Fillable Printable 2011 Form W-2
Fillable Printable 2011 Form W-2
2011 Form W-2
22222
Void
a Employee’s social security number
For Official Use Only
▶
OMB No. 1545-0008
b Employer identification number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s first name and initial Last name Suff.
f Employee’s address and ZIP code
1 Wages, tips, other compensation
2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care benefits
11 Nonqualified plans 12a See instructions for box 12
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Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20
Locality name
Form
W-2
Wage and Tax Statement
2011
Copy A For Social Security Administration — Send this entire page with
Form W-3 to the Social Security Administration; photocopies are not acceptable.
Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction
Act Notice, see back of Copy D.
Cat. No. 10134D
Do Not Cut, Fold, or Staple Forms on This Page — Do Not Cut, Fold, or Staple Forms on This Page
22222
a Employee’s social security number
OMB No. 1545-0008
b Employer identification number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s first name and initial Last name Suff.
f Employee’s address and ZIP code
1 Wages, tips, other compensation
2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9
10 Dependent care benefits
11 Nonqualified plans 12a
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12b
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12c
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13
Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20
Locality name
Form
W-2
Wage and Tax
Statement
2011
Department of the Treasury—Internal Revenue Service
Copy 1—For State, City, or Local Tax Department
a Employee’s social security number
OMB No. 1545-0008
Safe, accurate,
FAST! Use
Visit the IRS website at
www.irs.gov/efile
b Employer identification number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s first name and initial Last name Suff.
f Employee’s address and ZIP code
1 Wages, tips, other compensation
2 Federal income tax withheld
3 Social security wages
4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care benefits
11 Nonqualified plans 12a See instructions for box 12
C
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12b
C
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12c
C
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12d
C
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13
Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20
Locality name
Form
W-2
Wage and Tax
Statement
2011
Department of the Treasury—Internal Revenue Service
Copy B—To Be Filed With Employee’s FEDERAL Tax Return.
This information is being furnished to the Internal Revenue Service.
Notice to Employee
Refund. Even if you do not have to file a tax return, you
should file to get a refund if box 2 shows federal income
tax withheld or if you can take the earned income credit.
Earned income credit (EIC). You may be able to take the
EIC for 2011 if (a) you do not have a qualifying child and
you earned less than $13,660 ($18,740 if married filing
jointly), (b) you have one qualifying child and you earned
less than $36,052 ($41,132 if married filing jointly), (c) you
have two qualifying children and you earned less than
$40,964 ($46,044 if married filing jointly), or (d) you have
three or more qualifying children and you earned less
than $43,998 ($49,078 if married filing jointly). You and
any qualifying children must have valid social security
numbers (SSNs). You cannot take the EIC if your
investment income is more than $3,150. Any EIC that is
more than your tax liability is refunded to you, but only
if you file a tax return.
Clergy and religious workers. If you are not subject to
social security and Medicare taxes, see Pub. 517, Social
Security and Other Information for Members of the Clergy
and Religious Workers.
Corrections. If your name, SSN, or address is incorrect,
correct Copies B, C, and 2 and ask your employer to
correct your employment record. Be sure to ask the
employer to file Form W-2c, Corrected Wage and Tax
Statement, with the Social Security Administration (SSA)
to correct any name, SSN, or money amount error
reported to the SSA on Form W-2. If your name and SSN
are correct but are not the same as shown on your social
security card, you should ask for a new card that displays
your correct name at any SSA office or by calling
1-800-772-1213. You also may visit the SSA at
www.socialsecurity.gov.
Cost of employer-sponsored health coverage (if such
cost is provided by the employer). The reporting in Box
12, using Code DD, of the cost of employer-sponsored
health coverage is for your information only. The amount
reported with Code DD is not taxable.
Credit for excess taxes. If you had more than one
employer in 2011 and more than $4,485.60 in social
security and/or Tier I railroad retirement (RRTA) taxes
were withheld, you may be able to claim a credit for the
excess against your federal income tax. If you had more
than one railroad employer and more than $3,088.80 in
Tier II RRTA tax was withheld, you also may be able to
claim a credit. See your Form 1040 or Form 1040A
instructions and Pub. 505, Tax Withholding and
Estimated Tax.
(Also see Instructions for Employee on the back of Copy C.)
a Employee’s social security number
OMB No. 1545-0008
This information is being furnished to the Internal Revenue Service. If you
are required to file a tax return, a negligence penalty or other sanction
may be imposed on you if this income is taxable and you fail to report it.
b Employer identification number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s first name and initial Last name Suff.
f Employee’s address and ZIP code
1 Wages, tips, other compensation
2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9
10 Dependent care benefits
11 Nonqualified plans 12a See instructions for box 12
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12b
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12c
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13
Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20
Locality name
Form
W-2
Wage and Tax
Statement
2011
Department of the Treasury—Internal Revenue Service
Safe, accurate
FAST! Use
Copy C—For EMPLOYEE’S RECORDS (See Notice to
Employee on the back of Copy B.)
Instructions for Employee (Also see Notice to
Employee, on the back of Copy B.)
Box 1. Enter this amount on the wages line of your tax return.
Box 2. Enter this amount on the federal income tax withheld line of
your tax return.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For
information on how to report tips on your tax return, see your Form
1040 instructions.
Unless you have records that show you did not receive the
amount reported in box 8 as allocated tips, you must file Form
4137, Social Security and Medicare Tax on Unreported Tip Income,
with your income tax return to report the allocated tip amount. On
Form 4137 you will figure the social security and Medicare tax owed
on the allocated tips shown on your Form(s) W-2 that you must
report as income and on other tips you did not report to your
employer. By filing Form 4137, your social security tips will be
credited to your social security record (used to figure your benefits).
Box 10. This amount is the total dependent care benefits that your
employer paid to you or incurred on your behalf (including amounts
from a section 125 (cafeteria) plan). Any amount over $5,000 is also
included in box 1. Complete Form 2441, Child and Dependent Care
Expenses, to compute any taxable and nontaxable amounts.
Box 11. This amount is (a) reported in box 1 if it is a distribution
made to you from a nonqualified deferred compensation or
nongovernmental section 457(b) plan or (b) included in box 3 and/or
5 if it is a prior year deferral under a nonqualified or section 457(b)
plan that became taxable for social security and Medicare taxes this
year because there is no longer a substantial risk of forfeiture of
your right to the deferred amount.
Box 12. The following list explains the codes shown in box 12. You
may need this information to complete your tax return. Elective
deferrals (codes D, E, F, and S) and designated Roth
contributions (codes AA, BB, and EE) under all plans are generally
limited to a total of $16,500 ($11,500 if you only have SIMPLE plans;
$19,500 for section 403(b) plans if you qualify for the 15-year rule
explained in Pub. 571). Deferrals under code G are limited to
$16,500. Deferrals under code H are limited to $7,000.
However, if you were at least age 50 in 2011, your employer may
have allowed an additional deferral of up to $5,500 ($2,500 for
section 401(k)(11) and 408(p) SIMPLE plans). This additional deferral
amount is not subject to the overall limit on elective deferrals. For
code G, the limit on elective deferrals may be higher for the last 3
years before you reach retirement age. Contact your plan
administrator for more information. Amounts in excess of the overall
elective deferral limit must be included in income. See the “Wages,
Salaries, Tips, etc.” line instructions for Form 1040.
Note. If a year follows code D through H, S, Y, AA, BB, or EE, you
made a make-up pension contribution for a prior year(s) when you
were in military service. To figure whether you made excess
deferrals, consider these amounts for the year shown, not the
current year. If no year is shown, the contributions are for the
current year.
A—Uncollected social security or RRTA tax on tips. Include this tax
on Form 1040. See “Total Tax” in the Form 1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form
1040. See “Total Tax” in the Form 1040 instructions.
C—Taxable cost of group-term life insurance over $50,000 (included
in boxes 1, 3 (up to social security wage base), and 5)
D—Elective deferrals to a section 401(k) cash or deferred
arrangement. Also includes deferrals under a SIMPLE retirement
account that is part of a section 401(k) arrangement.
E—Elective deferrals under a section 403(b) salary reduction
agreement
(continued on back of Copy 2)
a Employee’s social security number
OMB No. 1545-0008
b Employer identification number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s first name and initial Last name Suff.
f Employee’s address and ZIP code
1 Wages, tips, other compensation
2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9
10 Dependent care benefits
11 Nonqualified plans 12a
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12b
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Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20
Locality name
Form
W-2
Wage and Tax
Statement
2011
Department of the Treasury—Internal Revenue Service
Copy 2—To Be Filed With Employee’s State, City, or Local
Income Tax Return.
Instructions for Employee (continued from back of
Copy C)
F—Elective deferrals under a section 408(k)(6) salary reduction SEP
G—Elective deferrals and employer contributions (including nonelective
deferrals) to a section 457(b) deferred compensation plan
H—Elective deferrals to a section 501(c)(18)(D) tax-exempt organization
plan. See “Adjusted Gross Income” in the Form 1040 instructions for
how to deduct.
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or
5)
K—20% excise tax on excess golden parachute payments. See “Total
Tax” in the Form 1040 instructions.
L—Substantiated employee business expense reimbursements
(nontaxable)
M—Uncollected social security or RRTA tax on taxable cost of group-
term life insurance over $50,000 (former employees only). See “Total
Tax” in the Form 1040 instructions.
N—Uncollected Medicare tax on taxable cost of group-term life
insurance over $50,000 (former employees only). See “Total Tax” in the
Form 1040 instructions.
P—Excludable moving expense reimbursements paid directly to
employee (not included in boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 or Form
1040A for details on reporting this amount.
R—Employer contributions to your Archer MSA. Report on Form 8853,
Archer MSAs and Long-Term Care Insurance Contracts.
S—Employee salary reduction contributions under a section 408(p)
SIMPLE (not included in box 1)
T—Adoption benefits (not included in box 1). Complete Form 8839,
Qualified Adoption Expenses, to compute any taxable and nontaxable
amounts.
V—Income from exercise of nonstatutory stock option(s) (included in
boxes 1, 3 (up to social security wage base), and 5). See Pub. 525 and
instructions for Schedule D (Form 1040) for reporting requirements.
W—Employer contributions (including amounts the employee elected to
contribute using a section 125 (cafeteria) plan) to your health savings
account. Report on Form 8889, Health Savings Accounts (HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation
plan
Z—Income under section 409A on a nonqualified deferred
compensation plan. This amount is also included in box 1. It is subject
to an additional 20% tax plus interest. See “Total Tax” in the Form 1040
instructions.
AA—Designated Roth contributions under a section 401(k) plan
BB—Designated Roth contributions under a section 403(b) plan
DD—Cost of employer-sponsored health coverage. The amount
reported with Code DD is not taxable.
EE—Designated Roth contributions under a governmental section
457(b) plan. This amount does not apply to contributions under a tax-
exempt organization section 457(b) plan.
Box 13. If the “Retirement plan” box is checked, special limits may
apply to the amount of traditional IRA contributions you may deduct.
Note. Keep Copy C of Form W-2 for at least 3 years after the due date
for filing your income tax return. However, to help protect your social
security benefits, keep Copy C until you begin receiving social security
benefits, just in case there is a question about your work record and/or
earnings in a particular year. Compare the Social Security wages and
the Medicare wages to the information shown on your annual (for
workers over 25) Social Security Statement.
Void
a Employee’s social security number
OMB No. 1545-0008
b Employer identification number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s first name and initial Last name Suff.
f Employee’s address and ZIP code
1 Wages, tips, other compensation
2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9
10 Dependent care benefits
11 Nonqualified plans 12a See instructions for box 12
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12b
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12c
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Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20
Locality name
Form
W-2
Wage and Tax
Statement
2011
Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction
Act Notice, see back of Copy D.
Copy D — For Employer.
Employers, Please Note—
Specific information needed to complete Form W-2 is available
in a separate booklet titled 2011 Instructions for Forms W-2 and
W-3. You can order those instructions and additional forms by
calling 1-800-TAX-FORM (1-800-829-3676). You also can get
forms and instructions at IRS.gov.
Caution. You cannot file Forms W-2/W-2c and W-3/W-3c that
you print from IRS.gov with SSA. The SSA's equipment is not
able to process these forms. Instead, you can use online fill-in
forms to create and submit Forms W-2/W-2c and W-3/W-3c to
the SSA electronically. For more information, visit the SSA's
Employer W-2 Filing Instructions & Information page at
www.socialsecurity.gov/employer and click on "How to File
W-2s."
Due dates. Furnish Copies B, C, and 2 to the employee
generally by January 31, 2012.
File Copy A with the SSA by February 29, 2012. Send all
Copies A with Form W-3, Transmittal of Wage and Tax
Statements. If you file electronically (required if submitting 250
or more Forms W-2), the due date is April 2, 2012.
Need help? If you have questions about reporting on Form W-2,
call the information reporting customer service site toll free at
1-866-455-7438 or 304-263-8700 (not toll free). For TTY/TDD
equipment, call 304-579-4827 (not toll free). The hours of
operation are 8:30 a.m. to 4:30 p.m., Eastern time.
Privacy Act and Paperwork Reduction Act Notice. We ask for
the information on Forms W-2 and W-3 to carry out the Internal
Revenue laws of the United States. We need it to figure and
collect the right amount of tax. Section 6051 and its regulations
require you to furnish wage and tax statements to employees,
the Social Security Administration, and the Internal Revenue
Service. Section 6109 requires you to provide your employer
identification number (EIN). If you fail to provide this information
in a timely manner, you may be subject to penalties. Failure to
provide this information, or providing false or fraudulent
information, may subject you to penalties.
You are not required to provide the information requested on
a form that is subject to the Paperwork Reduction Act unless
the form displays a valid OMB control number. Books or
records relating to a form or its instructions must be retained as
long as their contents may become material in the
administration of any Internal Revenue law.
Generally, tax returns and return information are confidential,
as required by section 6103. However, section 6103 allows or
requires the Internal Revenue Service to disclose or give the
information shown on your return to others as described in the
Code. For example, we may disclose your tax information to the
Department of Justice for civil and/or criminal litigation, and to
cities, states, the District of Columbia, and U.S. commonwealths
and possessions for use in administering their tax laws. We may
also disclose this information to other countries under a tax
treaty, to federal and state agencies to enforce federal nontax
criminal laws, or to federal law enforcement and intelligence
agencies to combat terrorism.
The time needed to complete and file these forms will vary
depending on individual circumstances. The estimated average
times are: Form W-2—30 minutes, and Form W-3—28 minutes.
If you have comments concerning the accuracy of these time
estimates or suggestions for making these forms simpler, we
would be happy to hear from you. You can write to the Internal
Revenue Service, Tax Products Coordinating Committee,
SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-6526,
Washington, DC 20224. Do not send Forms W-2 and W-3 to
this address. Instead, see Where to file paper forms in the
Instructions for Forms W-2 and W-3.
