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Fillable Printable Form W-2

Fillable Printable Form W-2

Form W-2

Form W-2

Attention:
You may file Forms W-2 and W-3 electronically on the SSA’s Employer
W-2 Filing Instructions and Information web page, which is also accessible
at www.socialsecurity.gov/employer. You can create fill-in versions of
Forms W-2 and W-3 for filing with SSA. You may also print out copies for
filing with state or local governments, distribution to your employees, and
for your records.
Note: Copy A of this form is provided for informational purposes only. Copy A appears in
red, similar to the official IRS form. The official printed version of this IRS form is scannable,
but the online version of it, printed from this website, is not. Do not print and file Copy A
downloaded from this website with the SSA; a penalty may be imposed for filing forms that
can’t be scanned. See the penalties section in the current
General Instructions for Forms
W-2 and W-3, available at www.irs.gov/w2, for more information.
Please note that Copy B and other copies of this form, which appear in black, may be
downloaded, filled in, and printed and used to satisfy the requirement to provide the
information to the recipient.
To order official IRS information returns such as Forms W-2 and W-3, which include a
scannable Copy A for filing, go to IRS’
Online Ordering for Information Returns and
Employer Returns page, or visit www.irs.gov/orderforms and click on Employer and
Information returns. We’ll mail you the scannable forms and any other products you order.
See IRS Publications 1141, 1167, and 1179
for more information about printing these tax
forms.
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 nameSuff.
f Employee’s address and ZIP code
1 Wages, tips, other compensation
2 Federal income tax withheld
3 Social security wages4 Social security tax withheld
5 Medicare wages and tips6 Medicare tax withheld
7 Social security tips8 Allocated tips
9 Verification code10 Dependent care benefits
11 Nonqualified plans12a 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 StateEmployer’s state ID number16 State wages, tips, etc.17 State income tax18 Local wages, tips, etc.19 Local income tax20
Locality name
Form
W-2
Wage and Tax Statement
2017
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 the separate instructions.
Cat. No. 10134D
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 initialLast nameSuff.
f Employee’s address and ZIP code
1 Wages, tips, other compensation
2 Federal income tax withheld
3 Social security wages4 Social security tax withheld
5 Medicare wages and tips6 Medicare tax withheld
7 Social security tips8 Allocated tips
9 Verification code10 Dependent care benefits
11 Nonqualified plans12a
C
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d
e
12b
C
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e
12c
C
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d
e
12d
C
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13
Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other
15 StateEmployer’s state ID number16 State wages, tips, etc.17 State income tax18 Local wages, tips, etc.19 Local income tax20
Locality name
Form
W-2
Wage and Tax
Statement
2017
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 initialLast nameSuff.
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 tips6 Medicare tax withheld
7 Social security tips8 Allocated tips
9 Verification code10 Dependent care benefits
11 Nonqualified plans12a See instructions for box 12
C
o
d
e
12b
C
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d
e
12c
C
o
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12d
C
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d
e
13
Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other
15 StateEmployer’s state ID number16 State wages, tips, etc.17 State income tax18 Local wages, tips, etc.19 Local income tax20
Locality name
Form
W-2
Wage and Tax
Statement
2017
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
Do you have to file? Refer to the Form 1040 instructions
to determine if you are required to file a tax return. Even
if you don’t have to file a tax return, you may be eligible
for a refund if box 2 shows an amount or if you are
eligible for any credit.
Earned income credit (EIC). You may be able to take the
EIC for 2017 if your adjusted gross income (AGI) is less
than a certain amount. The amount of the credit is based
on income and family size. Workers without children
could qualify for a smaller credit. You and any qualifying
children must have valid social security numbers (SSNs).
You can’t take the EIC if your investment income is more
than the specified amount for 2017 or if income is earned
for services provided while you were an inmate at a penal
institution. For 2017 income limits and more information,
visit www.irs.gov/eitc. Also see Pub. 596, Earned Income
Credit. 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 aren’t subject to
social security and Medicare taxes, see Pub. 517,Social
Security and Other Information for Members of theClergy
and Religious Workers.
Corrections. If your name, SSN, or address is incorrect,
correct Copies B, C, and 2 and ask your employer to
correctyour employment record. Be sure to ask the
employer to fileForm W-2c, Corrected Wage and Tax
Statement, with theSocial Security Administration (SSA)
to correct any name,SSN, or money amount error
reported to the SSA on FormW-2. Be sure to get your
copies of Form W-2c from your employer for all
corrections made so you may file them with your tax
return. If your name and SSN are correct but aren’t the
sameas shown on your social security card, you should
ask for anew card that displays your correct name at any
SSA officeor by calling 1-800-772-1213. You also may
visit the SSA at www.SSA.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 2017 and more than $7,886.40 in social
securityand/or Tier 1 railroad retirement (RRTA) taxes
were withheld,you may be able to claim a credit for the
excess againstyour federal income tax. If you had more
than one railroademployer and more than $4,630.50 in
Tier 2 RRTA tax waswithheld, you also may be able to
claim a credit. See yourForm 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 initialLast nameSuff.
f Employee’s address and ZIP code
1 Wages, tips, other compensation
2 Federal income tax withheld
3 Social security wages4 Social security tax withheld
5 Medicare wages and tips6 Medicare tax withheld
7 Social security tips8 Allocated tips
9 Verification code10 Dependent care benefits
11 Nonqualified plans12a See instructions for box 12
C
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d
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12b
C
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e
12c
C
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12d
C
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13
Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other
15 StateEmployer’s state ID number16 State wages, tips, etc.17 State income tax18 Local wages, tips, etc.19 Local income tax20
Locality name
Form
W-2
Wage and Tax
Statement
2017
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 toEmployee,
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 withheldline of your tax
return.
Box 5. You may be required to report this amount on Form 8959, Additional
Medicare Tax. See the Form 1040 instructions to determine if you are
required to complete Form 8959.
Box 6. This amount includes the 1.45% Medicare Tax withheld on all
Medicare wages and tips shown in box 5, as well as the 0.9% Additional
Medicare Tax on any of those Medicare wages and tips above $200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. Forinformation on
how to report tips on your tax return, see yourForm 1040 instructions.
You must file Form 4137, Social Security and Medicare Tax on Unreported
Tip Income, with your income tax return to report at least the allocated tip
amount unless you can prove that you received a smaller amount. If you have
records that show the actual amount of tips you received, report that amount
even if it is more or less than the allocated tips. On Form 4137 you will
calculate 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 9. If you are e-filing and if there is a code in this box, enter it when
prompted by your software. This code assists the IRS in validating the W-2
data submitted with your return. The code is not entered on paper-filed
returns.
Box 10. This amount includes the total dependent care benefits thatyour
employer paid to you or incurred on your behalf (includingamounts from a
section 125 (cafeteria) plan). Any amount over$5,000 is also included in box
1. Complete Form 2441, Child and Dependent CareExpenses, to compute
any taxable and nontaxable amounts.
Box 11. This amount is (a) reported in box 1 if it is a distributionmade 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. This box shouldn’t be used if
you had a deferral and a distribution in the same calendar year. If you made a
deferral and received a distribution in the same calendar year, and you are or
will be age 62 by the end of the calendar year, your employer should file
Form SSA-131, Employer Report of Special Wage Payments, with the Social
Security Administration and give you a copy.
Box 12. The following list explains the codes shown in box 12. You may
need this information to complete your taxreturn. Elective deferrals (codes
D, E, F, and S) and designatedRoth contributions (codes AA, BB, and EE)
under all plans aregenerally limited to a total of $18,000 ($12,500 if you only
have SIMPLE plans; $21,000 for section 403(b) plans if you qualify for the
15-year rule explained in Pub. 571). Deferrals under code G are limited to
$18,000. Deferrals under code H are limited to $7,000.
However, if you were at least age 50 in 2017, your employer may have
allowed an additional deferral of up to $6,000 ($3,000 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, youmade a
make-up pension contribution for a prior year(s) whenyou were in military
service. To figure whether you made excessdeferrals, consider these
amounts for the year shown, not thecurrent year. If no year is shown, the
contributions are for thecurrent year.
A—Uncollected social security or RRTA tax on tips. Include thistax on Form
1040. See “Other Taxes” in the Form 1040instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form1040. See
“Other Taxes” 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 deferredarrangement. Also
includes deferrals under a SIMPLE retirementaccount that is part of a
section 401(k) arrangement.
E—Elective deferrals under a section 403(b) salary reductionagreement
(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 initialLast nameSuff.
f Employee’s address and ZIP code
1 Wages, tips, other compensation
2 Federal income tax withheld
3 Social security wages4 Social security tax withheld
5 Medicare wages and tips6 Medicare tax withheld
7 Social security tips8 Allocated tips
9 Verification code10 Dependent care benefits
11 Nonqualified plans12a
C
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12b
C
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12c
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13
Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other
15 StateEmployer’s state ID number16 State wages, tips, etc.17 State income tax18 Local wages, tips, etc.19 Local income tax20
Locality name
Form
W-2
Wage and Tax
Statement
2017
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) salaryreduction SEP
G—Elective deferrals and employer contributions (includingnonelective
deferrals) to a section 457(b) deferredcompensation plan
H—Elective deferrals to a section 501(c)(18)(D) tax-exemptorganization
plan. See “Adjusted Gross Income” in the Form1040 instructions for
how to deduct.
J—Nontaxable sick pay (information only, not included inboxes 1, 3, or
5)
K—20% excise tax on excess golden parachute payments.See “Other
Taxes” in the Form 1040 instructions.
L—Substantiated employee business expensereimbursements
(nontaxable)
M—Uncollected social security or RRTA tax on taxable costof group-
term life insurance over $50,000 (former employeesonly). See “Other
Taxes” in the Form 1040 instructions.
N—Uncollected Medicare tax on taxable cost of group-termlife
insurance over $50,000 (former employees only). See“Other Taxes” in
the Form 1040 instructions.
P—Excludable moving expense reimbursements paiddirectly to
employee (not included in boxes 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form1040 or Form
1040A for details on reporting this amount.
R—Employer contributions to your Archer MSA. Report onForm 8853,
Archer MSAs and Long-Term Care InsuranceContracts.
S—Employee salary reduction contributions under a section408(p)
SIMPLE plan (not included in box 1)
T—Adoption benefits (not included in box 1). Complete Form 8839,
Qualified Adoption Expenses, tocompute 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,
Taxable and Nontaxable Income, 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 a nonqualified deferred compensation plan that fails
to satisfy section 409A. This amount is also included in box 1. Itis
subject to an additional 20% tax plus interest. See “Other Taxes” 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.
FF—Permitted benefits under a qualified small employer health
reimbursement arrangement
Box 13. If the “Retirement plan” box is checked, speciallimits may apply
to the amount of traditional IRAcontributions you may deduct. See
Pub. 590-A, Contributions to Individual Retirement Arrangements (IRAs).
Box 14. Employers may use this box to report information such as state
disability insurance taxes withheld, union dues, uniform payments,
health insurance premiums deducted, nontaxable income, educational
assistance payments, or a member of the clergy's parsonage allowance
and utilities. Railroad employers use this box to report railroad
retirement (RRTA) compensation, Tier 1 tax, Tier 2 tax, Medicare tax and
Additional Medicare Tax. Include tips reported by the employee to the
employer in railroad retirement (RRTA) compensation.
Note: Keep Copy C of Form W-2 for at least 3 years afterthe due date
for filing your income tax return. However, tohelp protect your social
security benefits, keep Copy Cuntil you begin receiving social security
benefits, just in casethere is a question about your work record and/or
earningsin a particular year.
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 initialLast nameSuff.
f Employee’s address and ZIP code
1 Wages, tips, other compensation
2 Federal income tax withheld
3 Social security wages4 Social security tax withheld
5 Medicare wages and tips6 Medicare tax withheld
7 Social security tips8 Allocated tips
9 Verification code10 Dependent care benefits
11 Nonqualified plans12a 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 StateEmployer’s state ID number16 State wages, tips, etc.17 State income tax18 Local wages, tips, etc.19 Local income tax20
Locality name
Form
W-2
Wage and Tax
Statement
2017
Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction
Act Notice, see separate instructions.
Copy D — For Employer
Employers, Please Note—
Specific information needed to complete Form W-2 is available
in a separate booklet titled the 2017 General Instructions for
Forms W-2 and W-3. You can order those instructions and
additional forms at www.irs.gov/orderforms.
Caution: Do not send the SSA Forms W-2 and W-3 that you
have printed from IRS.gov. The SSA is unable to process these
forms. Instead, you can create and submit them online. See
E-filing, later.
Due dates. By January 31, 2018, furnish Copies B, C, and 2 to
each person who was your employee during 2017. Mail or
electronically file Copy A of Form(s) W-2 and W-3 with the SSA
by January 31, 2018. See the separate instructions.
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 for persons who are deaf, hard of hearing, or have a
speech disability, call 304-579-4827 (not toll free).
E-filing. If you file 250 or more Form(s) W-2, you must file
electronically. Even if you aren’t required to file electronically,
doing so can save you time and effort. Employers may now use
the SSA's W-2 Online service to create, save, print, and submit
up to 50 Form(s) W-2 at a time over the Internet. When you e-file
with the SSA, no separate Form W-3 filing is required. An
electronic Form W-3 will be created for you by the W-2 Online
service. For information, visit the SSA's Employer W-2 Filing
Instructions & Information website at www.SSA.gov/employer.
Future developments. Information about any future
developments affecting Form W-2 and its instructions (such as
legislation enacted after we release them) will be posted at
www.irs.gov/w2.
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