiver. For details, see the General Instructions for Forms W–2c and W–3c (Including Forms W–2AS, W–2GU, W–2VI, W–3SS, W–2c, and W–3c). SSA publication EFW2C, Specifications for Filing Forms W–2c Electronically, contains specifications and procedures for filing Forms W–2c. Employers are cautioned to obtain the most recent revision of EFW2C (and supplements) due to any subsequent changes in specifications and procedures.

Note. same year For purposes of the electronic filing requirement, only Forms W–2c for the immediate prior year are taken into account. For example, if an employer must file 200 Forms W–2c for the immediate prior year in March and then discovers that another 100 Forms W–2c for the current year must be filed in August, only the 100 Forms W–2c filed in August must be filed electronically.

.02 You may obtain a copy of the EFW2C by:

.03 Electronic filers do not file a paper Form W–3c. SSA creates this for you when Forms W–2c are submitted electronically. See the SSA publication EFW2 for guidance on transmitting Form W–2c (Copy A) information to the SSA electronically.

.04 Employers with fewer than 250 Forms W–2 to be corrected are encouraged to electronically file Forms W–2c (Copy A) with the SSA. Doing so will enhance the timeliness and accuracy of forms processing.

.05 Employers who do not comply with the electronic filing requirements for Form W–2c (Copy A) and who are not granted a waiver by the IRS may be subject to penalties. Employers who file Form W–2c information with the SSA electronically must not send the same data to the SSA on paper Forms W–2c (Copy A). Any duplicate reporting may subject filers to unnecessary contacts by the SSA or the IRS.

.01 The official IRS-printed red dropout ink Form W–2c (Copy A) and W–3c and their exact substitutes are referred to as red-ink in this revenue procedure. Employers may file substitute Forms W–2c (Copy A) and W–3c with the SSA. The substitute forms must be exact replicas of the official IRS forms with respect to layout and content because they will be read by scanner equipment. Even the slightest deviation can result in incorrect scanning, and may affect money amounts reported for employees.

.02 Color and paper quality for Form W–2c (Copy A) (cut sheets and continuous pin-fed forms) and Form W–3c, as specified by JCP Code 0–25 dated November 29, 1978, must be white 100% bleached chemical wood, optical character recognition (OCR) bond. The contractor must initiate or have a quality control program to assure OCR ink density

Bulletin No. 2014–28 107 July 07, 2014

Acidity: Ph value, average, not less than 4.5

Basis weight: 17 x 22 inch 500 cut sheets, pound 18–20 Metric equivalent—gm./sq. meter (a tolerance of �5 pct. is allowed) 68–75

Stiffness: Average, each direction, not less than—milligrams 50–80 Cross direction Machine direction

Tearing strength: Average, each direction, not less than—grams 50–80

Opacity: Average, not less than—percent 82

Reflectivity: Average, not less than—percent 68

Thickness: Average—inch 0.0038 Metric equivalent—mm. (a tolerance of �0.0005 inch 0.097 (0.0127 mm) is allowed) Paper cannot vary more than 0.0004 inch (0.0102 mm) from one edge to the other

Porosity: Average, not less than—seconds 10

Finish (smoothness): Average, each side—seconds 20–55

(for information only) the Sheffield equivalent—units 170–d200

Dirt: Average, each side, not to exceed—parts per million 8

Note. Reclaimed fiber in any percentage is permitted, provided the requirements of this standard are met.

.03 All printing of substitute Forms W–2c (Copy A) and W–3c must be in Flint red OCR dropout ink except as specified below. The following must be printed in nonreflective black ink:

  • Identifying number “44444” or “55555” at the top of the forms.

  • The four (4) corner register marks on the forms.

  • The form identification number (“W–3c”) at the bottom of Form W–3c.

  • All the instructions below Form W–3c beginning with “Purpose of Form” line to the bottom

of Form W–3c.

.04 The vertical and horizontal spacing on Forms W–2c and W–3c must meet specifications. See Exhibits A and B.

  • On Form W–3c and Form W–2c (Copy A), all the perimeter rules must be 1-point (0.014–inch), while all other rules must be one-half point (0.007–inch). Vertical rules must be parallel to the left edge of the form; horizontal rules parallel to the top edge.

    • The left and top margins on Form W–2c (Copy A) and Form W–3c must be .5 inches. The width

of a substitute Form W–2c (Copy A) or W–3c must be 7.5 inches. See Exhibits A and B.

  • The first three column’s on Form W–2c (Copy A) and Form W–3c must measure 1.9 inches

in width.

  • The last column on Form W–2c (Copy A) and Form W–3c must measure 1.8 inches in width.

.05 The official red-ink Form W–3c and Form W–2c (Copy A) are 7.5 inches wide. Employers filing Forms W–2c (Copy A) with the SSA on paper must also file a Form W–3c. Form W–3c must be the same width (7.5 inches) as the Form W–2c (Copy A). One Form W–2c (Copy A) or Form W–3c is contained on a standard-size, 8.5 x 11-inch page.

06 The top, left, and right margins for the FormW–2c (Copy A) and Form W–3c are .5 inches (½ inch). All margins must be free of printing except for the words “DO NOT CUT, FOLD, OR STAPLE THIS FORM” on red-ink Form W–2c (Copy A) or “DO NOT CUT, FOLD, OR STAPLE” on red-ink Form W–3c.

.07 The identifying numbers are “44444” for Form W–2c and “55555” for Form W–3c. No printing should appear anywhere near the identifying numbers.

Note. The identifying number must be printed in nonreflective black ink in OCR-A font of 10 characters per inch.

.08 Continuous pin-fed Forms W–2c (Copy A) must be separated into 11-inch deep pages. The pin-fed strips must be removed when Forms W–2c (Copy A) are filed with the SSA.

July 07, 2014 108 Bulletin No. 2014–28

.09 Box 12 of Form W–2c (Copy A) contains four entry boxes – 12a, 12b, 12c, and 12d. Do not make more than one entry per box. Enter your first code in box 12a (for example, enter Code D in box 12a, not 12d, if it is your first entry). If more than four items need to be reported in box 12, use a second Form W–2c to report the additional items. Do not report the same federal tax data to the SSA on more than one Form W–2c (Copy A). However, repeat the identifying information (employee’s name, address, and SSN; employer’s name, address, and EIN) on each additional form.

.10 The checkboxes in box 13 of Form W–2c (Copy A) must be .14 inches each; the space before the first checkbox is .20 inches; the spacing on each remaining side of the three checkboxes is .36 inches. The checkboxes in box c of Form W–3c must also be .14 inches.

Note. More than 50% of an applicable checkbox must be covered by an “X.”

.11 All substitute Forms W–2c (Copy A) and W–3c in the red-ink format must have the form number and form title printed on the bottom face of each form using type identical or a close approximation to that of the official IRS form. The red-ink substitute must have the form producer’s (not the form filer’s) EIN entered in red in place of the Cat. No. (directly to the left of “Department of the Treasury” for Form W–2c (Copy A) and at the bottom for Form W–3c).

.12 The words “For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.” must be printed on all Forms W–2c (Copy A) and Forms W–3c.

.13 The Office of Management and Budget (OMB) Number must be printed on substitute Forms W–3c and W–2c (Copy A) (on each ply) in the same location as on the official IRS forms.

.14 All substitute Forms W–3c must include the instructions that are printed on the same sheet below the official IRS form.

.15 The appropriate SSA addresses must be printed on the front of Form W–3c below the body of the form (see Exhibit B).

If you use the U.S. Postal Service, the address is:

Social Security Administration Data Operations Center P.O. Box 3333 Wilkes-Barre, PA 18767-3333

If you use a carrier other than the U.S. Postal Service, the address is:

Social Security Administration Data Operations Center Attn: W–2c Process 1150 E. Mountain Drive Wilkes-Barre, PA 18702-7997

.16 The back of substitute Form W–2c (Copy A) and Form W–3c must be free of all printing.

.17 All copies must be clearly legible. Fading must be minimized to assure legibility.

.18 Chemical transfer paper is permitted for Form W–2c (Copy A) only if the following standards are met:

  • Only chemically-backed paper is acceptable for Form W–2c (Copy A). Front and back

chemically-treated paper cannot be processed properly by scanning equipment.

  • Chemically-transferred images must be black.

  • Carbon-coated forms are not permitted.

.19 The Government Printing Office (GPO) symbol and the Catalog Number (Cat. No.) must be deleted from substitute Form W–2c (Copy A) and Form W–3c.

Bulletin No. 2014–28 109 July 07, 2014

SECTION 1.5 SPECIFICATIONS FOR SUBSTITUTE BLACK-AND-WHITE FORMS W–2c (COPY A) AND W–3c FILED WITH THE

.20 The sequence for assembling the copies of Form W–2c is as follows.

  • Copy A—For Social Security Administration

  • Copy 1—State, City, or Local Tax Department

  • Copy B—To Be Filed with Employee’s FEDERAL Tax Return

  • Copy C—For EMPLOYEE’s RECORDS

  • Copy 2—To Be Filed with Employee’s State, City, or Local Income Tax Return

  • Copy D—For Employer

.01 The SSA-approved substitute black-and-white Forms W–2c (Copy A) and W–3c are referred to as substitute black-and-white Form W–2c (Copy A) and W–3c. Specifications for the substitute black-and-white Form W–2c (Copy A) and W–3c are similar to the red-ink forms (Section 4) except for the items that follow (see Exhibits C and D). You may contact the SSA via email at copy.a.forms@ssa.gov for more information.

Note. Exhibits are samples only and must not be downloaded to meet tax obligations.

  1. Forms must be printed on 8.5 x 11-inch single-sheet paper only, not on continuous pin-fed paper. There must be one Form W–2c (Copy A) or W–3c printed on a page.
  2. All forms and data must be printed in nonreflective black ink only.
  3. The data and forms must be programmed to print simultaneously. Forms cannot be produced separately from wage data entries.
  4. The forms must not contain corner register marks.
  5. The forms must not contain any shaded areas including those boxes that are entirely shaded on the red-ink forms.
  6. Identifying numbers on both Form W–2c (Copy A) (“44444”) and Form W–3c (“55555”) must be preprinted in 14-point Arial bold font or a close approximation.
  7. The form numbers (“W–2c” and “W–3c”) must be in 18-point Arial font or a close approximation
  8. No part of the box titles or the data printed on the forms may touch any of the vertical or horizontal lines, nor should any of the data intermingle with the box titles. The data should be centered in the boxes.
  9. Do not print any information in the margins of the black-and-white forms (for example, do not print “DO NOT CUT, FOLD, OR STAPLE” in the top margin of Form W–3c).
  10. The word “Code” must not appear in box 12 on Form W–2c (Copy A).
  11. A 4-digit vendor code (not filer code) preceded by four zeros and a slash (for example, 0000/9876) must appear in 12-point Arial font, or a close approximation, in place of the Cat. No. to the left of “Department of the Treasury”on Form W–2c (Copy A) and in the bottom right corner of Form W–3c. Note. Do not display the form producer’s EIN. The vendor code will be used to identify the form producer.
  12. Do not print Catalog Numbers (Cat. No.) on either Form W–2c (Copy A) or Form W–3c.
  13. Do not print dollar signs. If there are no money amounts being reported, the entire field should be left blank.

.02 The dimensions for the substitute black-and-white Forms W–2c (Copy A) and W–3c are as follows. See Exhibits C and D.

  1. The left and top margins on Form W–2c (Copy A) and Form W–3c must measure 1/2 (0.5) inch.
  2. The distance from the top line of Form W–3c to the bottom line of the form must measure 7 1/6

(7.17) inches. 3. The distance from the top line of Form W–2c (Copy A) to the bottom line of the form must measure 9 1/3 (9.33) inches. 4. Each box on Form W–2c (Copy A) and Form W–3c must measure 1/3 inch in height. 5. Box b on Form W–3c must measure (1) inch in height. 6. Box a on Form W–2c (Copy A) must measure 1 1/3 inches in height and box 14 must measure 5/6 (0.83) inch in height. 7. The first three column on the right of Form W–2c (Copy A) and Form W–3c must measure 1 9/10 (1.9) inches in width. 8. The last column on the right of Form W–2c (Copy A) and Form W–3c must measure 1 8/10

(1.8) inches in width.

July 07, 2014 110 Bulletin No. 2014–28

SECTION 1.6 REQUIREMENTS FOR SUBSTITUTE PRIVATELY-PRINTED FORMS W–2c (COPIES B, C, AND 2) FURNISHED TO EMPLOYEES

  1. The “Explain decreases here” box has been reduced to measure 1/3 (0.33) inches to allow for an increase in Box b and the “Signature” box on Form W–3c must measure 1/2 (0.5) inches in height.

.03 You must submit samples of your black-and-white substitute forms to the SSA. Only black-and-white substitute Forms W–2c (Copy A) and W–3c will be accepted for approval by the SSA. Questions regarding other forms (that is, red-ink Forms W–2, W–2c, W–3, W–3c, 1099 series, 1096, etc.) must be directed to the IRS. Also, see IRS Publications 1141 and 1179.

.04 You will be required to send one set of blank and one set of dummy-data substitute black-and-white Form W–2c (Copy A) and W–3c for approval. Sample data entries should be filled in to the maximum length for each box entry, preferably using numeric data or alpha data, depending upon the type required to be entered. Include in your submission the name, telephone number, fax number, and email address of a contact person who can answer questions regarding your sample forms.

.05 To receive approval, you may first contact the SSA at to obtain a template and further instructions in PDF format. Do not mail completed Form W–2c (Copy A) and W–3c employer reports to the Substitute Black-and-White Forms (Copy A) address. Submitters should use the address shown on the Form W–3c. You may also send your sample substitute black-and-white forms to:

Social Security Administration Data Operations Center Attn: Substitute Black-and-White Copy A Forms, Room 360 1150 E. Mountain Drive Wilkes-Barre, PA 18702-7997

Send your sample forms via private mail carrier or certified mail in order to verify their receipt. You may send your sample forms via electronic mail to copy.a.forms@ssa.gov .

.06 The 4-digit vendor code preceded by four zeros and a slash (0000/9876) must be preprinted on the sample black-and-white substitute forms. Forms not containing a vendor code will be rejected and will not be submitted for testing or approval. If you have a valid vendor code provided to you through the National Association of Computerized Tax Processors, you should use that code. If you do not have a valid vendor code, contact the Social Security Administration at to obtain an SSA-issued code. (Additional information on vendor codes may be obtained from the SSA or the National Association of Computerized Tax Processors via email at.)

Note. Vendor codes are only required by those companies producing the W–2 family of forms as part of a product for resale to be used by multiple employers and payroll professionals. Employers developing Forms W–2c or W–3c to be used only for their individual company do not require a vendor code.

.07 If you use forms produced by a vendor and have questions concerning approval, do not send the forms to the SSA for approval. Instead, you may contact the software vendor to obtain a copy of SSA’s dated approval notice supplied to that vendor.

.01 All employers (including those who file electronically) must furnish employees with at least two copies of Form W–2c (three or more for employees required to file a state, city, or local income tax return). Employee copies do not require approval as long as these requirements are followed.

Note. Although substitute Copy 1 of Form W–2c can be printed in black instead of the red dropout ink, it should conform as closely as possible to Copy A of the official IRS form in content, format, and layout in order to satisfy state and local reporting requirements.

.02 Some Forms W–2c that include logos, slogans, and advertisements (including advertisements for tax preparation software) may be confused with questionable Forms W–2c. An employee may not recognize the importance of the employee copy for tax reporting purposes due to the use of logos, slogans, and advertisements. Thus, the IRS has determined that logos, slogans, and advertising will not be allowed on Forms W–3c, Copy A of Forms W–2c, or any employee copies reporting wages paid during the 2011 calendar year, and thereafter, with the following exceptions:

Bulletin No. 2014–28 111 July 07, 2014

  • Forms may include the exact name of the employer or agent, primary trade name, trademark,

service mark, or symbol of the employer or agent.

  • Presentation may be in any typeface, font, stylized fashion, or print color normally used by the

employer or agent; and used in a non-intrusive manner.

  • These items do not materially interfere with the ability of the recipient to recognize,

understand, and use the tax information on the employee copies.

  • Corrected information on information returns and employee copies that was shown on Forms

W–2c for amounts paid before January 1, 2011.

The IRS e-file logo on the IRS official employee copies may be included, but it is not required, on any of the substitute form copies.

The information return and employee copies must clearly identify the employer’s name associated with its employer identification number.

Forms W–2c and W–3c are subject to annual review and possible change. If you have comments about the prohibition against including slogans, advertising, and logos on information returns and employee copies, send or email your comments to: Internal Revenue Service, Attn: substitute Forms Program, 5000 Ellin Road, C7–623, Lanham, MD 20706 or substituteforms@irs.gov

.03 Chemical transfer paper for employee copies must be clearly legible, have the capability to be photocopied, and not fade to such a degree as to preclude legibility and the ability to photocopy.

.04 Chemical transfer paper for employee copies must be clearly legible, have the capability to be photocopied, and not fade to such a degree as to preclude legibility and the ability to photocopy.

.05 Type must be substantially identical in size and shape to that on the official form.

.06 Substitute forms for employees need to contain only the payment boxes and captions that are applicable. These boxes, box numbers, and box titles must, when applicable, match the IRSprinted form. In all cases, the employee name, address, and SSN, as well as the employer name, address, and EIN, must be present.

.07 The dimensions of the boxes on these copies (Copies B, C, and 2), but not Copy A, may be adjusted to allow space for conveying additional information. This may permit the employer to eliminate other statements or notices that would otherwise be furnished to employees.

.08 The maximum allowable dimensions for employee copies of Form W–2c are no more than 11 inches deep by 8.5 inches wide. The minimum allowable dimensions for employee copies of Form W–2c are 2.67 inches deep by 4.25 inches wide.

Note. These maximum and minimum size specifications are subject to future change.

.09 Either horizontal or vertical format is permitted for substitute employee copies of Forms W–2c. That is, the width of the form may be either greater or less than the depth of the form.

.10 All copies of Form W–2c must clearly and prominently display the form number and the form title together in one area of the form. It is recommended (but not required) that this be located on the bottom left of Form W–2c. The reference to the “Department of the Treasury - Internal Revenue Service” must be on all copies of Form W–2c. It is recommended (but not required) that this be located on the bottom right of Form W–2c.

.11 If the substitute Forms W–2c are not labeled as to the disposition of the copies, then written notification must be provided to each employee as specified below.

  • The first copy of Form W–2c (Copy B) is filed with the employee’s federal tax return.

  • The second copy of Form W–2c (Copy C) is for the employee’s records.

  • If applicable, the third copy (Copy 2) of Form W–2c is filed with the employee’s state, city,

or local income tax return.

If the substitute Forms W–2c are labeled, the forms must contain the applicable description as stated on the official form.

July 07, 2014 112 Bulletin No. 2014–28

SECTION 1.7 INSTRUCTIONS FOR EMPLOYERS

SECTION 1.8 OMB REQUIREMENTS FOR BOTH RED-INK AND BLACK-AND-WHITE COPY A AND W–3c SUBSTITUTE

.12 Instructions similar to those on the back of Form W–2c (Copy C) of the official form must be provided to each employee.

.01 Privately-printed substitute Forms W–2c are not required to contain a copy to be retained by employers (Copy D). However, employers must retain copies of the Forms W–2 filed with SSA or have the ability to reconstruct the data for at least four years. Employers must be able to generate a facsimile of Form W–2 (Copy A), in case of loss.

.02 If Copy D is provided for the employer, instructions contained on the back of Copy D of the official form must appear on the back of the substitute form. If Copy D is not provided, these instructions must be furnished to the employer on a separate statement.

.03 Only originals or compliant substitute copies of Forms W–2c (Copy A) and Forms W–3c may be filed with the SSA. Carbon copies and photocopies are unacceptable.

.04 Employers should type or machine print entries on non-laser generated forms whenever possible and provide good quality data entries by using a high quality type face, inserting data in the middle of blocks that are well separated from other printing and guidelines, and taking any other measures that will guarantee clear, sharp images.

.05 Because employers must file a machine-scannable Form W–2c, they should meet the following requirements.

  • Use 12-point Arial font or a close approximation for data entries.

  • Proportional-spaced fonts are unacceptable.

  • Refrain from printing any data in the top margin of the forms.

.06 The employer must also furnish payee copies of Forms W–2c (Copies B, C, and 2) that are legible and capable of being photocopied (by the employee).

.07 When Forms W–2c or W–3c are typed, black ink must be used with no script type, inverted font, italics, or dual-case alpha characters.

.08 Forms W–2c (Copy A) requires decimal entries for wage data. Dollar signs should not be printed with money amounts on Forms W–2c (Copy A) and Form W–3c.

.09 The filer’s employer identification number (EIN) must be entered in box (b) of Form W–2c and box (e) of Form W–3c.

.10 The employer’s name, address, EIN, and state ID number may be preprinted.

.01 The Paperwork Reduction Act (the Act) of 1995 (Public Law 104–13) requires the following.

  • The Office of Management and Budget (OMB) approves all IRS tax forms that are subject to the Act.

  • Each IRS form contains (in or near the upper right corner) the OMB approval number, if assigned. (The official OMB numbers may be found on the official IRS printed forms and are also shown on the forms in the exhibits.)

  • Each IRS form (or its instructions) states:

.02 This information must be provided to any users of official or substitute IRS forms or instructions.

.03 The OMB requirements for substitute IRS Form W–2c (Copy A) and Form W–3c are the following.

  • Any substitute form or substitute statement to a recipient must show the OMB number as it appears on the official IRS form.

  • For Form W–3c and Form W–2c (Copy A), the OMB number (1545-0008) must appear exactly as shown on the official IRS form.

  • For any copy of Form W–3c or Form W–2c, other than Copy A, the OMB number must use one of the following formats.

Bulletin No. 2014–28 113 July 07, 2014

SECTION 1.9 ORDER FORMS AND INSTRUCTIONS

SECTION 1.10 EFFECT ON OTHER DOCUMENTS

.04 Any substitute Form W–3c and Form W–2c (Copy A only) must state “For Privacy Act and Paperwork Reduction Act Notice, see back of Copy D.” If no instructions are provided to users of your forms, you must furnish them the exact text of the Privacy Act and Paperwork Reduction Act Notice.

.01 You can order official IRS Forms W–2c, Forms W–3c, and the General Instructions for Forms W–2 and W–3 (Including Forms W–2AS, W–2GU, W–2VI, W–3SS, W–2c, and W–3c), online at IRS.gov. Click on the Forms and Pubs link and then click the Order Forms and Pubs link. You may also order these forms and instructions by calling 1-800-TAX-FORM (1-800-829-3676).

  • Accessing IRS.gov.

  • IRS Tax Products on DVD (Publication 1796).

Only contact the IRS, not the SSA, for forms.

Note. Many IRS forms are provided on IRS.gov and on the IRS Tax Products on DVD. But copies of Form W–2c (Copy A) and Form W–3c cannot be used for filing with the IRS or SSA when obtained by these methods because the forms do not meet the specific printing specifications as described in this publication. Copies of Forms W–2c and W–3c obtained from these sources are for information purposes only.

.02 Copies of Form W–2c (Copy A) and Form W–3c downloaded from IRS.gov cannot be used for filing with the SSA. These copies of Forms W–2c and W–3c are for information purposes only.

.01 Revenue Procedure 2012–22, 2012–17 I.R.B. 853 (reprinted as Publication 1223, Rev. 047–2012), is superseded.

July 07, 2014 114 Bulletin No. 2014–28

SECTION 1.11 EXHIBITS

Exhibit A

.5”

7.5”

.5”

.5”

DO NOT CUT, FOLD, OR STAPLE THIS FORM
44444 For Official UseOnly
OMB No. 1545-0008
For Official UseOnly
OMB No. 1545-0008
For Official UseOnly
OMB No. 1545-0008
For Official UseOnly
OMB No. 1545-0008
For Official UseOnly
OMB No. 1545-0008
a Employer’s name, address, and ZIPcode a Employer’s name, address, and ZIPcode a Employer’s name, address, and ZIPcode c Tax year/Formcorrected
/ W-2
d Employee’s correct SSN
d Employee’s correct SSN
a Employer’s name, address, and ZIPcode a Employer’s name, address, and ZIPcode a Employer’s name, address, and ZIPcode eCorrectedSSNand/or name(Checkthis box and completeboxesf and/or
g if incorrect on form previously filed.)
eCorrectedSSNand/or name(Checkthis box and completeboxesf and/or
g if incorrect on form previously filed.)
eCorrectedSSNand/or name(Checkthis box and completeboxesf and/or
g if incorrect on form previously filed.)
a Employer’s name, address, and ZIPcode a Employer’s name, address, and ZIPcode a Employer’s name, address, and ZIPcode Complete boxes f and/or g only if incorrect on form previouslyfiled
Complete boxes f and/or g only if incorrect on form previouslyfiled
Complete boxes f and/or g only if incorrect on form previouslyfiled
a Employer’s name, address, and ZIPcode a Employer’s name, address, and ZIPcode a Employer’s name, address, and ZIPcode f Employee’s previously reported SSN
3.7”
f Employee’s previously reported SSN
3.7”
f Employee’s previously reported SSN
3.7”
b Employer’s Federal EIN b Employer’s Federal EIN b Employer’s Federal EIN g Employee’s previously reportedname g Employee’s previously reportedname g Employee’s previously reportedname
h Employee’s first name andinitial Lastname Suff.
i Employee’s address and ZIPcode

Note. Only complete money fields that are being corrected
(exception: for corrections involvingMQGE, seetheInstructions
for Forms W-2c andW-3c,boxes 5 and 6).

Previouslyreported Previouslyreported Correct information Previouslyreported Correctinformation Correctinformation
1Wages, tips, othercompensation 1Wages, tips, othercompensation 1Wages, tips, othercompensation 2 Federal income taxwithheld 2 Federal income taxwithheld 2 Federal income taxwithheld
3 Social security wages 3 Social security wages 3 Social security wages 4 Social security taxwithheld 4 Social security taxwithheld 4 Social security taxwithheld
5 Medicare wages andtips 5 Medicare wages andtips 5 Medicare wages andtips 6 Medicare taxwithheld 6 Medicare taxwithheld 6 Medicare taxwithheld
7 Social securitytips 7 Social securitytips 7 Social securitytips 8 Allocatedtips 8 Allocatedtips 8 Allocatedtips
9 AdvanceEICpayment 9 AdvanceEICpayment 9 AdvanceEICpayment 10 Dependent carebenefits 10 Dependent carebenefits 10 Dependent carebenefits
11 Nonqualified plans


11 Nonqualified plans


d
eifila
u
q
n
o
N
1
1
plans


12aSeeinstructions for box 12
C
o
d
e
12aSeeinstructions for box 12
C
o
d
e
12aSeeinstructions for box 12
C
o
d
e
13Statutory
Retirement
Third-party
employee
plan
sickpay
13Statutory
Retirement
Third-party
employee
plan
sickpay
13Statutory
Retirement
Third-party
employee
plan
sick pay
1.9”
b
2
1
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d
2
1
b
C
o
1.8”
e
d
2
1
b
C
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1.8”
e
1.9”
14 Other (see instructions)
1.9”
14 Other (see instructions)
1.9”
14 Other (seeinstructions)
c
2
1
C


c
2
1
C o
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d e
e


c
2
1
C o
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d e
e


1.9”
14 Other (see instructions)
1.9”
14 Other (see instructions)
1.9”
14 Other (seeinstructions)
d
2
1
C
2
1
d
C o
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d e
e
2
1
d
C o
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d e
e
State CorrectionInformation



Previouslyreported






Previouslyreported






Correctinformation






Previouslyreported






Correctinformation






Correctinformation






e
t
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5
1
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5
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e
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S
5
1
Employer’s state IDnumber
e
t
a
t
S
5
1
Employer’s state IDnumber
DO NOT CUT, FOLD, OR STAPLE THIS FORM
Employer’s state ID number
Employer’s state ID number
Employer’s state ID number
Employer’s state ID number
Employer’s state ID number
Employer’s state ID number
16 State wages, tips, etc.














16 State wages, tips, etc.














16 State wages, tips, etc.












16 State wages, tips, etc.
16 State wages, tips, etc.
16 State wages, tips, etc.
x
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tax
17 State incometax
17 State incometax 17 State incometax
Locality CorrectionInformation



Previouslyreported
Previouslyreported
Correctinformation
Previouslyreported
Correctinformation
Correctinformation
18 Local wages, tips, etc.












18 Local wages, tips, etc.












18 Local wages, tips, etc.










18 Local wages, tips, etc.
18 Local wages, tips, etc.
18 Local wages, tips, etc.
x
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19 Local incometax
19 Local incometax
19 Local incometax
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20 Localityname 20 Localityname 20 Localityname

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Copy A—For Social Security Administration

Form W-2c (Rev. 2-2009) Corrected Wage and Tax Statement Cat. No. 61437D Internal Revenue ServiceDepartment of the Treasury

Bulletin No. 2014–28 115 July 07, 2014

Exhibit B

0.50 in

DO NOT CUT, FOLD, OR STAPLE

0.50 in

0.50 in

55555 a Tax year/Form corrected
/ W-
For Official Use Only
OMB No. 1545-0008

**b **Employer’s name, address, and ZIP code
3.18in

**b **Employer’s name, address, and ZIP code
3.18in

**b **Employer’s name, address, and ZIP code
3.18in
1 in
cKind of Payer(Check one)
941/941-SS Military
943
944/944-SS
CT-1
Hshld.
emp.
Medicare
govt. emp.
1 in
cKind of Payer(Check one)
941/941-SS Military
943
944/944-SS
CT-1
Hshld.
emp.
Medicare
govt. emp.
1 in
cKind of Payer(Check one)
941/941-SS Military
943
944/944-SS
CT-1
Hshld.
emp.
Medicare
govt. emp.
1 in
cKind of Payer(Check one)
941/941-SS Military
943
944/944-SS
CT-1
Hshld.
emp.
Medicare
govt. emp.
Kind
None a
State/l
non-5
Kind
None a
State/l
non-5
** ofEmployer**(Checkone)
pply 501cnon-govt.
ocal
01c
State/local
501c
Federal
govt.
** ofEmployer**(Checkone)
pply 501cnon-govt.
ocal
01c
State/local
501c
Federal
govt.
** ofEmployer**(Checkone)
pply 501cnon-govt.
ocal
01c
State/local
501c
Federal
govt.
** ofEmployer**(Checkone)
pply 501cnon-govt.
ocal
01c
State/local
501c
Federal
govt.
** ofEmployer**(Checkone)
pply 501cnon-govt.
ocal
01c
State/local
501c
Federal
govt.
Third-party
sickpay
(Checkif
applicable)

**b **Employer’s name, address, and ZIP code
3.18in

**b **Employer’s name, address, and ZIP code
3.18in

**b **Employer’s name, address, and ZIP code
3.18in
1 in
cKind of Payer(Check one)
941/941-SS Military
943
944/944-SS
CT-1
Hshld.
emp.
Medicare
govt. emp.
1 in
cKind of Payer(Check one)
941/941-SS Military
943
944/944-SS
CT-1
Hshld.
emp.
Medicare
govt. emp.
1 in
cKind of Payer(Check one)
941/941-SS Military
943
944/944-SS
CT-1
Hshld.
emp.
Medicare
govt. emp.
1 in
cKind of Payer(Check one)
941/941-SS Military
943
944/944-SS
CT-1
Hshld.
emp.
Medicare
govt. emp.
Kind
None a
State/l
non-5
dNumber of Forms W-2c dNumber of Forms W-2c eEmployer’sFederalEIN eEmployer’sFederalEIN eEmployer’sFederalEIN eEmployer’sFederalEIN fEstablishmentnumber fEstablishmentnumber fEstablishmentnumber gEmployer’s state ID number gEmployer’s state ID number gEmployer’s state ID number gEmployer’s state ID number gEmployer’s state ID number gEmployer’s state ID number
Complete boxes h, i, or jonlyif
incorrect on last formfled.
Complete boxes h, i, or jonlyif
incorrect on last formfled.
hEmployer’sincorrectFederalEIN hEmployer’sincorrectFederalEIN hEmployer’sincorrectFederalEIN hEmployer’sincorrectFederalEIN i Incorrectestablishment number i Incorrectestablishment number i Incorrectestablishment number jEmployer'sincorrectstate IDnumber jEmployer'sincorrectstate IDnumber jEmployer'sincorrectstate IDnumber jEmployer'sincorrectstate IDnumber jEmployer'sincorrectstate IDnumber jEmployer'sincorrectstate IDnumber
Total ofamounts previouslyreported
as shown onenclosedFormsW-2c.
Total ofamounts previouslyreported
as shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total ofamounts previouslyreported
as shown onenclosedFormsW-2c.
Total ofamounts previouslyreported
as shown onenclosedFormsW-2c.
Total ofamounts previouslyreported
as shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
1Wages,tips, other compensation 1Wages,tips, other compensation 1Wages,tips, other compensation 1Wages,tips, other compensation 1Wages,tips, other compensation 1Wages,tips, other compensation 2Federalincome tax withheld 2Federalincome tax withheld 2Federalincome tax withheld 2Federalincome tax withheld 2Federalincome tax withheld 2Federalincome tax withheld 2Federalincome tax withheld 2Federalincome tax withheld 2Federalincome tax withheld
3Social security wages 3Social security wages 3Social security wages 3Social security wages 3Social security wages 3Social security wages 4Social security tax withheld 4Social security tax withheld 4Social security tax withheld 4Social security tax withheld 4Social security tax withheld 4Social security tax withheld 4Social security tax withheld 4Social security tax withheld 4Social security tax withheld
5Medicare wages andtips 5Medicare wages andtips 5Medicare wages andtips 5Medicare wages andtips 5Medicare wages andtips 5Medicare wages andtips 6Medicare tax withheld 6Medicare tax withheld 6Medicare tax withheld 6Medicare tax withheld 6Medicare tax withheld 6Medicare tax withheld 6Medicare tax withheld 6Medicare tax withheld 6Medicare tax withheld
7Social securitytips 7Social securitytips 7Social securitytips 7Social securitytips 7Social securitytips 7Social securitytips 7.2i
8Allocatedtips
7.2i
8Allocatedtips
7.2i
8Allocatedtips

8Allocatedtips

8Allocatedtips

8Allocatedtips

8Allocatedtips

8Allocatedtips

8Allocatedtips
9AdvanceEICpayments
1.90 in
9AdvanceEICpayments
1.90 in
9AdvanceEICpayments
1.90 in
9AdvanceEICpayments
1.90 in
9AdvanceEICpayments
1.90 in
9AdvanceEICpayments
1.90 in
n
10Dependent carebenefts
n
10Dependent carebenefts
n
10Dependent carebenefts
10Dependent carebenefts 10Dependent carebenefts 10Dependent carebenefts 10Dependent carebenefts 10Dependent carebenefts 10Dependent carebenefts
11Nonqualifed plans 11Nonqualifed plans 11Nonqualifed plans 11Nonqualifed plans 11Nonqualifed plans 11Nonqualifed plans 12aDeferredcompensation 12aDeferredcompensation 12aDeferredcompensation 12aDeferredcompensation 12aDeferredcompensation 12aDeferredcompensation 12aDeferredcompensation 12aDeferredcompensation 12aDeferredcompensation
14Inc. tax w/h by third-party sick paypayer 14Inc. tax w/h by third-party sick paypayer 14Inc. tax w/h by third-party sick pay payer 14Inc. tax w/h by third-party sick pay payer 14Inc. tax w/h by third-party sick pay payer 14Inc. tax w/h by third-party sick pay payer 12bHIREexempt wages andtips 12bHIREexempt wages andtips 12bHIREexempt wages andtips 12bHIREexempt wages andtips 12bHIREexempt wages andtips 12bHIREexempt wages andtips 12bHIREexempt wages andtips 12bHIREexempt wages andtips 12bHIREexempt wages andtips
16State wages, tips,etc. 16State wages, tips,etc. 16State wages, tips,etc.
16State wages, tips,etc.
16State wages, tips,etc.
16State wages, tips,etc.
17State income tax 17State income tax 17State income tax 17State income tax 17State income tax 17State income tax 17State income tax 17State income tax 17State income tax
18Local wages, tips,etc. 18Local wages, tips,etc. 18Local wages, tips,etc.
7.50in
18Local wages, tips,etc.
7.50in
18Local wages, tips,etc.
7.50in
18Local wages, tips,etc.
7.50in
19Local income tax 19Local income tax 19Local income tax 19Local income tax 19Local income tax 19Local income tax 19Local income tax 19Local income tax 19Local income tax
Explain decreases here: Explain decreases here: Explain decreases here: Explain decreases here: Explain decreases here: Explain decreases here: Explain decreases here: Explain decreases here: Explain decreases here:
Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Yes No No
If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled





Under penalties of perjury, I declare that I have examined this return, including accompanyingdocuments, and, to the best of my
correct, and complete.
Signature
Title
0.50”
Under penalties of perjury, I declare that I have examined this return, including accompanyingdocuments, and, to the best of my
correct, and complete.
Signature
Title
0.50”
Under penalties of perjury, I declare that I have examined this return, including accompanyingdocuments, and, to the best of my
correct, and complete.
Signature
Title
0.50”
Under penalties of perjury, I declare that I have examined this return, including accompanyingdocuments, and, to the best of my
correct, and complete.
Signature
Title
0.50”
Under penalties of perjury, I declare that I have examined this return, including accompanyingdocuments, and, to the best of my
correct, and complete.
Signature
Title
0.50”
Under penalties of perjury, I declare that I have examined this return, including accompanyingdocuments, and, to the best of my
correct, and complete.
Signature
Title
0.50”
Under penalties of perjury, I declare that I have examined this return, including accompanyingdocuments, and, to the best of my
correct, and complete.
Signature
Title
0.50”
Under penalties of perjury, I declare that I have examined this return, including accompanyingdocuments, and, to the best of my
correct, and complete.
Signature
Title
0.50”
Under penalties of perjury, I declare that I have examined this return, including accompanyingdocuments, and, to the best of my
correct, and complete.
Signature
Title
0.50”
knowledge and belief, it is true,
Date
knowledge and belief, it is true,
Date
knowledge and belief, it is true,
Date
knowledge and belief, it is true,
Date
knowledge and belief, it is true,
Date
knowledge and belief, it is true,
Date
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Form W-3c (Rev. 8-2013) Transmittal of Corrected Wage and Tax Statements

Department of the Treasury

Internal Revenue Service

Purpose of Form

Use this form to transmit Copy A of Form(s) W-2c, Corrected Wage and Tax Statement (Rev. 2-2009). Make a copy of Form W-3c and keep it with Copy D (For Employer) of Forms W-2c for your records. File Form W-3c even if only one Form W-2c is being fled or if those Forms W-2c are being fled only to correct an employee’s name and social security number (SSN) or the employer identifcation number (EIN). See the General Instructions for Forms W-2 and W-3 for information on completing this form.

E-Filing

The SSA strongly suggests employers report Form W-3c and Forms W-2c Copy A electronically instead of on paper. The SSA provides two free e-fling options on its Business Services Online (BSO) website:

  • W-2 Online. Use fll-in forms to create, save, print, and submit up to 25 Forms W-2c at a time to the SSA.

  • File Upload. Upload wage fles to the SSA you have created using payroll or tax software that formats the fles according to the SSA’s Specifications for Filing Forms W-2c Electronically (EFW2C). For more information, go to www.socialsecurity.gov/employer and select “First Time Filers” or “Returning Filers” under “BEFORE YOU FILE.”

When To File

File this form and Copy A of Form(s) W-2c with the Social Security Administration as soon as possible after you discover an error on Forms W-2, W-2AS, W-2GU, W-2CM, W-2VI, or W-2c. Provide Copies B, C, and 2 of Form W-2c to your employees as soon as possible.

Where To File

If you use the U.S. Postal Service, send Forms W-2c and W-3c to the following address:

Social Security Administration Data Operations Center P.O. Box 3333 Wilkes-Barre, PA 18767-3333 If you use a carrier other than the U.S. Postal Service, send Forms W-2c and W-3c to the following address:

Social Security Administration Data Operations Center Attn: W-2c Process 1150 E. Mountain Drive Wilkes-Barre, PA 18702-7997

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 10164R

July 07, 2014 116 Bulletin No. 2014–28

Exhibit C

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44444 For Official Use Only
OMB No. 1545-0008
aEmployer’s name, address,andZIPcode
1.3”
9.3”
aEmployer’s name, address,andZIPcode
1.3”
9.3”
aEmployer’s name, address,andZIPcode
1.3”
9.3”
aEmployer’s name, address,andZIPcode
1.3”
9.3”
cTax year/Formcorrected
/ W-2
dEmployee’s correct SSN dEmployee’s correct SSN
aEmployer’s name, address,andZIPcode
1.3”
9.3”
aEmployer’s name, address,andZIPcode
1.3”
9.3”
aEmployer’s name, address,andZIPcode
1.3”
9.3”
aEmployer’s name, address,andZIPcode
1.3”
9.3”
eCorrectedSSNand/or name(Checkthis box and completeboxesf and/or
g if incorrect on form previously filed.)
eCorrectedSSNand/or name(Checkthis box and completeboxesf and/or
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eCorrectedSSNand/or name(Checkthis box and completeboxesf and/or
g if incorrect on form previously filed.)
aEmployer’s name, address,andZIPcode
1.3”
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aEmployer’s name, address,andZIPcode
1.3”
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1.3”
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aEmployer’s name, address,andZIPcode
1.3”
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Complete boxes f and/or g only if incorrect on form previouslyfiled Complete boxes f and/or g only if incorrect on form previouslyfiled Complete boxes f and/or g only if incorrect on form previouslyfiled
aEmployer’s name, address,andZIPcode
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aEmployer’s name, address,andZIPcode
1.3”
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1.3”
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f Employee’spreviouslyreportedSSN
3.7”
f Employee’spreviouslyreportedSSN
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f Employee’spreviouslyreportedSSN
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bEmployer’s Federal EIN bEmployer’s Federal EIN bEmployer’s Federal EIN g Employee’spreviouslyreported name g Employee’spreviouslyreported name g Employee’spreviouslyreported name
hEmployee’sfirstnameandinitial Lastname Suff.
iEmployee’s addressandZIPcode iEmployee’s addressandZIPcode iEmployee’s addressandZIPcode
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Note. Only complete money fields that are being corr
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Note. Only complete money fields that are being corr
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Previouslyreported Previouslyreported Correct inform ation
Previouslyreported
Correctinformation Correctinformation

1Wages,tips, other compensation

1Wages,tips, other compensation

1Wages,tips, other com

pensation

2Federal incometax withheld

2Federal incometax withheld

2Federal incometax withheld
3Social securitywages 3Social securitywages 3Social securitywage s 4Social securitytax withheld 4Social securitytax withheld 4Social securitytax withheld
5Medicare wagesand tips 5Medicare wagesand tips 5Medicare wagesan d tips 6Medicaretax withheld 6Medicaretax withheld 6Medicaretax withheld
7Social securitytips 7Social securitytips 7Social securitytips 8Allocatedtips
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8Allocatedtips 8Allocatedtips
9Advance EICpayment 9Advance EICpayment 9Advance EICpayme nt 10Dependent carebenefits 10Dependent carebenefits 10Dependent carebenefits
11Nonqualifiedplans 11Nonqualifiedplans 11Nonqualifiedplans 12aSeeinstructionsfor box 12
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13Statutory
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13Statutory
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16State wages, tips,etc. 16State wages, tips,etc. 16State wages, tips,et c. 16State wages, tips,etc. 16State wages, tips,etc. 16State wages, tips,etc.
17State income
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17State incometax 17State incometax 17State incometax
Loc Loc Loc ality CorrectionInformation ality CorrectionInformation ality CorrectionInformation ality CorrectionInformation
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18Local wages, tips,etc. 18Local wages, tips,etc. 18Local wages, tips,et c. 18Local wages, tips,etc. 18Local wages, tips,etc. 18Local wages, tips,etc.
19Local income
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20Locality
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Copy 1—State, City, or Local Tax Department

Form W-2c (Rev. 2-2009) Corrected Wage and Tax Statement

Department of the Treasury Internal Revenue Service

Bulletin No. 2014–28 117 July 07, 2014

Exhibit D

0.50 in

DO NOT CUT, FOLD, OR STAPLE

0.50 in

0.50 in

55555 a Tax year/Form corrected
/ W-
For Official Use Only
OMB No. 1545-0008

**b **Employer’s name, address, and ZIP code
3.18in

**b **Employer’s name, address, and ZIP code
3.18in

**b **Employer’s name, address, and ZIP code
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1 in
cKind of Payer(Check one)
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**b **Employer’s name, address, and ZIP code
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dNumber of Forms W-2c dNumber of Forms W-2c eEmployer’sFederalEIN eEmployer’sFederalEIN eEmployer’sFederalEIN eEmployer’sFederalEIN fEstablishmentnumber fEstablishmentnumber fEstablishmentnumber gEmployer’s state ID number gEmployer’s state ID number gEmployer’s state ID number gEmployer’s state ID number gEmployer’s state ID number gEmployer’s state ID number
Complete boxes h, i, or jonlyif
incorrect on last formfled.
Complete boxes h, i, or jonlyif
incorrect on last formfled.
hEmployer’sincorrectFederalEIN hEmployer’sincorrectFederalEIN hEmployer’sincorrectFederalEIN hEmployer’sincorrectFederalEIN i Incorrectestablishment number i Incorrectestablishment number i Incorrectestablishment number jEmployer'sincorrectstate IDnumber jEmployer'sincorrectstate IDnumber jEmployer'sincorrectstate IDnumber jEmployer'sincorrectstate IDnumber jEmployer'sincorrectstate IDnumber jEmployer'sincorrectstate IDnumber
Total ofamounts previouslyreported
as shown onenclosedFormsW-2c.
Total ofamounts previouslyreported
as shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total ofamounts previouslyreported
as shown onenclosedFormsW-2c.
Total ofamounts previouslyreported
as shown onenclosedFormsW-2c.
Total ofamounts previouslyreported
as shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
Total of correctedamountsas
shown onenclosedFormsW-2c.
1Wages,tips, other compensation 1Wages,tips, other compensation 1Wages,tips, other compensation 1Wages,tips, other compensation 1Wages,tips, other compensation 1Wages,tips, other compensation 2Federalincome tax withheld 2Federalincome tax withheld 2Federalincome tax withheld 2Federalincome tax withheld 2Federalincome tax withheld 2Federalincome tax withheld 2Federalincome tax withheld 2Federalincome tax withheld 2Federalincome tax withheld
3Social security wages 3Social security wages 3Social security wages 3Social security wages 3Social security wages 3Social security wages 4Social security tax withheld 4Social security tax withheld 4Social security tax withheld 4Social security tax withheld 4Social security tax withheld 4Social security tax withheld 4Social security tax withheld 4Social security tax withheld 4Social security tax withheld
5Medicare wages andtips 5Medicare wages andtips 5Medicare wages andtips 5Medicare wages andtips 5Medicare wages andtips 5Medicare wages andtips 6Medicare tax withheld 6Medicare tax withheld 6Medicare tax withheld 6Medicare tax withheld 6Medicare tax withheld 6Medicare tax withheld 6Medicare tax withheld 6Medicare tax withheld 6Medicare tax withheld
7Social securitytips 7Social securitytips 7Social securitytips 7Social securitytips 7Social securitytips 7Social securitytips 7.2i
8Allocatedtips
7.2i
8Allocatedtips
7.2i
8Allocatedtips

8Allocatedtips

8Allocatedtips

8Allocatedtips

8Allocatedtips

8Allocatedtips

8Allocatedtips
9AdvanceEICpayments
1.90 in
9AdvanceEICpayments
1.90 in
9AdvanceEICpayments
1.90 in
9AdvanceEICpayments
1.90 in
9AdvanceEICpayments
1.90 in
9AdvanceEICpayments
1.90 in
n
10Dependent carebenefts
n
10Dependent carebenefts
n
10Dependent carebenefts
10Dependent carebenefts 10Dependent carebenefts 10Dependent carebenefts 10Dependent carebenefts 10Dependent carebenefts 10Dependent carebenefts
11Nonqualifed plans 11Nonqualifed plans 11Nonqualifed plans 11Nonqualifed plans 11Nonqualifed plans 11Nonqualifed plans 12aDeferredcompensation 12aDeferredcompensation 12aDeferredcompensation 12aDeferredcompensation 12aDeferredcompensation 12aDeferredcompensation 12aDeferredcompensation 12aDeferredcompensation 12aDeferredcompensation
14Inc. tax w/h by third-party sick paypayer 14Inc. tax w/h by third-party sick paypayer 14Inc. tax w/h by third-party sick paypayer 14Inc. tax w/h by third-party sick paypayer 14Inc. tax w/h by third-party sick paypayer 14Inc. tax w/h by third-party sick paypayer 12bHIREexempt wages andtips 12bHIREexempt wages andtips 12bHIREexempt wages andtips 12bHIREexempt wages andtips 12bHIREexempt wages andtips 12bHIREexempt wages andtips 12bHIREexempt wages andtips 12bHIREexempt wages andtips 12bHIREexempt wages andtips
16State wages, tips,etc. 16State wages, tips,etc. 16State wages, tips,etc.
16State wages, tips,etc.
16State wages, tips,etc.
16State wages, tips,etc.
17State income tax 17State income tax 17State income tax 17State income tax 17State income tax 17State income tax 17State income tax 17State income tax 17State income tax
18Local wages, tips,etc. 18Local wages, tips,etc. 18Local wages, tips,etc.
7.50in
18Local wages, tips,etc.
7.50in
18Local wages, tips,etc.
7.50in
18Local wages, tips,etc.
7.50in
19Local income tax 19Local income tax 19Local income tax 19Local income tax 19Local income tax 19Local income tax 19Local income tax 19Local income tax 19Local income tax
Explain decreases here: Explain decreases here: Explain decreases here: Explain decreases here: Explain decreases here: Explain decreases here: Explain decreases here: Explain decreases here: Explain decreases here:
Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Has an adjustment been made on an employment tax return fled with the Internal Revenue Service? Yes No No
If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled If“Yes,” givedate the return was fled





Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my
correct, and complete.
Signature
Title
0.50”
Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my
correct, and complete.
Signature
Title
0.50”
Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my
correct, and complete.
Signature
Title
0.50”
Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my
correct, and complete.
Signature
Title
0.50”
Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my
correct, and complete.
Signature
Title
0.50”
Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my
correct, and complete.
Signature
Title
0.50”
Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my
correct, and complete.
Signature
Title
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Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my
correct, and complete.
Signature
Title
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Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my
correct, and complete.
Signature
Title
0.50”
knowledge and belief, it is true,
Date
knowledge and belief, it is true,
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knowledge and belief, it is true,
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knowledge and belief, it is true,
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knowledge and belief, it is true,
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knowledge and belief, it is true,
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Exceptions & meaning →

Form W-3c (Rev. 8-2013) Transmittal of Corrected Wage and Tax Statements

Department of the Treasury

Internal Revenue Service

Purpose of Form

Use this form to transmit Copy A of Form(s) W-2c, Corrected Wage and Tax Statement (Rev. 2-2009). Make a copy of Form W-3c and keep it with Copy D (For Employer) of Forms W-2c for your records. File Form W-3c even if only one Form W-2c is being fled or if those Forms W-2c are being fled only to correct an employee’s name and social security number (SSN) or the employer identifcation number (EIN). See the General Instructions for Forms W-2 and W-3 for information on completing this form.

E-Filing

The SSA strongly suggests employers report Form W-3c and Forms W-2c Copy A electronically instead of on paper. The SSA provides two free e-fling options on its Business Services Online (BSO) website:

  • W-2 Online. Use fll-in forms to create, save, print, and submit up to 25 Forms W-2c at a time to the SSA.

  • File Upload. Upload wage fles to the SSA you have created using payroll or tax software that formats the fles according to the SSA’s Specifications for Filing Forms W-2c Electronically (EFW2C). For more information, go to www.socialsecurity.gov/employer and select “First Time Filers” or “Returning Filers” under “BEFORE YOU FILE.”

When To File

File this form and Copy A of Form(s) W-2c with the Social Security Administration as soon as possible after you discover an error on Forms W-2, W-2AS, W-2GU, W-2CM, W-2VI, or W-2c. Provide Copies B, C, and 2 of Form W-2c to your employees as soon as possible.

Where To File

If you use the U.S. Postal Service, send Forms W-2c and W-3c to the following address:

Social Security Administration Data Operations Center P.O. Box 3333 Wilkes-Barre, PA 18767-3333 If you use a carrier other than the U.S. Postal Service, send Forms W-2c and W-3c to the following address:

Social Security Administration Data Operations Center Attn: W-2c Process 1150 E. Mountain Drive Wilkes-Barre, PA 18702-7997

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 10164R

July 07, 2014 118 Bulletin No. 2014–28

Exceptions & meaning →

Get a plain-English answer with a citation back to this text.

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▸Contents — Internal Revenue Bulletin 2014-28

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