Fillable Printable 2012 Form W-3
Fillable Printable 2012 Form W-3
2012 Form W-3
DO NOT STAPLE
33333
a Control number
For Official Use Only
a
OMB No. 1545-0008
b
Kind
of
Payer
(Check one)
F
941 Military 943 944
CT-1
Hshld.
emp.
Medicare
govt. emp.
Kind
of
Employer
(Check one)
F
None apply 501c non-govt.
State/local
non-501c
State/local 501c Federal govt.
Third-party
sick pay
(Check if
applicable)
c Total number of Forms W-2
d Establishment number
e Employer identification number (EIN)
f Employer’s name
g Employer’s address and ZIP code
h Other EIN used this year
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 Deferred compensation
12b
13 For third-party sick pay use only
14 Income tax withheld by payer of third-party sick pay
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
Contact person
Telephone number
For Official Use Only
Email address
Fax number
Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and
complete.
Signature
a
Title
a Date
a
Form
W-3
Transmittal of Wage and Tax Statements
2012
Department of the Treasury
Internal Revenue Service
Send this entire page with the entire Copy A page of Form(s) W-2 to the Social Security Administration (SSA).
Photocopies are not acceptable. Do not send Form W-3 if you filed electronically with the SSA.
Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3.
Reminder
Separate instructions. See the 2012 General Instructions for Forms
W-2 and W-3 for information on completing this form.
Purpose of Form
A Form W-3 Transmittal is completed only when paper Copy A of
Form(s) W-2, Wage and Tax Statement, is being filed. Do not file Form
W-3 alone. Do not file Form W-3 for Form(s) W-2 that were submitted
electronically to the SSA (see below). All paper forms must comply
with IRS standards and be machine readable. Photocopies are not
acceptable. Use a Form W-3 even if only one paper Form W-2 is being
filed. Make sure both the Form W-3 and Form(s) W-2 show the correct
tax year and Employer Identification Number (EIN). Make a copy of this
form and keep it with Copy D (For Employer) of Form(s) W-2 for your
records. The IRS recommends retaining copies of these forms for four
years.
E-Filing
The SSA strongly suggests employers report Form W-3 and Forms W-2
Copy A electronically instead of on paper. The SSA provides two free e-
filing options on its Business Services Online (BSO) website:
• W-2 Online. Use fill-in forms to create, save, print, and submit up to
50 Forms W-2 at a time to the SSA.
• File Upload. Upload wage files to the SSA you have created using
payroll or tax software that formats the files according to the SSA’s
Specifications for Filing Forms W-2 Electronically (EFW2).
W-2 Online fill-in forms or file uploads will be on time if submitted by
April 1, 2013. For more information, go to www.socialsecurity.gov/
employer and select “First Time Filers” or “Returning Filers” under
“BEFORE YOU FILE.”
When To File
Mail Copy A of Form W-3 with Form(s) W-2 by February 28, 2013.
Where To File Paper Forms
Send this entire page with the entire Copy A page of Form(s) W-2 to:
Social Security Administration
Data Operations Center
Wilkes-Barre, PA 18769-0001
Note. If you use “Certified Mail” to file, change the ZIP code to
“18769-0002.” If you use an IRS-approved private delivery service, add
“ATTN: W-2 Process, 1150 E. Mountain Dr.” to the address and change
the ZIP code to “18702-7997.” See Publication 15 (Circular E),
Employer’s Tax Guide, for a list of IRS-approved private delivery
services.
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10159Y
