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2019 Payroll Source Book

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American Payroll Association
2019 Edition
By Michael P. O’Toole, Esq.
In-House Counsel and Government Relations/Editorial Advisor, APA
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
In the preparation of this text, every effort has been made to offer the most current, correct, and clearly understandable
information possible. Nonetheless, inadvertent errors can occur, and tax rules and regulations are constantly changing.
This text is intended to provide authoritative information in regard to the subject matter covered and can be used as a
training tool. As such, it is not an evaluation device upon which to base performance reviews and/or promotions.
This material is distributed with the understanding that the publisher and author are not engaged in rendering legal,
accounting, or other professional services. If legal advice or other professional assistance is required, the service of
your attorney or certified public accountant should be sought. Readers are encouraged to consult with appropriate
professional advisors for advice concerning specific matters before making decisions affecting their individual operations. The publisher disclaims any responsibility for positions taken by practitioners in their individual cases or for any
misunderstanding on the part of readers. The information in this text is current as of February 1, 2019.
© 2019, American Payroll Institute, Inc.
All rights reserved. No portion of this text can be reproduced in any format without prior permission of the
American Payroll Institute, Inc.
Please visit our Web site at https://www.americanpayroll.org/.
ISBN: 978-1-944301-33-0
Printed in the United States
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
ANSWER KEY AND APPENDIX
TABLE OF CONTENTS
Section
Page
Answer Key ........................................................................................................................................................... 1
Bonus CPP Exam Questions and Answers.................................................................................................. CPP-1
Appendix........................................................................................................................................................... A-1
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
ANSWER KEY
TABLE OF CONTENTS
Section
Page
Section 1: The Employer-­Employee Relationship.................................................................................................. 2
Section 2: Federal and State Wage-­Hour Laws...................................................................................................... 5
Section 3: Taxable and Nontaxable Compensation............................................................................................... 11
Section 4: Health, Accident, and Retirement Benefits......................................................................................... 16
Section 5: Paying The Employee.......................................................................................................................... 22
Section 6: Withholding Taxes.............................................................................................................................. 25
Section 7: Unemployment Insurance.................................................................................................................... 31
Section 8: Depositing and Reporting Withheld Taxes......................................................................................... 45
Section 9: Other Deductions From Pay................................................................................................................ 60
Section 10: Recordkeeping And Record Retention.............................................................................................. 64
Section 11: Payroll Accounting............................................................................................................................ 67
Section 12: Payroll Systems and Technology........................................................................................................ 73
Section 13: Managing a Payroll Department....................................................................................................... 77
Section 14: Payroll for U.S. Employees Abroad and Aliens in the U.S................................................................. 81
Section 15: Preparing for the CPP Exam............................................................................................................. 84
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
1
The Payroll Source
SECTION 1: THE EMPLOYER-­EMPLOYEE
RELATIONSHIP
Review Questions
1. The factors used by the IRS in determining whether an employer has the right to direct or control the
financial aspects of a worker’s activities (i.e., whether the worker can suffer a profit or loss) include:
•
•
•
•
Whether the worker has made a significant financial investment in performing the work
Whether the worker has business expenses that are unreimbursed
Whether the worker makes his or her services available to the general market
Whether the worker is paid on a regularly recurring basis or by the job
2. The four categories of statutory employees are:
•
•
•
•
Agent-­drivers or commission-­drivers
Full-­time life insurance salespersons
Homeworkers
Traveling or city salespersons
3. The two categories of statutory nonemployees are:
•
•
Qualified real estate agents
Direct sellers
4. Temporary workers are hired, screened, and trained by the temporary help agency to provide services for
clients. They are employees of the temporary help agency, which sets their wages and has the sole right to
hire and fire. The agency is also responsible for all payroll taxes.
Leased employees are hired, trained, and qualified by a leasing company, which provides workers for a
client company. The client pays a fee to the leasing company to cover the cost of payroll, benefits, etc.
Responsibility for payroll taxes depends on the degree of control exercised by the client over the employees’
work and which entity has control over the payment of their wages.
5. Employers should make sure they are dealing with a financially secure and reputable company before
entering into a contract, since the temporary help agency or leasing company’s financial failure could lead
to the client company becoming liable for any withholding or employment taxes that remain unpaid.
6. a. The three parts of the ABC test are:
•
•
•
The worker is free from control or direction in performing the work both by agreement and in reality
(Absence of control).
The work is performed outside the usual course of the company’s business or away from any of the
employer’s facilities (Business—­unusual and/or away).
The worker is customarily engaged in an independent trade, occupation, or business (Customarily
independent contractor).
b. The ABC test is used by many states to determine a worker’s status as an employee or independent
contractor under state unemployment insurance laws.
2
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
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Answer Key
7. Form I-­9 is used to verify that an individual has the legal right to work in the United States. The Immigration Reform and Control Act of 1986 makes it illegal for an employer to hire an unauthorized worker.
8. Under the Certified Professional Employer Organization program, a certified PEO may assume the
responsibility for withholding and/or paying federal income, social security, Medicare, and FUTA taxes on
the wages the PEO pays to the employees at the client’s worksite.
9. The factors courts and the DOL consider when making an employment status determination under the
FLSA include:
•
•
•
•
•
•
Whether the work performed is an integral part of the employer’s business operation
Whether the worker has the chance to make a profit or risks a loss based on his or her managerial
skills
Whether the worker invests in tools or materials required to perform the work and the extent of the
worker’s investment in relation to the employer’s
Whether the work requires special skills or initiatives
How permanent the working relationship is
The degree of control exercised or retained by the employer
10. Employers would rather use workers who are not employees to perform services for them because employers must withhold income and employment taxes from employees’ wages and pay employment taxes with
their own funds. Employers also must pay federal and state unemployment taxes based on their employees’
wages. If a worker is an employee, most companies have their own list of benefits and other entitlements
that are provided to employees but not to independent contractors.
11. A social security card that does not contain language saying that employment is not work-­authorized is
proof of an employee’s authorization to work in the U.S., but not proof of identity.
12. Factors that the IRS does not consider important in making worker classification determinations include
part-­time or full-­time work, the location of the work, and hours of work.
13. The employer must report each new hire’s name, address, social security number, and first day of work for
which compensation is paid, as well as the employer’s name, address, and federal employer identification
number.
14. In general, employers must report new hires within 20 calendar days of the date of hire. Employers that
report magnetically or electronically must send 2 transmissions per calendar month which are 12-­16 days
apart.
15. The name of the program offered by U.S. Citizenship and Immigration Services that employers can use to
verify the employment authorization status of new hires is the E-­Verify Program.
True or False Questions
1. True
2. False
Their earnings must consist solely of commissions to be exempt from FUTA tax.
4. False
If telemarketers work under the direction and control of a company, they are employees of that
company.
3. True
5. True
6. True
7. True
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3
The Payroll Source
8. False
9. alse
10. True
If an employer uses the E-­Verify program, new hires must enter their SSN in Section 1 of
Form I-­9.
Managers and executives are classified as employees for tax purposes, although they are exempt
under most wage-­hour and labor relations laws.
11. True
12. True
13. False
14. True
15. False
16. False
17. True
18. True
19. False
20. False
Part-­time employees are covered under the federal payroll tax laws if they meet the common
law test for employment status.
Employers cannot demand specific documents to prove an employee’s eligibility to work. New
hires can produce any approved documents listed in the Form I-­9 instructions that prove identity and work authorization.
The IRS cannot require an employer to show that more than 25% of its industry treated similarly situated workers as independent contractors.
Multistate employers can designate one state in which they have employees as the state to
which they will report all new hires.
The employer must retain the employee’s Form I-­9 for one year after the employee’s last day of
employment.
Multiple Choice Questions
4
1. c
6. b
11. c
2. b
7. c
12. c
3. a
8. c
13. b
4. b
9. a
14. c
5. c
10. a
15. d
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From: APA Digital Publications (bookshelf.americanpayroll.org)
Answer Key
SECTION 2: FEDERAL AND STATE
WAGE-­HOUR LAWS
Review Questions
1. The five major areas regulated by the Fair Labor Standards Act are:
•
•
•
•
•
Minimum wage
Overtime
Child labor
Equal pay
Recordkeeping
2. Under enterprise coverage, all the employees of a business are covered by the FLSA so long as at least two
employees of the business are engaged in interstate commerce or involved in the production of goods or
services for interstate commerce, and the business has annual gross sales of at least $500,000. Individual
employees can be covered even if the business is not a covered enterprise if the employee is engaged in
interstate commerce or the production of goods for interstate commerce.
3. Exempt employees do not have to be paid the required minimum wage or overtime pay, and the employer
does not have to keep certain records detailing their work, while nonexempt employees must be paid the
required minimum wage and overtime pay and the employer must keep detailed records of their work
hours and wage payments.
4. The time limit is two years after the alleged violation or three years if the violation was willful.
5. The plan is called the “Belo” plan, named after the company involved in the Supreme Court’s decision, and
the plan guarantees a fixed salary for irregular hours that includes a set amount of overtime pay.
6. “Compensable time” is defined as all hours during which the employee is under the employer’s control,
even if the time is unproductive, so long as the time spent is for the employer’s benefit.
7. The following categories of employees make up the “white collar” exemption under the FLSA:
•
•
•
•
•
Administrative
Executive
Professional
Computer-­related professional
Outside sales
8. The following questions must be answered to properly calculate overtime pay:
•
•
•
•
What is the employee’s workweek?
What constitutes hours worked?
What payments made to the employee are considered wages?
What is the employee’s regular rate of pay?
9. The regular rate of pay is an hourly rate of pay determined by dividing the total regular pay actually earned
for the workweek by the total number of hours worked. For salaried nonexempt employees, the regular rate
of pay is the employee’s salary divided by the number of hours the salary is intended to compensate.
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5
The Payroll Source
10. Yes. In order for the computer professional exemption to apply to an hourly paid employee, the employee
would have to be paid at least $27.63 per hour.
11. To qualify as an administrative employee:
•
•
The employee’s primary duty must be the performance of office or nonmanual work directly related to
the management or general business operations of the employer or the employer’s customers.
The employee’s primary duty must include the exercise of discretion and independent judgment
regarding matters of significance.
12. The following conditions must be met for an employer to apply the tip credit to the minimum wage:
•
•
•
•
•
The employee must be a “tipped employee,” which is an employee working in an occupation in which
he or she regularly receives at least $30 per month in tips.
The employee must receive at least as much in tips as the credit taken by the employer.
The employee must be informed about the tip credit provisions of the law before the credit is taken.
All tips received by the employee must be kept by the employee, although tip pooling may be required
among employees who are customarily and regularly tipped.
Credit card tips must be given to the employee by the next payday.
13. All the following conditions must be met for attendance at meetings, lectures, seminars, and training sessions to be considered nonwork time:
•
•
•
•
The meeting, lecture, etc., is not held during the employee’s regular work hours.
Attendance is voluntary.
The meeting, lecture, etc., is not directly related to the employee’s job.
The employee does not perform any productive work for the employer while attending.
14. No minors under age 18 can work in a job that has been declared hazardous by the Wage and Hour
Division. Some minors age 16 and 17 are exempt from these restrictions under student learner or apprenticeship programs, under an exception for loading paper balers and compactors, or under an exception
for 17-­year-­olds who work with wood products under the supervision of a parent and meet several other
requirements.
15. Employers can be fined up to $12,529 for each violation of the child labor restrictions and up to $56,947
for each violation that causes the death or serious injury of a minor.
True or False Questions
1. False
2. True
3. True
4. False
5. True
Employers must comply with whichever law is more beneficial to the employee.
An important sounding job title does not exempt an employee from the minimum wage and
overtime pay provisions of the FLSA. The employee’s actual duties and salary must meet the
tests of the exemption.
6. True
7. True
8. False
6
The FLSA does not require overtime pay for hours worked on Sunday, unless the total hours
worked for the workweek exceed 40.
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From: APA Digital Publications (bookshelf.americanpayroll.org)
Answer Key
9. False
10. False
11. False
12. True
13. False
14. True
15. False
16. True
Under the FLSA, employers are not required to give rest periods to employees. However, rest
periods may be required by state law.
Bona fide meal periods during which the employee is completely relieved from duty are not
working time.
The FLSA does not require the employer to pay for hours not worked because of illness.
To determine gross earnings, the total overtime earnings are added to the total regular
earnings.
The Hawaii state minimum hourly wage is higher than the federal minimum wage, so Sharon
must be paid the state minimum hourly wage of $10.10.
17. True
18. True
19. True
20. False
Taxicab drivers are only exempt from the overtime pay requirements.
22. False
In addition to wages paid in the form of cash, employees may be paid in other forms as well.
They may be paid partly in room, board, or other facilities provided by the employer. These
facilities must primarily benefit the employee, not the employer, in order to be classified as
wages.
21. True
23. True
24. False
25. False
Where service charges are automatically added to customers’ bills and then turned over to the
employee, these amounts are not tips and are considered wages when determining whether
the minimum wage has been paid.
When employees are required to wear uniforms that cannot be worn as regular “street clothing” and their cost and maintenance would put the employee below the minimum hourly
wage, the employer must pay for the purchase, cleaning, and repair of the uniforms. If the
uniform can be worn off the job, the employer need not reimburse the employee, even if the
employee’s wages go below the minimum.
Multiple Choice Questions
1. b
6. b
2. b
7. b
3. d
8. d
4. d
9. b
5. a
10. b
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7
The Payroll Source
Problems
1.
Step 1: Calculate total earnings due if overtime pay is required for hours worked over 8 in a day.
Regular pay: $10 x 85 hours = $850
Overtime hours: [5 x (9 –­8)] + [4 x (10 –­8)] = 13
Overtime premium rate: $10 x .5 = $5
Overtime premium pay: $5 x 13 hours = $65
Total earnings: $850 + $65 = $915
Step 2: Calculate total earnings due if overtime pay is required for hours worked over 80 in the 14-­day
work period.
Regular pay: $10 x 85 hours = $850
Overtime hours: 85 –­80 = 5
Overtime premium rate: $10 x .5 = $5
Overtime premium pay: $5 x 5 hours = $25
Total earnings: $850 + $25 = $875
Step 3: David must be paid the higher of the result in Step 1 or 2 —­$915.
8
2.
Regular pay: $9.00 x 47 hours = $423.00
Overtime hours: 47 –­40 = 7
Overtime premium rate: $9.00 x .5 = $4.50
Overtime premium pay: $4.50 x 7 = $31.50
Total earnings: $423.00 + $31.50 = $454.50
3.
Regular pay: $12 x 42 hours = $504.00
Overtime hours: 42 –­40 = 2
Overtime premium rate: $12.00 x .5 = $6.00
Overtime premium pay: $6.00 x 2 = $12.00
Total earnings: $504.00 + $12.00 = $516.00
4.
Regular pay: ($10 + $1) x 45 hours = $495
Overtime hours: 45 –­40 = 5
Overtime premium rate: $11.00 x .5 = $5.50
Overtime premium pay: $5.50 x 5 = $27.50
Total earnings: $495.00 + $27.50 = $522.50
5.
Regular hourly pay: $10.00 x 44 hours = $440.00
Total regular pay: $440 + $38.00 = $478.00
Regular rate of pay: $478 ÷ 44 hours = $10.86
Overtime hours: 44 –­40 = 4
Overtime premium rate: $10.86 x .5 = $5.43
Overtime premium pay: $5.43 x 4 = $21.72
Total earnings: $478.00 + $21.72 = $499.72
6.
Regular pay: $9.50 x 48 hours = $456.00
Overtime hours: 48 –­40 = 8
Overtime premium rate: $9.50 x .5 = $4.75
Overtime premium pay: $4.75 x 8 = $38.00
Discretionary bonus: $100.00
Total earnings: $456.00 + $38.00 + $100.00 = $594.00
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From: APA Digital Publications (bookshelf.americanpayroll.org)
Answer Key
7.
Regular pay: ($10.00 x 24 hours) + ($12.00 x 20 hours) = $240.00 + $240.00 = $480.00
Regular rate of pay: $480.00 ÷ 44 hours = $10.91
Overtime hours: 44 –­40 = 4
Overtime premium rate: $10.91 x .5 = $5.46
Overtime premium pay: $5.46 x 4 = $21.84
Total earnings: $480.00 + $21.84 = $501.84
8.
Regular rate of pay: $520.00 ÷ 40 hours = $13.00
Regular pay: $13.00 x 49 hours = $637.00
Overtime hours: 49 –­40 = 9
Overtime premium rate: $13.00 x .5 = $6.50
Overtime premium pay: $6.50 x 9 = $58.50
Total earnings: $637.00 + $58.50 = $695.50
9.
Hours worked in a year: 52 weeks x 40 hours = 2,080
Regular rate of pay: $23,400 ÷ 2,080 = $11.25
Regular pay: $11.25 x 48 hours = $540.00
Overtime hours: 48 –­40 = 8
Overtime premium rate: $11.25 x .5 = $5.63
Overtime premium pay: $5.63 x 8 = $45.04
Total earnings: $540.00 + $45.04 = $585.04
10.
Yearly earnings: $1,500 x 12 months = $18,000
Hours worked in a year: 52 weeks x 40 hours = 2,080
Regular rate of pay: $18,000 ÷ 2,080 = $8.65
Regular pay: $8.65 x 49 hours = $423.85
Overtime hours: 49 –­40 = 9
Overtime premium rate: $8.65 x .5 = $4.33
Overtime premium pay: $4.33 x 9 = $38.97
Total earnings: $423.85 + $38.97 = $462.82
11.
Yearly earnings: $1,000 x 24 = $24,000
Hours worked in a year: 52 weeks x 32 hours = 1,664
Regular rate of pay: $24,000 ÷ 1,664 = $14.42
Regular pay: $14.42 x 42 hours = $605.64
Overtime hours: 42 –­40 = 2
Overtime premium rate: $14.42 x .5 = $7.21
Overtime premium pay: $7.21 x 2 = $14.42
Total earnings: $605.64 + $14.42 = $620.06
12.
Yearly earnings: $2,500 x 12 months = $30,000
Hours worked in a year: 52 weeks x 35 hours = 1,820
Regular rate of pay: $30,000 ÷ 1,820 = $16.48
Regular pay: $16.48 x 43 hours = $708.64
Overtime hours: 43 –­40 = 3
Overtime premium rate: $16.48 x .5 = $8.24
Overtime premium pay: $8.24 x 3 = $24.72
Total earnings: $708.64 + $24.72 = $733.36
13.
Regular piecework earnings: $0.50 x 840 units = $420.00
Regular rate of pay: $420.00 ÷ 46 hours = $9.13
Overtime hours: 46 –­40 = 6
Overtime premium rate: $9.13 x .5 = $4.57
Overtime premium pay: $4.57 x 6 = $27.42
Total earnings: $420.00 + $27.42 = $447.42
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9
The Payroll Source
10
14.
Regular piecework earnings: $2.00 x 326 units = $652.00
Production bonus: $0.50 x 26 units = $13.00
Total piecework earnings plus bonus: $652.00 + $13.00 = $665.00
Regular rate of pay: $665.00 ÷ 43 hours = $15.47
Overtime hours: 43 –­40 = 3
Overtime premium rate: $15.47 x .5 = $7.74
Overtime premium pay: $7.74 x 3 = $23.22
Total earnings: $652.00 + $13.00 + $23.22 = $688.22
15.
Regular piecework earnings: $0.30 x 1,560 units = $468.00
Overtime piece rate: $0.30 x 1.5 = $0.45
Overtime earnings: $0.45 x 212 = $95.40
Total earnings: $468.00 + $95.40 = $563.40
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Answer Key
SECTION 3: TAXABLE AND NONTAXABLE
COMPENSATION
Review Questions
1. The following conditions must be met for an employer to use the vehicle cents-­per-­mile method of valuing
an employee’s personal use of an employer-­provided car.
•
•
•
The employer must expect the employee to regularly use the vehicle while conducting the employer’s business, or the vehicle must actually be driven at least 10,000 miles and be used primarily by
employees.
The fair market value of the vehicle cannot exceed $50,400 for cars placed in service in 2019.
If the employee pays for fuel, the mileage rate is reduced by $.055 per mile.
2. A benefit whose value is so small that accounting for it would be unreasonable or impracticable.
3. The three special valuation methods are:
•
•
•
Annual lease value method
Vehicle cents-­per-­mile method
Commuting method
4. a. $90,000 -­$50,000 = $40,000
b. $.15 per $1,000 of the taxable value of the coverage
5. $2,000. If the employer provides more than $2,000 in group-­term life insurance to an employee’s dependent, the value of the total amount including the first $2,000 becomes taxable to the employee. However, if
the difference between the Table I value of the insurance and the amount paid by the employee in after-­tax
dollars is considered de minimis, then there is no income for the employee.
6. Taxable: When the employer has a nonaccountable plan because it does not require the employee to substantiate business travel expenses and to return any amount not spent by the employee on business within a
reasonable period of time.
Nontaxable: When the employer has an accountable plan and the employee is required to substantiate
business travel expenses and refund the balance of the advance not used within a reasonable period of time.
7. Yes. The method allowed by the IRS is called “grossing-­up.”
8. Outplacement services are not included in employees’ income under the following circumstances:
•
•
•
The employer derives a substantial business benefit from providing the outplacement services other
than providing the compensation (e.g., a positive corporate image, an attractive benefit that encourages
new hires).
The employees do not have the choice of accepting cash rather than the outplacement services (e.g., a
higher severance payment if the services are refused).
The employees would be able to deduct the cost of the outplacement services as a business expense on
their personal tax returns.
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11
The Payroll Source
9. In the private sector, a control employee is an employee who:
•
•
•
•
Is a corporate officer earning at least $110,000 in 2019 (indexed annually)
Is a director
Earns at least $225,000 in 2019 (indexed annually) or
Is a 1% owner
•
In the public sector, a control employee is an employee who:
•
•
Is an elected official or
Earns more than a federal employee at Executive Level V ($153,800) in 2019
10. If a reimbursement is made under an “accountable plan,” the amount reimbursed is excluded from income
and is not subject to federal income tax withholding or social security, Medicare, and FUTA taxes. If
the reimbursement is made under a “nonaccountable plan,” the reimbursement or the excess amount is
included in income and is subject to federal income tax withholding and social security, Medicare, and
FUTA taxes.
11. If an employer regularly fails to comply with the requirements for reimbursing or advancing amounts paid
or incurred by employees for business expenses, the IRS will consider this a “pattern of abuse” and will treat
all payments as being made under a nonaccountable plan.
12. Five years.
13. When a manufacturer pays a bonus to sales employees working for a retailer to get them to “push” its
products, the bonus is not wages because it is being paid by a third party, not the employer (for services
performed for the third party), and is not subject to federal income tax withholding or social security,
Medicare, and FUTA taxes. The bonus is taxable income to the sales employees, however, and must be
reported on their personal income tax return.
14. Exclusion limitation: The excluded amount of dependent care assistance cannot exceed $5,000 in a year or
the employee’s earned income for the year, whichever is less.
When expenses are incurred: An employer’s dependent care expenses are treated as incurred when the care
is provided, not when payments are made to the employee or third party.
Written plan: The dependent care assistance program must be a separate, written plan of the employer and
it must be designed solely for the employees’ benefit.
No discrimination: The program must not discriminate in favor of highly compensated employees.
Notification: Eligible employees must receive reasonable notification of the availability and terms of the
program.
Annual statement: The employer must give the employee a statement each year by January 31 showing the
dependent care assistance provided by the employer during the previous year (Box 10 of Form W-­2).
15. When companies change ownership, key executives are often provided with “golden parachutes” to soften
their landing should they be terminated by the new owner. The tax law defines a “parachute payment” as
compensation that is paid to an officer, shareholder, or highly compensated employee only after a change in
corporate ownership or control and that is at least three times the employee’s average compensation during
the five most recent tax years.
12
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Answer Key
True or False Questions
1. False
2. True
3. False
4. True
The Internal Revenue Code does not define the term “fringe benefits,” although it includes
several examples.
The goods or services must be offered for sale to customers in the employer’s line of business
in which the employee normally works.
5. True
6. True
7. False
8. True
9. False
10. False
11. True
Restaurant employers wishing to participate in a TRDA must agree with the IRS on a certain
tip percentage based on the charge tips it reported and an IRS formula to determine cash
tips. Also, 75% of the employees at each establishment must agree to report the tip percentage
agreed on in the TRDA.
The annual lease value does not include the value of employer-­provided fuel.
If an employee uses a company aircraft for business and personal use, the value of the personal
use is included in the employee’s income.
12. True
13. True
14. False
15. True
16. False
17. True
Cash gifts or gift certificates with a cash value are never de minimis fringes. They are included
in income and are taxable to the employee.
Scholarships and fellowships covering tuition and related fees are excluded from an individual’s income if the individual is a candidate for a degree at an educational institution.
18. True
19. True
20. True
21. True
22. False
23. False
24. True
25. False
Gifts provided to employees must be included in the employees’ income unless they can be
excluded as a de minimis fringe benefit or as a gift between relatives that is not based on the
employer-­employee relationship.
This exclusion was repealed in 1996.
Special rules and limitations apply to combined business and pleasure travel outside the
United States. Even though the trip is primarily for business, if the trip has any element of
pleasure, the cost of traveling to and from the destination must be allocated between the business and personal portions of the trip.
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26. False
27. True
To deduct travel expenses, an employee must be in travel status. The employee must usually
be away from home “overnight.” Overnight does not literally mean 24 hours. It is a period of
time longer than an ordinary work day during which rest or relief from work is required. The
deduction may also be available to employees who travel from their residence to a temporary
work location and return home on the same day. In addition, the deduction may be available
to employees staying overnight near where the employee lives if certain requirements are met
that show the employer benefits from the overnight stay.
28. True
29. True
Multiple Choice Questions
1. 1. c
7. 7. a
13. 13. d
2. 2. d
8. 8. c
14. 14. b
3. 3. b
9. 9. d
15. 15. b
4. 4. d
10. 10. b
16. 16. a
5. 5. a
11. 11. a
6. 6. b
12. 12. b
Problems
1. Annual lease value = $6,850
Taxable amount: $6,850 x 40% = $2,740
2. Personal use: 100% -­70% = 30%
Personal mileage: 12,000 miles x .30 = 3,600 miles
Taxable amount: (3,600 miles x $0.58) = $2,088.00
3. Step 1: 2 x $75,000 = $150,000
Step 2: $150,000 -­$50,000 = $100,000
Step 3: $100,000 ÷ $1,000 = 100
Step 4: Bill is 39 years old as of 12-­31-­19
Step 5: $0.09 x 100 = $9.00 monthly taxable coverage
4. Step 1: 2 x $78,000 = $156,000
Step 2: $156,000 -­$50,000 = $106,000
Step 3: $106,000 ÷ $1,000 = 106
Step 4: Bill is 39 years old as of 12-­31-­19
Step 5: $0.09 x 106 = $9.54 monthly taxable coverage
Step 6: $9.54 -­$5.00 = $4.54 monthly taxable coverage for May -­December
14
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Answer Key
5. a.
Total tax % = 22% + 5% + 6.2% + 1.45% = 34.65%
Gross-­up % = 100% -­34.65% = 65.35%
Gross earnings = $4,500 ÷ .6535 = $6,886.00
To check:
FITW = 22% x $6,886.00 = $1,514.92
SITW = 5% x $6,886.00 = $344.30
Soc. Sec. = 6.2% x $6,886.00 = $426.93
Medicare = 1.45% x $6,886.00 = $99.85
$6,886.00 -­$1,514.92 -­$344.30 -­$426.93 -­$99.85 = $4,500.00
b. Soc. Sec. tax on $1,500 = .062 x $1,500 = $93
Total to be grossed-­up = $4,500 + $93 = $4,593
Total tax % = 22% + 5% + 1.45% = 28.45%
Gross-­up % = 100% -­28.45% = 71.55%
Gross earnings = $4,593 ÷ .7155 = $6,419.29
To check:
FITW = 22% x $6,419.29 = $1,412.24
SITW = 5% x $6,419.29 = $320.97
Soc. Sec. = 6.2% x $1,500 = $93.00
Medicare = 1.45% x $6,419.29 = $93.08
$6,419.29 -­$1,412.24 -­$320.97 -­$93.00 -­$93.08 = $4,500.00
6. Total tax % = 22% + 3.5% + 6.2% + 1.45% = 33.15%
Gross-­up % = 100% -­33.15% = 66.85%
a.
b.
c.
d.
e.
f.
Gross earnings = $6,000 ÷ .6685 = $8,975.32
FITW = 22% x $8,975.32= -­$1,974.57
SITW = 3.5% x $8,975.32= -­$314.14
Soc. Sec. = 6.2% x $8,975.32= -­$556.47
Medicare = 1.45% x $8,975.32= -­$130.14
Check: $6,000.00
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SECTION 4: HEALTH, ACCIDENT, AND
RETIREMENT BENEFITS
Review Questions
1. Family and Medical Leave Act.
2. Cafeteria plan.
3. Only if the §401(k) plan existed prior to the effective date of the Tax Reform Act of 1986.
4. 12 weeks (26 weeks if the child, spouse, or parent is a covered military servicemember suffering a serious
injury or illness).
5. The status changes that allow a cafeteria plan to permit an employee to change a cafeteria plan benefit election during the year are:
•
•
•
•
•
•
•
•
Marital status changes –­marriage (including same-­sex marriage), divorce, death of spouse, legal separation, or annulment
Changes in the number of dependents –­birth, adoption, placement for adoption, or death of a
dependent
Employment status changes (applies to employee, spouse, dependent, or adult child under 27) –­termination or commencement of employment, strike or lockout, starting or ending an unpaid leave of
absence, change in worksite, change from full-­time to part-­time, exempt to nonexempt, or salaried to
hourly status
Change in dependent or adult child status –­any event that causes an employee’s dependent or adult
child under 27 to become covered or lose coverage (e.g., attainment of a certain age)
Residence change –­a change in the place of residence of the employee, spouse, dependent, or adult
child under 27
Adoptions –­the commencement or termination of an adoption proceeding
Reduction in hours not resulting in loss of coverage –­a change in work hours from at least 30 to less
than 30 per week
Enrollment in a qualified health plan through a Marketplace under the ACA –­employee can revoke
current coverage
6. Cafeteria plans must satisfy the following three nondiscrimination tests:
•
•
•
Eligibility test
Contributions and benefits test
Concentration test
7. The three major types of health insurance plans offered by employers are:
•
•
•
Traditional health insurance (fee-­for-­service)
Health Maintenance Organizations
Preferred Provider Organizations
8. “Amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of
affecting any structure or function of the body.”
16
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Answer Key
9. To be nondiscriminatory in terms of eligibility, an employer-­provided group health insurance plan must
benefit:
•
•
•
At least 70% of all employees
At least 80% of all employees who are eligible to participate in the plan (if at least 70% of all employees are eligible to participate) or
A classification of employees that the Secretary of the Treasury finds not to be discriminatory
In terms of benefits, an employer-­provided group plan is nondiscriminatory if all the benefits provided
to highly compensated employees are provided to all other participating employees. Plans may have
limits on benefits, but they must be uniform for all participants when based on employer contributions
and must not be proportionately based on employee compensation. Until the IRS issues guidance on
applying the nondiscrimination rules to third-­party insured plans, they apply only to employers with
self-­insured plans.
10. Sick pay may take many forms, but its essential purpose is to replace the wages of an employee who cannot
work because of a nonjob-­related illness or injury. Workers’ compensation, however, deals with payments to
employees who cannot work because of job-­related injuries or illness.
11. Information an employer should provide a third-­party payer of sick pay includes:
•
•
•
The total wages paid by the employer to the employee during the calendar year before the third party
begins making payments (helps determine whether the social security and FUTA wage bases have
been met)
The last month in which the employee worked for the employer (helps determine how long the third
party is responsible for social security and Medicare taxes)
Employee contributions made to the cost of the insurance after taxes have been withheld (helps determine how much of each disability payment is taxable)
12. While an employer’s business generally determines its classification code, and the more dangerous the
business the higher the dollar value assigned to that code, some employees may be assigned a different or
less costly code because of the duties they perform. Employees who work exclusively in an office, outside
sales employees, and drivers and their helpers may be assigned a “standard exception classification.” Such
classifications generally carry a significantly lower dollar value than other employee classifications.
13. A pre-­tax contribution is one that is made from an employee’s wages before the taxes on those wages are
calculated, while an after-­tax contribution is made after the tax is calculated. A pre-­tax contribution will
result in higher take-­home pay for the employee.
14. The payroll department must maintain accurate records of:
•
•
•
•
Hours worked
Compensation earned
Date of birth
Date of hire
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15. A defined contribution plan sets up individual accounts for each employee, with a set amount being
contributed into the account by the employer and/or the employee periodically. The employee’s retirement
benefit depends on the amount of money in his or her account at retirement, which is determined by the
contribution amounts and any investment gains or losses. Other characteristics of defined contribution
plans include:
•
•
•
•
•
The plan provides for a contribution formula involving the employer and/or the employees
Employer contributions are made no less frequently than annually (usually more often)
Being able to see how much is in their accounts makes the plan easy to understand for employees
No need for actuarial calculations
Annual reports must be filed with the IRS and the Department of Labor
True or False Questions
1. True
2. True
3. False
A pre-­tax contribution will result in more take-­home pay for the employee.
5. False
In this case, cafeteria plans are exempt from the nondiscrimination tests.
4. True
6. True
7. True
8. False
9. False
10. True
11. True
12. False
13. True
Only the premium portion of overtime is excluded. The straight time portion is included.
Employers can require eligible employees to use any paid vacation, personal, sick, medical, or
family leave as part of the 12-­week guaranteed leave.
Employer contributions to an accident or health insurance plan for the benefit of its employees and their spouses, dependents, and adult children under age 27 are not wages and are not
subject to federal income tax withholding or social security, Medicare, and FUTA taxes.
14. True
15. True
16. True
17. True
18. False
19. True
20. True
21. False
22. True
18
The general rules for depositing withheld federal income, social security, and Medicare taxes
do apply to sick pay, although the party liable for depositing the taxes may change.
Cafeteria plans can allow employees to carry over up to $500 of their health FSA salary
reductions from one year to the next.
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Answer Key
23. False
24. True
25. False
Once selected, benefits cannot be changed during the plan year unless the cafeteria plan permits the employee to make a change if there is a change in status that causes the employee or
the employee’s spouse, dependent, or adult child under age 27 to lose or gain coverage under
the plan, or premiums or coverage are significantly altered by the insurance carrier or the
employer.
An employee may not be reimbursed for amounts spent on over-­the-­counter drugs that are
not prescribed by a licensed physician through her health FSA.
Multiple Choice Questions
1. c
10. d
19. a
2. c
11. d
20. c
3. b
12. c
21. b
4. c
13. b
22. c
5. b
14. c
23. c
6. a
15. b
24. a
7. c
16. d
25. c
8. a
17. c
9. b
18. d
Problems
1. a. $1,000 x 6 months x 60% = $3,600
b. $1,000 x 10 months x 60% = $6,000
2. a.
$900 x 6 months x 2/3 = $3,600
b. $900 x 7 months x 2/3 = $4,200
c.
3. a.
$900 x 7 months x 1/3 = $2,100
If the contribution is pre-­tax:
Regular wages
Medical and dental
FITW
Soc. Sec. ($600 -­25) x 6.2%
Medicare ($600 -­25) x 1.45%
SITW $56.00 x 10%
Net Pay:
$600.00
-­ 25.00
-­ 56.00
-­ 35.65
-­ 8.34
-­ 5.60
$469.41
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b. b. If the contribution is after-­tax:
Regular wages
FITW
Soc. Sec. ($600 x 6.2%)
Medicare ($600 x 1.45%)
SITW ($59.00 x 10%)
Medical and dental
Net Pay:
4. a.
b.
c.
d.
e.
f.
g.
$600.00
-­ 59.00
-­37.20
-­8.70
-­5.90
-­ 25.00
$464.20
§408(k)
§501(c)(18)(D)
§457(b)
§403(b)
§401(k)
§401(a)
§408(p)
5. a. $7,500 —­the lesser of 15% x $50,000 ($7,500) or $19,000 (annual dollar limit effective for 2019).
b. $19,000 —­the lesser of 15% x $130,000 ($19,500) or $19,000 (annual dollar limit effective for 2019).
6. $6,000 —­the lesser of $27,500 x 100% or $6,000 annual applicable dollar limit for 2019.
7. a.
Federal income taxable wages
Gross wages ($38,000 ÷ 24):
Cafeteria plan ($125 ÷ 2):
§401(k) plan ($1,583.33 x .05):
Taxable wages:
$1,583.33
-­62.50
-­ 79.17
$1,441.66
b. Social security taxable wages
Gross wages ($38,000 ÷ 24):
Cafeteria plan ($125 ÷ 2):
Taxable wages
c.
$1,583.33
-­62.50
$1,520.83
Medicare taxable wages
Gross wages ($38,000 ÷ 24):
Cafeteria plan ($125 ÷ 2):
Taxable wages:
$1,583.33
-­ 62.50
$1,520.83
d. FUTA taxable wages
Gross wages ($38,000 ÷ 24):
Cafeteria plan ($125 ÷ 2):
Taxable wages:
20
$1,583.33
-­ 62.50
$1,520.83
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Answer Key
8. a.
Federal income taxable wages
Gross wages:
Cafeteria plan:
§401(k) plan ($3,760 x .075):
Taxable wages:
$3,760.00
-­75.00
-­ 282.00
$3,403.00
b. Social security taxable wages
Gross wages:
Cafeteria plan:
Taxable wages:
c.
$3,760.00
-­75.00
$3,685.00
Medicare taxable wages
Gross wages:
Cafeteria plan:
Taxable wages:
$3,760.00
-­75.00
$3,685.00
d. FUTA taxable wages
Gross wages:
Cafeteria plan:
Taxable wages:
9. Gross wages:
Cafeteria plan ($650 x 6%):
Taxable wages:
FITW:
Soc. Sec. ($611.00 x 6.2%):
Medicare ($611.00 x 1.45%):
Net Pay:
10. Gross wages:
Cafeteria plan:
§401(k) plan ($900 x 6%):
FITW:
Soc. Sec. [($900 -­$10) x 6.2%]:
Medicare [($900 -­$10) x 1.45%]:
Net pay:
$3,760.00
-­75.00
$3,685.00
$650.00
-­39.00
$611.00
-­ 22.00
-­37.88
-­8.86
$542.26
$900.00
-­10.00
-­54.00
-­ 78.00
-­55.18
-­ 12.91
$689.91
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SECTION 5: PAYING THE EMPLOYEE
Review Questions
1. State laws govern how often employers must pay employees.
2. Advantages of direct deposit for an employer include:
•
•
•
•
Prevents lost and stolen checks
Employees do not have to take time out of their work day to cash or deposit their paycheck
Employers do not have to file/store cashed checks and related documents
Better control of check stock
Disadvantages of direct deposit for an employer include:
•
•
•
•
Direct deposit is not a paperless system, since employers still may have to provide employees with a
written statement of hours worked and deductions from gross pay, as well as collect a written authorization form, depending on their policies and procedures
Direct deposit cannot be made mandatory in many states
Employer cannot dictate the financial institution that the employee uses in most states
Employer’s loss of interest on payroll funds before paychecks clear
3. State escheat laws govern the treatment of unclaimed paychecks. Under these laws, employers are generally
required to:
•
•
•
Try to locate and contact the employee
File an annual report with the state where the employee resides that includes the employee’s name, last
known address, amount of the check, and the related payday
Hold the checks for a certain length of time before turning them over to the state as abandoned
property
4. Prenotification involves sending zero dollar amounts through the ACH network as a test before the first
actual direct deposit for an employee. If such a “prenote” is used (it is an optional procedure), it must be
sent at least 3 business days before any actual pay is sent through the network. This is a test of the accuracy
of the information in the authorization agreement.
5. Authorization agreements (where they are in paper form) still must be signed, checked for accuracy, and
retained, and employees using direct deposit must be given statements on payday showing the compensation they earned and the deductions taken for the pay period. Some employers do use electronic pay
statements in meeting that requirement.
6. The main problem is whether to recompute weekly or biweekly paychecks for exempt salaried employees
who are earning a certain amount annually. Employers are free to reduce exempt salaried employees’ pay
when faced with an extra payday, so long as there is no contract guaranteeing a certain amount of pay each
weekly or biweekly pay period and the employee’s pay is not reduced below the minimum required by state
or federal law. Employers may also face a hostile reaction from salaried employees whose pay is reduced in
this manner.
22
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Answer Key
7. The benefits for employers in paying employees with electronic paycards include:
•
•
•
•
•
Reduced costs for manual checks, lost and stolen checks, stop payment orders, fraudulent cashing of
duplicate checks, paycheck production and handling, and bank reconciliation fees
Enhanced efficiency by eliminating paper paychecks
All employees are eligible for electronic funds transfer
Increased employee productivity as less time is spent cashing paychecks
Reduction of escheat issues
8. A branded paycard has either a Mastercard®, Visa®, or Discover Network® logo imprinted on it and is
accepted wherever cards issued by these companies are accepted.
9. The following are the steps involved in establishing an electronic funds transfer:
•
•
•
•
•
•
The employee must give authorization for direct deposit by designating the financial institution(s) to
which the employee’s pay will be transferred, the type of account to which the pay will be transferred,
the number of the account, and the financial institution’s routing number.
The employer prepares an automated file of direct deposit records which is sent to a financial institution with the ability to process the file, known as the Originating Depository Financial Institution
(ODFI).
The ODFI processes the file through the Automated Clearing House (ACH) operator.
The ACH operator processes electronic payments between the ODFI and the financial institutions
designated by the employees to receive the payments and coordinates the financial settlement between
the participating financial institutions.
The Receiving Depository Financial Institutions (RDFI) designated by the employees accept the electronic payments and post them to their customers’ (the employees’) accounts.
On payday, the employees receive an information statement containing the same data that would have
been shown on the pay stub, had the employee been paid by check.
10. Disadvantages for an employer in paying employees by paycheck include:
•
•
•
•
•
•
Lost or stolen checks
Unclaimed or uncashed checks
Employee time off needed to cash checks
Storage of cashed checks and related documents
Early preparation of vacation checks
Reconciliation of bank account with outstanding checks
True or False Questions
1. False
These matters are left up to the individual states.
3. False
Most states have a separate set of rules governing when employees must be paid when they
separate from employment, either through discharge, layoff, or resignation.
2. True
4. False
5. True
6. True
7. False
8. True
More than 15 states have no statutory provisions dealing with paying wages owed to deceased
employees.
A biweekly salary is paid every two weeks.
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9. True
10. False
11. False
12. True
13. True
14. False
15. False
There is no minimum number required. Each state has its own regulations and requirements
regarding mandatory direct deposit.
The FLSA does not regulate the frequency of wage payments. Each state regulates when
employees must be paid.
When selecting a paycard vendor, it is very important for an employer to determine whether
the vendor can comply with state wage payment requirements.
Reduced escheat issues is an important employer benefit of implementing a paycard program.
Multiple Choice Questions
24
1. 1. c
6. 6. c
11. 11. c
2. 2. b
7. 7. c
12. 12. b
3. 3. a
8. 8. c
13. 13. c
4. 4. b
9. 9. d
14. 14. b
5. 5. c
10. 10. b
15. 15. a
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Answer Key
SECTION 6: WITHHOLDING TAXES
Review Questions
1. Employee’s Withholding Allowance Certificate
2. Employers must retain each employee’s Form W-­4 for at least four years after the date the last tax return
was due using information from the form, which is April 15 of the following year (e.g., if an employee files
an amended W-­4 in 2019, the previous W-­4 must be retained until at least April 15, 2024).
3. Constructive payment indicates the point in time when an employee has the ability to control the payments for services from an employer.
4. The date of actual or constructive payment is important because it determines when wages are taxed and
reported and at what rates.
5. A Form W-­4 filed by a newly hired employee must be put into effect by the employer for the first wage
payment after the form is filed.
6. Form W-­4 tells the employer how many withholding allowances the employee is claiming and the employee’s marital status. The number of allowances and marital status help determine the amount of federal
income tax to withhold from the employee’s wages. Form W-­4 also notifies the employer whether the
employee is claiming exempt from withholding and whether the employee is a nonresident alien. In addition, it may indicate that the employee wants an additional dollar amount withheld beyond the amount
that is calculated on the withholding allowances and marital status claimed.
7. In order to be exempt from withholding, the employee must certify that all of the following are true:
•
•
•
He or she had a right to a refund of all federal income tax withheld in the prior year because the
employee had no tax liability.
He or she expects to have no tax liability in the current year.
He or she cannot be claimed as a dependent on someone else’s income tax return if the employee will
have more than $1,100 in income (including at least $350 in nonwage income) in 2019.
8. The employer must submit Form W-­4 to the IRS in the following situations:
•
•
The IRS directs the employer to do so in a written notice to the employer.
The IRS directs the employer to do so in published guidance, such as a revenue procedure.
9. Types of payments that are treated as supplemental wage payments include:
•
•
•
•
•
•
•
•
•
•
•
Reported tips
Overtime pay
Bonuses
Back pay
Commissions
Payments made under reimbursement or other expense allowance arrangements that are made under a
nonaccountable plan
Nonqualified deferred compensation payments included in wages
Noncash fringe benefits
Sick pay paid by a third party as an agent of the employer
Amounts includible in gross income under IRC §409A
Income recognized on the exercise of a nonstatutory stock option
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•
•
Wages imputed for health coverage of someone who is not a spouse, dependent, or adult child under
age 27 of an employee
Wages recognized on the lapse of restrictions on restricted property transferred from an employer to
an employee
10. The withholding exemption would apply to the supplemental wages as well, so no withholding for federal
income tax would be done.
11. Generally all nonperiodic payments of all or any portion of the balance of a recipient’s account in a qualified deferred compensation plan are eligible rollover distributions other than:
•
•
•
•
•
•
•
Substantially equal periodic payments made over the lifetime or life expectancy of the employee or his
or her beneficiary, or made for a specified period of at least 10 years
Any minimum distribution that is required under IRC §401(a)(9) regarding qualified plans
Distributions not included in gross income (e.g., return of an employee’s after-­tax contributions),
except for net unrealized appreciation of employer securities
Returns of amounts deferred under a §401(k) or §403(b) plan that exceed the elective deferral limits
Loans treated as deemed distributions
Dividends paid on employer securities
Distributions of the cost of current life insurance coverage
12. Payers must generally withhold 24% of reportable nonpayroll payments during 2019 if payees fail to furnish payers with their taxpayer identification number or the IRS notifies them to withhold. This withholding is referred to as backup withholding.
13. The employer social security tax rate for wages paid in 2019 is 6.2%.
14. No. Advance payments of the Earned Income Credit were eliminated for wages paid after December 31,
2010.
15. Employers must provide notification of the right to the earned income credit by giving the employees one
of the following:
•
•
•
Copy B of Form W-­2, Wage and Tax Statement (IRS-­supplied forms have the required EIC statement
on the back of Copy B; substitutes used for this purpose must have the required statement on the back
of the employee copy)
Notice 797, Possible Federal Tax Refund Due to the Earned Income Credit
A written statement with the exact same wording as Notice 797
True or False Questions
1. True
2. False
3. True
Wages are considered constructively paid only if they are made available to the employee
without “substantial limitation or restriction.”
4. True
5. True
6. False
7. True
8. False
26
Under the principle of constructive payment, an employee is considered to have been paid
wages when they are actually or constructively paid, not when they are earned or payable.
The required rate for backup withholding in 2019 is 24%.
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Answer Key
9. True
10. True
11. True
12. True
13. False
14. True
15. True
16. False
17. True
Employees cannot indicate on their W-­4 form that they wish to have a flat amount of tax
withheld rather than an amount based on the number of withholding allowances that can be
claimed.
For wage payments equaling or exceeding the maximum amount, the percentage method of
withholding must be used.
18. True
19. True
20. True
Multiple Choice Questions
1. b
8. c
15. a
2. a
9. b
16. b
3. b
10. b
17. b
4. b
11. a
18. d
5. d
12. d
19. a
6. b
13. d
20. b
7. b
14. a
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27
The Payroll Source
Problems
1. a.
Semimonthly wages ($1,800 ÷ 2):
Allowance value:
Wages subject to withholding:
Percentage method formula:
FITW:
b. Monthly wages ($42,500 ÷ 12):
Allowance value ($350.00 x 3):
Wages subject to withholding:
Percentage method formula:
FITW:
c.
Weekly wages ($27,500 ÷ 52):
Allowance value ($80.80 x 2):
Wages subject to withholding:
Percentage method formula:
FITW:
2. a.
Quarterly wages ($72,000 ÷ 4):
Allowance value ($1,050.00 x 4):
Wages subject to withholding:
Percentage method formula:
FITW:
b. Weekly wages [($2,650 x 12) ÷ 52]:
Allowance value:
Wages subject to withholding:
Percentage method formula:
FITW:
28
$900.00
-­175.00
$725.00
-­563.00
162.00
x .12
$19.44
+40.50
$59.94
$3,541.67
-­ 1,050.00
2,491.67
-­ 983.00
1,508.67
x .10
$150.87
$528.85
-­ 161.60
367.25
-­ 260.00
107.25
x .12
$12.87
+18.70
$31.57
$18,000.00
-­4,200.00
13,800.00
-­7,800.00
6,000.00
x .12
$720.00
+485.00
$1,205.00
$611.54
-­ 80.80
530.74
-­ 260.00
270.74
x .12
$32.49
+18.70
$51.19
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Answer Key
c.
Biweekly wages ($53,000 ÷ 26):
Allowance value ($161.50 x 3):
Wages subject to withholding:
Percentage method formula:
FITW:
$2,038.46
-­484.50
1,553.96
-­ 1,200.00
353.96
x .12
$42.48
+74.60
$117.08
3. $29.00
4. Annual wages = $1,200 x 26 payroll periods = $31,200
Withholding using the percentage method:
Gross wages:
Allowance value ($4,200 x 3):
Wages subject to withholding:
Percentage method formula:
$31,200.00
-­ 12,600.00
$18,600.000
-­ 11,800.00
$6,800.00
x .10
$680.00
Withholding per payroll period = $680.00 ÷ 26 = $26.15
5. Annual wages = $6,000 x 12 payroll periods = $72,000
Withholding using the percentage method:
Gross wages:
Allowance value ($4,200 x 2):
Wages subject to withholding:
Percentage method formula:
$72,000.00
-­ 8,400.00
$63,600.00
-­43,275.00
$20,325.00
x .22
4,471.50
+4,543.00
$9,014.50
Withholding per payroll period = $9,014.50 ÷ 12 = $751.21
6. $2,000 x 22% = $440
7. a.
FITW on regular wages = $20
b. FITW on supplemental wages = $1,000 x 22% = $220
c.
FITW on total wages $20 + $220 = $240
8. Total of latest wages and bonus ($1,200 + $750) =
FITW on total amount (wage-­bracket method) =
FITW from latest wage payment =
FITW from supplemental wage payment =
$1,950
187
-­ 96
$91
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29
The Payroll Source
9. a.
Using the flat rate method:
FITW on regular wages =
FITW on supplemental wages ($100 x 22%) =
Total FITW = $49 + $22 =
$49
+ 22
$71
b. Using the aggregate method:
FITW on $700 ($600 in regular wages plus $100 bonus) = $62
10. Social security: $430 x 6.2% = $26.66
Medicare: $430 x 1.45% = $6.24
11. Weekly wages: $36,000 ÷ 52 = $692.31
Social security: $692.31 x 6.2% = $42.92
Medicare: $692.31 x 1.45% = $10.04
12. Social security wage limit:
Wages paid to date ($2,900 x 45):
Social security taxable wages this pay:
Social security tax to withhold:
$132,900
-­130,500
2,400
x 6.2%
$148.80
Medicare taxable wages this pay:
Medicare tax to withhold:
$2,900
x 1.45%
$42.05
13. Social security wage limit:
Wages paid to date ($11,500 x 11):
Social security taxable wages this pay:
Social security tax to withhold:
$132,900
-­126,500
6,400
x 6.2%
$396.80
Medicare taxable wages this pay:
Medicare tax to withhold:
$11,500
x 1.45%
$166.75
14. Social security wage limit:
Wages paid to date ($10,000 x 21):
Social security taxable wages this pay:
Social security tax to withhold:
$132,900
-­210,000
0
$0.00
Medicare taxable wages this pay:
$10,000
x 1.45%
$145.00
Medicare tax to withhold:
Total Medicare taxable wages through this pay: ($10,000 x 21):
Additional Medicare tax withholding threshold:
Additional Medicare taxable wages this pay:
Additional Medicare tax to withhold:
Total Medicare and Additional Medicare tax to withhold:
30
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$210,000
200,000
10,000
x 0.9%
$90.00
$235.00
Answer Key
SECTION 7: UNEMPLOYMENT INSURANCE
Review Questions
1. The normal credit against FUTA tax liability equals the amount of an employer’s required contributions
that are timely paid into a certified state unemployment insurance fund. It is also called the 90% credit
because the amount of the credit is limited to 90% of the 6.0% FUTA tax rate.
2. The following individuals can sign an employer’s Form 940:
•
•
•
•
•
The individual owning the business, if it is a sole proprietorship
The president, vice president, or other principal corporate officer authorized to act, if the employer is a
corporation (including a limited liability company treated as a corporation)
An authorized member, partner, or officer of an unincorporated association or partnership (including a
limited liability company treated as a partnership) having knowledge of the organization’s affairs
The owner or principal officer authorized to act, if it is a single member limited liability company
treated as a disregarded entity
A fiduciary if the employer is a trust or estate
3. A Form 940 that is mailed through the U.S. Postal Service is considered filed at the time it is postmarked
by the U.S. Postal Service.
4. An employer that ceases doing business must file a Form 940 for the portion of the last calendar year it was
in business and check Box d in the upper right hand corner of page 1 indicating no future returns will be
filed. The employer must also attach a statement to the form including the following information:
•
•
•
The location where required records will be kept
Who is responsible for keeping the records
The name and address of the purchaser of the business or the fact that there was no purchaser or that
the purchaser’s name is unknown
5. Unless there is reasonable cause and no willful neglect, late payment of tax owed as shown on Form
940 results in an “addition to tax,” the amount of which depends on how late the payment is made. The
amounts are:
•
•
5% of any unpaid tax shown on the return (after accounting for credits) for each month or fraction of
a month that the payment is late, up to a maximum of 25%
An additional 0.5% per month of any unpaid tax that is not shown on the return but for which the
IRS has issued a notice and demand, if the tax is not paid within 21 calendar days of the notice and
demand (10 business days if the amount is at least $100,000), up to a maximum of 25%
6. The four factors used by employers in allocating employees who work in more than one state for purposes
of unemployment insurance are:
•
•
•
•
Are services “localized?”
Does the employee have a “base of operations?”
Is there a “place of direction or control?”
What is the employee’s “state of residence?”
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31
The Payroll Source
7. The following employers are not subject to FUTA tax:
•
•
•
Federal, state, and local government employers, including their political subdivisions
Indian tribes
Nonprofit religious, charitable, or educational organizations that are tax-­exempt
8. Following is a list of several FUTA exempt payments:
•
•
•
•
•
•
•
•
•
•
•
•
Sick or disability pay paid more than six calendar months after the last month the employee worked
for an employer
Sickness or injury payments made under a state workers’ compensation law or a law in the nature of a
workers’ compensation law
Payments made under a deferred compensation plan, except elective deferrals to the plan
Noncash payments to an employee for work done outside the employer’s trade or business
Qualified moving expense reimbursements (This exclusion has been suspended for tax years 2018
through 2025. The suspension, however, does not apply to certain moves of American military personnel. (see Sections 7.1-­2 and 3.3-­2))
Death or disability retirement benefits
Noncash payments to agricultural workers
Reimbursements for, or provision of, deductible dependent care assistance
Value of group-­term life insurance coverage
Value of deductible meals and lodging provided by the employer
Wages owed to a deceased employee and paid to a beneficiary after the year of the employee’s death
Tips not reported by an employee to an employer (generally if less that $20 a month)
9. Following is a list of several types of employment that are exempt from FUTA:
•
•
•
•
•
•
•
•
•
•
•
•
Work on a foreign ship outside the U.S.
Work done by students for the school where they attend classes or for an organized camp
Work performed as student nurses or hospital interns
Life insurance agents who receive only commissions
Newspaper deliverers under age 18 who deliver directly to customers
Certain nonimmigrant aliens working under F, J, M or Q visas
Work performed for a spouse or child
Work performed by a child under age 21 for his or her parents
Work performed by an inmate of a penal institution
Work performed by an election worker who is paid less than $1,800 in 2019
Work performed by alien agricultural workers under an H-­2A visa
Work performed by statutory nonemployees
10. Employers that make an error on Form 940 need to file an amended return. They do this by filing a new
Form 940 for the year being amended with the correct numbers. Box a in the upper right corner of page
1 indicating an amended return should be checked. The form should be accompanied by a statement as to
why the amended return is necessary.
11. The four methods used to determine an employer’s unemployment insurance experience rating are:
•
•
•
•
32
Reserve ratio
Benefit ratio
Benefit-­wage ratio
Payroll stabilization
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Answer Key
12. The voluntary contribution option is often made unavailable to:
•
•
•
New employers
Negative reserve balance employers,
Employers that have not paid state taxes on time
13. When faced with a claim for unemployment benefits, the employer should:
•
•
•
•
•
Be complete and truthful in listing the grounds for an employee’s termination when responding to
forms and notices from the unemployment benefits agency
Document any and all evidence of misconduct that may be needed to challenge a claim for benefits
Respond to notices and requests for information within the time frame allowed
Detail any final payments made to terminated employees, since they may disqualify the employee, at
least temporarily
Urge the unemployment agency to make sure the claimant is looking for work
14. The following standards must be met for employees to be eligible for unemployment benefits:
•
•
•
•
•
•
•
•
Earning a certain amount of wages in the “base period”
Being involuntarily unemployed for reasons other than misconduct connected with their work
Filing a claim for benefits
Registering for work with the state employment security office
Being physically and mentally able to work
Be looking for and available for work (other than during time spent on job training or jury duty)
Not being unemployed because of a labor dispute other than a lockout
Being truthful in applying for benefits
15. A FUTA credit reduction state is a state or territory that has a loan from the Federal Unemployment
Account that is taken out in one year and has not repaid the full amount of the loan by the end of the
following calendar year. If the loan is not repaid by November 10 of the year the reduction is scheduled to
take effect, a credit reduction of 0.3% goes into effect, with employers in that state having their effective
FUTA tax rate increased to 0.9% (0.6% + 0.3%).
True or False Questions
1. True
2. True
3. False
The employer receives the normal credit for timely payments it makes.
5. False
Nonprofit and public sector employers may choose the direct reimbursement method or the
experience-­rated method to satisfy their state unemployment insurance liability.
4. True
6. True
7. True
8. True
9. False
10. True
11. False
12. False
The employer must file Form 940 annually, no later than January 31 following the close of the
calendar year.
If the employer’s quarterly FUTA tax liability is more than $500, a deposit is required.
If the FUTA tax deposit due date falls on a Saturday, the deposit is due on the next business day.
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33
The Payroll Source
13. True
14. False
15. True
16. True
17. False
18. True
FUTA tax is based on the first $7,000 in wages paid to each employee in 2019.
If an employee works for more than one employer, the wage limit must be applied to the
wages paid by each employer.
19. False
Employers that have a great deal of turnover generally have a higher experience rate.
21. False
The period for which a terminated employee is eligible to claim benefits is known as the
“benefit year.”
20. True
22. True
23. False
24. False
25. 25. True
Employees whose hours are reduced are also eligible, so long as they are not earning more
than the weekly benefit amount.
Employers in a credit reduction state pay FUTA tax at a higher rate than employers in a state
that is not subject to credit reduction.
Multiple Choice Questions
1. 1. a
7. 7. a
13. 13. d
2. 2. c
8. 8. c
14. 14. c
3. 3. b
9. 9. b
15. 15. a
4. 4. a
10. 10. b
16. 16. b
5. 5. d
11. 11. c
17. 17. b
6. 6. b
12. 12. c
Problems
1. a.
$14,000 x .006 = $84
b. No, because the liability did not exceed $500.
2. a.
$70,000 x .006 = $420
b. $70,000 x .032 = $2,240
c.
34
$420 + $2,240 = $2,660
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Answer Key
3. a.
$7,000 x 5 x 6.0% = $2,100
b. $7,000 x 5 x 5.4% = $1,890
c.
$2,100 -­$1,890 = $210
4. Six employees earned $7,000 or more during the first quarter.
Taxable wages:
$7,000 x 6 =
Total taxable wages:
$42,000
+ 6,000
+ 3,150
+ 4,600
+ 5,400
$61,150
1st quarter FUTA liability = $61,150 x .006 = $366.90
5. a.
$6,000 x .049 = $294
b. $1,000 x .049 = $49
c.
6. a.
$7,000 x .006 = $42
$6,600 x .006 = $39.60
b. $7,000 x .006 = $42
7. a.
Gross FUTA tax:
Total wages paid during 2018 =
Wages paid in excess of $7,000:
Total taxable wages:
Rate of tax:
Amount of gross FUTA tax:
$72,680.00
-­26,230.00
46,450.00
x 6.0%
$2,787.00
b. State tax credit:
Total taxable wages:
Credit against tax:
Total credit:
c.
$46,450.00
x 5.4%
$2,508.30
Net FUTA tax: $2,787.00 -­$2,508.30 = $278.70
8. Four employees earned $7,000 or more during the first quarter.
Taxable wages:
David Jones
Sheryl Smith
Johnny Foster
Melissa Denney
Jackie Stewart
Kathy Jensen
Paul Thornton
Total
$7,000
7,000
7,000
5,400
7,000
4,300
2,600
$40,300
1st quarter FUTA tax liability: $40,300 x .006 = $241.80
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35
The Payroll Source
9. See the completed Form 940 on pages 37 and 38.
10. a.
First quarter:
$1,800 x 10 x 3 months =
$2,000 x 6 x 3 months =
$1,000 x 4 x 3 months =
FUTA taxable wages:
$54,000
36,000
12,000
$102,000
Net 1st quarter FUTA tax: $102,000 x .006 = $612
Second quarter:
$1,600 x 10 x 1 month =
$1,000 x 6 x 1 month =
$1,000 x 4 x 3 months =
FUTA taxable wages:
$16,000
6,000
12,000
$34,000
Net 2nd quarter FUTA tax: $34,000 x .006 = $204
Third quarter:
$1,000 x 4 x 1 month =
$4,000
Net 3rd quarter FUTA tax: $4,000 x .006 = $24
b.
Taxable wages
1st Quarter
2nd Quarter
3rd Quarter
Total
$102,000
34,000
4,000
$140,000 x 1.8% =
Less year-­to-­date liability
($612 + $204 + $24)
4th quarter liability
FUTA Tax
$2,520
-­840
$1,680
11. See the completed Form 940 and the completed Schedule A on pages 39 - 41.
12. See the completed Form 940 and the completed Schedule A on pages 42 - 44.
36
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Answer Key
Problem 9
2
2
3
4
2
1
3
4
5
Fine Arts
31 West Street
Tulsa
OK
98243
O
27000
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
K
69000
00
27000
00
42000
00
252
00
252
00
252
00
00
37
The Payroll Source
Problem 9 continued
Fine Arts
22-3412345
405-918-1111
38
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From: APA Digital Publications (bookshelf.americanpayroll.org)
Answer Key
Problem 11
8
6
2
3
5
4
6
7
8
Conrow Lumber Company
1234 San Francisco Street
San Francisco
CA
56789-1234
✖
460000
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
600000
00
460000
00
140000
00
840
00
840
00
840
00
00
39
The Payroll Source
Problem 11 continued
Conrow Lumber Company
40
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
86-2345678
480
00
144
00
129
00
87
00
840
00
Answer Key
Problem 11 continued
Schedule A (Form 940) for 2018:
860312
Multi-State Employer and Credit Reduction Information
OMB No. 1545-0028
Department of the Treasury — Internal Revenue Service
Employer identification number (EIN)
Name (not your trade name)
8
6
—
2
3
4
5
6
7
See the
instructions on
page 2. File this
schedule with
Form 940.
8
Conrow Lumber Company
Place an “X” in the box of EVERY state in which you had to pay state unemployment tax this year. For each state with
a credit reduction rate greater than zero, enter the FUTA taxable wages, multiply by the reduction rate, and enter the
credit reduction amount. Don't include in the FUTA Taxable Wages box wages that were excluded from state
unemployment tax (see the instructions for Step 2). If any states don't apply to you, leave them blank.
Postal
Abbreviation
AK
AL
AR
✖ AZ
✖ CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
FUTA
Taxable Wages
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Reduction
Rate
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
Credit Reduction
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Postal
Abbreviation
FUTA
Taxable Wages
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Reduction
Rate
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.024
× 0.000
Total Credit Reduction. Add all amounts shown in the Credit Reduction boxes. Enter the total
here and on Form 940, line 11
. . . . . . . . . . . . . . . . . . . . .
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 940.
Credit Reduction
Cat. No. 16997C
.
Schedule A (Form 940) 2018
41
The Payroll Source
Problem 12
8
2
4
0
0
2
3
0
4
MiloSuisse Textured Yarns
1000 East State Street
FL
Campton
13579-2468
✖
56000
00
589500
00
995500
00
645500
00
350000
00
2100
00
2100
00
2100
00
✖
✖
42
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Answer Key
Problem 12 continued
MiloSuisse Textured Yarns
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
82-4020304
1200
00
361
00
323
00
216
00
2100
00
43
The Payroll Source
Problem 12 continued
Schedule A (Form 940) for 2018:
860312
Multi-State Employer and Credit Reduction Information
OMB No. 1545-0028
Department of the Treasury — Internal Revenue Service
Employer identification number (EIN)
Name (not your trade name)
8
2
—
4
0
2
0
3
0
See the
instructions on
page 2. File this
schedule with
Form 940.
4
MiloSuisse Textured Yarns
Place an “X” in the box of EVERY state in which you had to pay state unemployment tax this year. For each state with
a credit reduction rate greater than zero, enter the FUTA taxable wages, multiply by the reduction rate, and enter the
credit reduction amount. Don't include in the FUTA Taxable Wages box wages that were excluded from state
unemployment tax (see the instructions for Step 2). If any states don't apply to you, leave them blank.
Postal
Abbreviation
AK
AL
AR
✖ AZ
✖ CA
CO
CT
DC
DE
✖ FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
✖ MS
MT
FUTA
Taxable Wages
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Reduction
Rate
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
Credit Reduction
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Postal
Abbreviation
FUTA
Taxable Wages
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Reduction
Rate
44
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.000
× 0.024
× 0.000
Total Credit Reduction. Add all amounts shown in the Credit Reduction boxes. Enter the total
here and on Form 940, line 11
. . . . . . . . . . . . . . . . . . . . .
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 940.
Credit Reduction
Cat. No. 16997C
.
Schedule A (Form 940) 2018
Answer Key
SECTION 8: DEPOSITING AND REPORTING
WITHHELD TAXES
Review Questions
1. Monthly depositors must deposit their accumulated tax liability for each calendar month by the 15th of the
following month.
Semiweekly depositors must deposit their payroll tax liability for wages paid on Wednesday, Thursday and
Friday by the following Wednesday. The payroll tax liability for wages paid on Saturday, Sunday, Monday,
and Tuesday must be paid by the following Friday.
If an employer’s accumulated payroll tax liability reaches $100,000 on any day during a monthly or semiweekly deposit period, the liability must be deposited by the close of the next business day.
2. Under the “shortfall” rule, employers are not penalized for depositing a small amount less than the entire
amount of their deposit obligation. An employer satisfies its deposit obligation if the shortfall is no more
than the greater of $100 or 2% of the entire amount due and the shortfall is made up by the appropriate
“make-­up” date.
3. Beginning with payroll tax deposits based on wages paid after December 31, 2010, they may not be mailed
because they must be made by electronic funds transfer through the Electronic Federal Tax Payment System. Federal tax deposit coupons and paper checks are no longer acceptable as a method of deposit.
4. Schedule R (Form 941), Allocation Schedule for Aggregate Form 941 Filers, is filed to allocate the aggregate
information reported on Form 941 to each of the reporting agent’s clients.
5. Individuals who are responsible for collecting, accounting for, and paying over withheld income and
employment taxes and who willfully fail to do so are subject to an additional penalty equal to the total
amount of the taxes owed. This is known as the “Trust Fund Recovery Penalty” or the “100% penalty.”
6. If a Form W-­2c cannot be delivered to an employee after a reasonable effort to do so has been made, the
employer must keep the form for four years or maintain an electronic file containing the information on
the form for the same time period.
7. Employers that have a payroll tax liability of up to $1,000 in a calendar year file Form 944, Employer’s
Annual Federal Tax Return, rather than Form 941, Employer’s Quarterly Federal Tax Return.
8. Only foreign employers can take the following steps to obtain an EIN by phone:
•
•
•
•
Complete Form SS-­4 before calling
Call 267-­941-­1099
Provide the requested information from Form SS-­4
Write the EIN on the SS-­4, sign and date it, and keep it for your records
9. The lookback period is the 12-­month period ending June 30 of the previous year.
10. March 5, 2019 through June 30, 2019.
11. Mark’s deposit obligation as of July 12 is $110,000. It must be deposited by the close of the next business
day (Monday, July 15). Mark becomes a semiweekly depositor for the rest of 2019 and all of 2020.
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
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45
The Payroll Source
12. The following are the penalties for not making payroll tax deposits on time:
•
•
•
•
2% of the undeposited amount if it is deposited within 5 days of the due date
5% of the undeposited amount if it is deposited within 6-­15 days of the due date
10% of the undeposited amount if it is deposited more than 15 days after the due date
15% of the undeposited amount if it is not paid within 10 days after the employer receives its first IRS
delinquency notice or on the same day that a notice and demand for payment is received
13. An employer that will no longer be in business and will not be paying wages subject to federal income
withholding, social security, and Medicare taxes should do the following:
•
•
•
•
•
Check the box on Line 17 when completing its last Form 941 indicating that it will not file any
returns in the future;
Enter the date that final wages were paid;
Attach a statement showing the address where the employer’s records will be kept, the name of the
person keeping the records, and, if the business has been sold or transferred, the name and address of
the new owner and the date of the sale or transfer;
File the Form 941 by the end of the first month after the end of the quarter during which the
employer stopped paying wages; and
File Schedule D (Form 941), Report of Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations, if the employer is no longer in business as the result of a statutory merger or consolidation, or
if it qualifies as a predecessor or successor after an acquisition.
14. Enter on Line 7 the difference between the total security and Medicare taxes on Line 5e and the amount actually withheld from employees’ wages and paid by the employer that is due to rounding to the nearest penny.
15. Schedule B records an employer’s payroll tax liability, not its deposits. Semiweekly depositors at any time
during a quarter must file a Schedule B with Form 941.
16. Form 945, Annual Return of Withheld Federal Income Tax.
17. Unless an employer has reasonable cause and is not guilty of willful neglect, late filing of Form 941 or
other employment tax returns results in an “addition to tax,” the amount of which depends on how late the
return is filed. The amount is: 5% of the amount of tax required to be shown on the return (after accounting for deposits and credits) for each month or fraction of a month that the return is late, to a maximum of
25% (15% per month to a maximum of 75% of the unpaid tax if the late filing is fraudulent).
18. The purpose of backup withholding is to ensure that income tax is paid on income reported on Forms 1099.
19. The amounts compared by the SSA include:
•
•
•
Social security wages
Social security tips
Medicare wages and tips
20. The general penalties for failure to file information returns for tax year 2019 on time and with correct
information are as follows:
46
•
$50 per return if the failure to file or provide correct information is corrected within 30 days after the
due date, with a maximum penalty of $556,500 a year ($194,500 for small businesses)
•
$110 per return if the failure to file or provide correct information is corrected more than 30 days
after the due date but before August 1 of the same year the return is due, with a maximum penalty of
$1,669,500 a year ($556,500 for small businesses)
•
$270 per return if the failure to file or provide correct information is not corrected by August 1, with a
maximum penalty of $3,339,000 ($1,113,000 for small businesses)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Answer Key
True or False Questions
1. True
2. False
3. False
4. True
5. True
6. False
New employers are classified as monthly depositors.
At least 98% of the tax liability (or the liability -­$100, if that is less) must be deposited to
avoid a late payment penalty.
Form SS-­4 is filed with the IRS, not the SSA.
7. False
This scenario creates 2 separate deposit obligations that must be satisfied by the same day.
9. False
For calendar year 2019, the payroll tax deposit lookback period is July 1, 2017 -­June 30, 2018.
8. True
10. False
11. True
12. False
13. True
14. True
The employer is a monthly depositor for 2019 because its total payroll tax liability for the
2019 lookback period is less than $50,000.
Forms 941 sent by U.S. mail are considered timely if postmarked no later than the form’s due
date.
15. False
The employer has the option to either deposit the amount or pay it with Form 941.
17. False
When recovering undercollections from employees, each employee must be treated separately,
so an overcollection of taxes from one employee cannot be used to offset an undercollection
from another.
16. True
18. True
19. False
20. False
21. True
22. True
23. False
24. False
25. True
Allocated tips should not be included in Box 1, 5, or 7 of Form W-­2, but they should be
included in Box 8.
In general, employers wishing to use substitute W-­2 forms should not send a sample to the
IRS for approval prior to use.
Nonprofit organizations engaged in a trade or business are not exempt from Form 1099
reporting requirements.
Paper Forms 1099 MISC must be sent to the IRS Processing Center listed on the 1099 series
instructions. Those with an amount reported in Box 7, Nonemployee Compensation, must be
sent by January 31 of the year following the year in which the payments were made.
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
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47
The Payroll Source
Multiple Choice Questions
1. c
10. d
19. c
2. d
11. b
20. d
3. a
12. c
21. a
4. d
13. a
22. c
5. c
14. b
23. a
6. c
15. b
24. c
7. b
16. d
25. b
8. b
17. b
9. a
18. d
Problems
1.
J
Sick pay not included as income
E
Section 403(b) elective deferrals
C
EE
Q
D
FF
G
W
T
AA
F
H
GG
DD
Y
B
R
A
V
BB
L
K
48
Value of group-­term life insurance over $50,000
Designated Roth contributions to a governmental 457(b) plan
Nontaxable combat pay
Section 401(k) elective deferrals
Permitted benefits under a qualified small employer health reimbursement arrangement
Section 457(b) elective deferrals
Health savings account contributions
Adoption benefits
Designated Roth contributions to a Section 401(k) plan
Section 408(k)(6) elective deferrals
Section 501(c)(18)(D) elective deferrals
Income from qualified equity grants under section 83(i)
Value of employer-­provided health coverage
Deferrals under a Section 409A nonqualified deferred compensation plan
Uncollected Medicare tax on tips
Medical savings account contributions
Uncollected social security tax on tips
Nonstatutory stock options
Designated Roth contributions to a Section 403(b) plan
Nontaxable part of employee business expense reimbursements
Tax on excess golden parachute payments
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Answer Key
HH
Aggregate deferrals under section 83(i) elections
M
Uncollected social security tax on value of group-­term life insurance coverage over $50,000
Z
N
S
Income under Section 409A on a nonqualified deferred compensation plan
Uncollected Medicare tax on value of group-­term life insurance coverage over $50,000
SIMPLE retirement account contributions
2. See the completed Form 941 on pages 50 - 51.
3. See the completed Form 941 on pages 52-53.
4. See the completed Form 941 and Schedule B on pages 54-56.
5. See the completed Forms W-­2 and Form W-3 on pages 57-59.
6. a.
No penalty is imposed for 13 of the failures to provide correct information (i.e., the greater of 10 or
0.5% x 2,600 = 13).
Late returns subject to penalty: 40 -­13 = 27
b. b. 27 x $110 = $2,970 since the corrections were made more than 30 days after the due date ( January
31) but before August 1.
7. a.
No penalty is imposed for 10 of the failures to provide correct information (i.e., the greater of 10 or
0.5% x 1,400 = 7).
Late returns subject to penalty: 30 -­10 = 20
b. b. 20 x $110 = $2,200 since the corrections were made more than 30 days after the due date ( January
31) but before August 1.
8. (50 x $270 maximum penalty) = $13,500 since the returns were filed after August 1.
9. 380 -­249 = 131 returns subject to penalty.
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
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49
The Payroll Source
Problem 2
941 for 2019:
Form
(Rev. January 2019)
Employer’s QUARTERLY Federal Tax Return
Report for this Quarter of 2019
—
Employer identification number (EIN)
Name (not your trade name)
950117
OMB No. 1545-0029
Department of the Treasury — Internal Revenue Service
(Check one.)
Allied Steel Products
1: January, February, March
2: April, May, June
Trade name (if any)
3: July, August, September
✖ 4: October, November, December
Address
Number
Street
Suite or room number
City
State
Foreign country name
Go to www.irs.gov/Form941 for
instructions and the latest information.
ZIP code
Foreign postal code
Foreign province/county
Read the separate instructions before you complete Form 941. Type or print within the boxes.
Part 1:
Answer these questions for this quarter.
Number of employees who received wages, tips, or other compensation for the pay period
including: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4)
1
2
Wages, tips, and other compensation
.
.
.
.
.
.
2
3
Federal income tax withheld from wages, tips, and other compensation .
.
.
.
.
.
3
4
If no wages, tips, and other compensation are subject to social security or Medicare tax
1
.
.
.
.
.
.
.
.
.
.
.
Column 1
5b
Taxable social security tips .
.
.
5c
Taxable Medicare wages & tips.
.
5d
Taxable wages & tips subject to
Additional Medicare Tax withholding
5e
Add Column 2 from lines 5a, 5b, 5c, and 5d
.
5f
Section 3121(q) Notice and Demand—Tax due on unreported tips (see instructions)
6
Total taxes before adjustments. Add lines 3, 5e, and 5f .
.
.
.
.
.
.
.
.
7
Current quarter’s adjustment for fractions of cents .
.
.
.
.
.
.
.
.
8
Current quarter’s adjustment for sick pay .
.
.
.
.
.
.
.
9
Current quarter’s adjustments for tips and group-term life insurance
.
.
Taxable social security wages .
.
83254
.
.
2414 .
.
90 × 0.124 =
10323
× 0.124 =
90 × 0.029 =
× 0.009 =
39
Total taxes after adjustments. Combine lines 6 through 9
.
10
11
Qualified small business payroll tax credit for increasing research activities. Attach Form 8974
11
12
Total taxes after adjustments and credits. Subtract line 11 from line 10 .
.
12
13
Total deposits for this quarter, including overpayment applied from a prior quarter and
overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter
13
21729
14
Balance due. If line 12 is more than line 13, enter the difference and see instructions
14
▶
.
.
.
49
61
10
.
.
90
Check and go to line 6.
.
.
21729 .
.
.
.
21729 .
.
21729 .
15
.
Overpayment. If line 13 is more than line 12, enter the difference
.
.
.
.
.
.
.
.
.
.
.
5e
.
.
5f
.
.
.
6
.
.
.
.
7
.
.
.
.
.
8
.
.
.
.
.
.
9
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Check one:
12738
Apply to next return.
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
00
.
.
49
49
40
49
Send a refund.
Next ■▶
You MUST complete both pages of Form 941 and SIGN it.
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.
50
.
8991 .
83254
Column 2
.
.
83254 .
.
5a
18
Cat. No. 17001Z
Form 941 (Rev. 1-2019)
Answer Key
Problem 2 continued
950217
Name (not your trade name)
Employer identification number (EIN)
Allied Steel Products
Part 2:
Tell us about your deposit schedule and tax liability for this quarter.
If you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 11
of Pub. 15.
Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500, and you didn’t
incur a $100,000 next-day deposit obligation during the current quarter. If line 12 for the prior quarter was less than $2,500 but
line 12 on this return is $100,000 or more, you must provide a record of your federal tax liability. If you are a monthly schedule
depositor, complete the deposit schedule below; if you are a semiweekly schedule depositor, attach Schedule B (Form 941). Go to
Part 3.
16 Check one:
✖
You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total
liability for the quarter, then go to Part 3.
Tax liability:
.
5866 .
6208 .
21729 .
9654
Month 1
Month 2
Month 3
Total liability for quarter
87
35
27
49 Total must equal line 12.
You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941),
Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941.
Part 3:
Tell us about your business. If a question does NOT apply to your business, leave it blank.
17 If your business has closed or you stopped paying wages .
enter the final date you paid wages
/
/
.
.
.
.
.
.
.
.
.
.
.
.
.
Check here, and
.
.
Check here.
.
18 If you are a seasonal employer and you don’t have to file a return for every quarter of the year
Part 4:
.
May we speak with your third-party designee?
Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions
for details.
Yes. Designee’s name and phone number
Select a 5-digit Personal Identification Number (PIN) to use when talking to the IRS.
✖ No.
Part 5:
Sign here. You MUST complete both pages of Form 941 and SIGN it.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
✗
Print your
name here
Sign your
name here
Date
Print your
title here
/
/
Best daytime phone
Paid Preparer Use Only
Check if you are self-employed
Preparer’s name
PTIN
Preparer’s signature
Date
Firm’s name (or yours
if self-employed)
EIN
Address
Phone
City
State
Page 2
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From: APA Digital Publications (bookshelf.americanpayroll.org)
/
.
.
.
/
ZIP code
Form 941 (Rev. 1-2019)
51
The Payroll Source
Problem 3
941 for 2019:
Form
(Rev. January 2019)
Employer’s QUARTERLY Federal Tax Return
Report for this Quarter of 2019
—
Employer identification number (EIN)
Name (not your trade name)
950117
OMB No. 1545-0029
Department of the Treasury — Internal Revenue Service
(Check one.)
Value Carpet Center
1: January, February, March
2: April, May, June
Trade name (if any)
✖ 3: July, August, September
4: October, November, December
Address
Number
Street
Suite or room number
City
State
Foreign country name
Go to www.irs.gov/Form941 for
instructions and the latest information.
ZIP code
Foreign postal code
Foreign province/county
Read the separate instructions before you complete Form 941. Type or print within the boxes.
Part 1:
Answer these questions for this quarter.
Number of employees who received wages, tips, or other compensation for the pay period
including: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4)
1
2
Wages, tips, and other compensation
.
.
.
.
.
.
2
3
Federal income tax withheld from wages, tips, and other compensation .
.
.
.
.
.
3
4
If no wages, tips, and other compensation are subject to social security or Medicare tax
1
.
.
.
.
.
.
.
.
.
.
.
Column 1
Taxable social security wages .
.
5b
Taxable social security tips .
.
.
5c
Taxable Medicare wages & tips.
.
5d
Taxable wages & tips subject to
Additional Medicare Tax withholding
.
.
36000 .
.
5e
Add Column 2 from lines 5a, 5b, 5c, and 5d
.
5f
Section 3121(q) Notice and Demand—Tax due on unreported tips (see instructions)
6
Total taxes before adjustments. Add lines 3, 5e, and 5f .
.
.
.
.
.
.
.
.
7
Current quarter’s adjustment for fractions of cents .
.
.
.
.
.
.
.
.
8
Current quarter’s adjustment for sick pay .
.
.
.
.
.
.
.
9
Current quarter’s adjustments for tips and group-term life insurance
.
.
34000
.
.
1044 .
.
00 × 0.124 =
4216
× 0.124 =
00 × 0.029 =
× 0.009 =
00
00
10
Total taxes after adjustments. Combine lines 6 through 9
.
10
11
Qualified small business payroll tax credit for increasing research activities. Attach Form 8974
11
12
Total taxes after adjustments and credits. Subtract line 11 from line 10 .
.
12
13
Total deposits for this quarter, including overpayment applied from a prior quarter and
overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter
13
11060
14
Balance due. If line 12 is more than line 13, enter the difference and see instructions
14
▶
.
.
.
.
00
Check and go to line 6.
.
.
11060 .
.
.
.
11060 .
.
11060 .
.
00
Column 2
5a
15
.
Overpayment. If line 13 is more than line 12, enter the difference
.
.
.
.
.
.
.
.
.
.
.
5e
.
.
5f
.
.
.
6
.
.
.
.
7
.
.
.
.
.
8
.
.
.
.
.
.
9
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Check one:
5260
Apply to next return.
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
00
.
.
00
00
00
00
Send a refund.
Next ■▶
You MUST complete both pages of Form 941 and SIGN it.
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.
52
.
5800 .
36000
Cat. No. 17001Z
Form 941 (Rev. 1-2019)
Answer Key
Problem 3 continued
950217
Name (not your trade name)
Employer identification number (EIN)
Value Carpet Center
Part 2:
Tell us about your deposit schedule and tax liability for this quarter.
If you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 11
of Pub. 15.
Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500, and you didn’t
incur a $100,000 next-day deposit obligation during the current quarter. If line 12 for the prior quarter was less than $2,500 but
line 12 on this return is $100,000 or more, you must provide a record of your federal tax liability. If you are a monthly schedule
depositor, complete the deposit schedule below; if you are a semiweekly schedule depositor, attach Schedule B (Form 941). Go to
Part 3.
16 Check one:
✖
You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total
liability for the quarter, then go to Part 3.
Tax liability:
.
3900 .
3260 .
11060 .
3900
Month 1
Month 2
Month 3
Total liability for quarter
00
00
00
00 Total must equal line 12.
You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941),
Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941.
Part 3:
Tell us about your business. If a question does NOT apply to your business, leave it blank.
17 If your business has closed or you stopped paying wages .
enter the final date you paid wages
/
/
.
.
.
.
.
.
.
.
.
.
.
.
.
Check here, and
.
.
Check here.
.
18 If you are a seasonal employer and you don’t have to file a return for every quarter of the year
Part 4:
.
May we speak with your third-party designee?
Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions
for details.
Yes. Designee’s name and phone number
Select a 5-digit Personal Identification Number (PIN) to use when talking to the IRS.
✖ No.
Part 5:
Sign here. You MUST complete both pages of Form 941 and SIGN it.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
✗
Print your
name here
Sign your
name here
Date
Print your
title here
/
/
Best daytime phone
Paid Preparer Use Only
Check if you are self-employed
Preparer’s name
PTIN
Preparer’s signature
Date
Firm’s name (or yours
if self-employed)
EIN
Address
Phone
City
State
Page 2
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
/
.
.
.
/
ZIP code
Form 941 (Rev. 1-2019)
53
The Payroll Source
Problem 4
941 for 2019:
Form
(Rev. January 2019)
Employer identification number (EIN)
Name (not your trade name)
Employer’s QUARTERLY Federal Tax Return
950117
OMB No. 1545-0029
Department of the Treasury — Internal Revenue Service
4
3
—
1
2
3
4
5
6
Report for this Quarter of 2019
7
(Check one.)
Bimms & Ferrow, Inc.
1: January, February, March
2: April, May, June
Trade name (if any)
✖ 3: July, August, September
Address
3456 Mid West Street
Number
4: October, November, December
Street
Suite or room number
Kansas City
MO
25783
City
State
ZIP code
Foreign country name
Go to www.irs.gov/Form941 for
instructions and the latest information.
Foreign postal code
Foreign province/county
Read the separate instructions before you complete Form 941. Type or print within the boxes.
Part 1:
Answer these questions for this quarter.
Number of employees who received wages, tips, or other compensation for the pay period
including: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4)
1
2
Wages, tips, and other compensation
.
.
.
.
.
.
2
3
Federal income tax withheld from wages, tips, and other compensation .
.
.
.
.
.
3
4
If no wages, tips, and other compensation are subject to social security or Medicare tax
1
.
.
.
.
.
.
.
.
.
.
.
Column 1
5a
Taxable social security wages .
.
5b
Taxable social security tips .
.
.
.
.
.
2400000 .
.
2000000
248000
× 0.124 =
00 × 0.029 =
5d
Taxable wages & tips subject to
Additional Medicare Tax withholding
5e
Add Column 2 from lines 5a, 5b, 5c, and 5d
5f
Section 3121(q) Notice and Demand—Tax due on unreported tips (see instructions)
6
Total taxes before adjustments. Add lines 3, 5e, and 5f .
.
.
.
.
.
.
.
.
7
Current quarter’s adjustment for fractions of cents .
.
.
.
.
.
.
.
.
8
Current quarter’s adjustment for sick pay .
.
.
.
.
.
.
.
9
Current quarter’s adjustments for tips and group-term life insurance
.
.
× 0.009 =
00
00
10
Total taxes after adjustments. Combine lines 6 through 9
.
10
11
Qualified small business payroll tax credit for increasing research activities. Attach Form 8974
11
12
Total taxes after adjustments and credits. Subtract line 11 from line 10 .
.
12
.
.
677600 .
.
.
.
677600 .
.
677600 .
13
Total deposits for this quarter, including overpayment applied from a prior quarter and
overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter
13
677600
14
Balance due. If line 12 is more than line 13, enter the difference and see instructions
14
▶
.
.
.
.
.
00
Check and go to line 6.
.
.
69600 .
.
00 × 0.124 =
Taxable Medicare wages & tips .
.
00
Column 2
5c
15
.
Overpayment. If line 13 is more than line 12, enter the difference
.
.
.
.
.
.
.
.
.
.
.
5e
.
.
5f
.
.
.
6
.
.
.
.
7
.
.
.
.
.
8
.
.
.
.
.
.
9
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Check one:
317600
Apply to next return.
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
00
.
.
00
00
00
00
Send a refund.
Next ■▶
You MUST complete both pages of Form 941 and SIGN it.
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.
54
.
360000 .
2400000
Cat. No. 17001Z
Form 941 (Rev. 1-2019)
Answer Key
Problem 4 continued
950217
Name (not your trade name)
Employer identification number (EIN)
Bimms & Ferrow, Inc.
Part 2:
43-1234567
Tell us about your deposit schedule and tax liability for this quarter.
If you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 11
of Pub. 15.
Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500, and you didn’t
incur a $100,000 next-day deposit obligation during the current quarter. If line 12 for the prior quarter was less than $2,500 but
line 12 on this return is $100,000 or more, you must provide a record of your federal tax liability. If you are a monthly schedule
depositor, complete the deposit schedule below; if you are a semiweekly schedule depositor, attach Schedule B (Form 941). Go to
Part 3.
16 Check one:
You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total
liability for the quarter, then go to Part 3.
Tax liability:
.
.
.
.
Month 1
Month 2
Month 3
Total liability for quarter
✖
Part 3:
Total must equal line 12.
You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941),
Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941.
Tell us about your business. If a question does NOT apply to your business, leave it blank.
17 If your business has closed or you stopped paying wages .
enter the final date you paid wages
/
/
.
.
.
.
.
.
.
.
.
.
.
.
.
Check here, and
.
.
Check here.
.
18 If you are a seasonal employer and you don’t have to file a return for every quarter of the year
Part 4:
.
May we speak with your third-party designee?
Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions
for details.
✖ Yes. Designee’s name and phone number
Select a 5-digit Personal Identification Number (PIN) to use when talking to the IRS.
No.
Part 5:
Sign here. You MUST complete both pages of Form 941 and SIGN it.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
✗
Print your
name here
Sign your
name here
Date
Print your
title here
/
/
Best daytime phone
Paid Preparer Use Only
Check if you are self-employed
Preparer’s name
PTIN
Preparer’s signature
Date
Firm’s name (or yours
if self-employed)
EIN
Address
Phone
City
State
Page 2
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
/
.
.
.
/
ZIP code
Form 941 (Rev. 1-2019)
55
The Payroll Source
Problem 4 continued
Schedule B (Form 941):
960311
Report of Tax Liability for Semiweekly Schedule Depositors
(Rev. January 2017)
OMB No. 1545-0029
Department of the Treasury — Internal Revenue Service
Employer identification number
(EIN)
Name (not your trade name)
4
3
—
1
2
3
4
5
6
Report for this Quarter...
(Check one.)
7
1: January, February, March
Bimms & Ferrow, Inc.
2
Calendar year
0
1
2: April, May, June
9
✖ 3: July, August, September
(Also check quarter)
4: October, November, December
Use this schedule to show your TAX LIABILITY for the quarter; don't use it to show your deposits. When you file this form with Form 941 or
Form 941-SS, don't change your tax liability by adjustments reported on any Forms 941-X or 944-X. You must fill out this form and attach it to
Form 941 or Form 941-SS if you're a semiweekly schedule depositor or became one because your accumulated tax liability on any day was
$100,000 or more. Write your daily tax liability on the numbered space that corresponds to the date wages were paid. See Section 11 in
Pub. 15 for details.
Month 1
1
2
3
4
5
6
7
8
Month 2
1
2
3
4
5
6
7
8
Month 3
1
2
3
4
5
6
7
8
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
9
10
11
12
13
14
15
16
9
10
11
12
13
14
15
16
9
10
11
12
13
14
15
16
.
.
.
.
.
.
114200 .
.
.
.
.
.
.
.
113600 .
.
.
.
.
.
111900 .
.
.
.
17
18
19
20
21
22
00
23
24
17
18
19
20
21
22
00
23
24
17
18
19
20
21
22
23
24
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
25
26
27
28
29
30
31
25
26
27
28
29
30
31
25
26
27
28
29
30
31
.
.
.
.
.
.
114200 .
.
.
.
.
.
112800 .
.
.
.
.
.
.
110900 .
.
Tax liability for Month 1
228400
.
00
.
00
.
00
.
00
00
Tax liability for Month 2
226400
00
Tax liability for Month 3
222800
00
Total liability for the quarter
Fill in your total liability for the quarter (Month 1 + Month 2 + Month 3) ▶
Total must equal line 12 on Form 941 or Form 941-SS.
For Paperwork Reduction Act Notice, see separate instructions.
56
IRS.gov/form941
Cat. No. 11967Q
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
677600
Schedule B (Form 941) (Rev. 1-2017)
Answer Key
Problem 5
22222
Void
a Employee’s social security number
486-11-3245
b Employer identification number (EIN)
For Official Use Only
OMB No. 1545-0008
▶
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
39500.00
12-3456789
c Employer’s name, address, and ZIP code
42500.00
Sanchez Corporation
640 San Francisco St., Ste. 6
Sacramento, CA 35123
9
Last name
David V
Sandoval
2635.00
42500.00
d Control number
e Employee’s first name and initial
5925.00
10 Dependent care benefits
1000.00
Suff. 11 Nonqualified plans
13
Statutory
employee
Retirement
plan
12a See instructions for box 12
C
o
d
e
Third-party
sick pay
✔
4213 Central Avenue
Sacramento, CA 35814
616.25
14 Other
12b
D 3000.00
C
o
d
e
12c
C
o
d
e
12d
C
o
d
e
f Employee’s address and ZIP code
15 State
CA
Form
16 State wages, tips, etc. 17 State income tax
Employer’s state ID number
985-4321
W-2
39500.00
Wage and Tax Statement
18 Local wages, tips, etc. 19 Local income tax
1777.50
2019
20 Locality name
Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction
Act Notice, see the separate instructions.
Copy A For Social Security Administration — Send this entire page with
Form W-3 to the Social Security Administration; photocopies are not acceptable.
Cat. No. 10134D
Do Not Cut, Fold, or Staple Forms on This Page
22222
Void
a Employee’s social security number
234-56-7890
b Employer identification number (EIN)
For Official Use Only
OMB No. 1545-0008
▶
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
28481.50
12-3456789
c Employer’s name, address, and ZIP code
30481.50
Sanchez Corporation
640 San Francisco St., Ste. 6
Sacramento, CA 35123
9
William T
Last name
Foster
1889.85
30481.50
d Control number
e Employee’s first name and initial
4272.23
10 Dependent care benefits
Suff. 11 Nonqualified plans
13
Statutory
employee
Retirement
plan
12a See instructions for box 12
C
o
d
e
Third-party
sick pay
✔
123 University Heights
Sacramento, CA 35111
441.98
14 Other
12b
C
o
d
e
C
D
481.50
2000.00
12c
C
o
d
e
12d
C
o
d
e
f Employee’s address and ZIP code
15 State
CA
Form
Employer’s state ID number
985-4321
W-2
16 State wages, tips, etc. 17 State income tax
28481.50
Wage and Tax Statement
1281.67
18 Local wages, tips, etc. 19 Local income tax
2019
Copy A For Social Security Administration — Send this entire page with
Form W-3 to the Social Security Administration; photocopies are not acceptable.
20 Locality name
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
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
57
The Payroll Source
Problem 5 continued
22222
Void
a Employee’s social security number
987-65-4321
b Employer identification number (EIN)
For Official Use Only
OMB No. 1545-0008
▶
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
31800 .00
12-3456789
c Employer’s name, address, and ZIP code
34200.00
Sanchez Corporation
640 San Francisco St., Ste. 6
Sacramento, CA 35123
9
Last name
Helen G
Roseville
2120.40
34200.00
d Control number
e Employee’s first name and initial
4770.00
10 Dependent care benefits
Suff. 11 Nonqualified plans
13
Statutory
employee
Retirement
plan
12a See instructions for box 12
D
C
o
d
e
Third-party
sick pay
✔
7000 Mt. Pleasant Rd.
Sacramento, CA 35900
495.90
2400.00
12b
C
o
d
e
14 Other
12c
Co Veh 1800.00
Ed Asst 2500.00
12d
C
o
d
e
C
o
d
e
f Employee’s address and ZIP code
15 State
CA
Form
16 State wages, tips, etc. 17 State income tax
Employer’s state ID number
985-4321
W-2
31800.00
Wage and Tax Statement
18 Local wages, tips, etc. 19 Local income tax
1431.00
2019
20 Locality name
Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction
Act Notice, see the separate instructions.
Copy A For Social Security Administration — Send this entire page with
Form W-3 to the Social Security Administration; photocopies are not acceptable.
Cat. No. 10134D
Do Not Cut, Fold, or Staple Forms on This Page
22222
Void
a Employee’s social security number
246-80-1357
b Employer identification number (EIN)
For Official Use Only
OMB No. 1545-0008
▶
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
18000.00
12-3456789
c Employer’s name, address, and ZIP code
19000.00
Sanchez Corporation
640 San Francisco St., Ste. 6
Sacramento, CA 35123
9
Beryl
Last name
Horstmann
1178.00
19000.00
d Control number
e Employee’s first name and initial
2700.00
10 Dependent care benefits
Suff. 11 Nonqualified plans
13
Statutory
employee
Retirement
plan
12a See instructions for box 12
C
o
d
e
Third-party
sick pay
✔
1212 Forest Ridge Drive
Sacramento, CA 35196
275.50
D
1000.00
12b
C
o
d
e
12c
14 Other
Ed Asst 800.00
C
o
d
e
12d
C
o
d
e
f Employee’s address and ZIP code
15 State
CA
Form
Employer’s state ID number
985-4321
W-2
16 State wages, tips, etc. 17 State income tax
18000.00
Wage and Tax Statement
540.00
18 Local wages, tips, etc. 19 Local income tax
2019
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.
Do Not Cut, Fold, or Staple Forms on This Page
58
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
20 Locality name
Cat. No. 10134D
Answer Key
Problem 5 continued
DO NOT STAPLE
a Control number
33333
(Check one)
941
Military
X
Hshld.
emp.
CT-1
943
944
Medicare
govt. emp.
Kind
of
Employer
(Check one)
d Establishment number
c Total number of Forms W-2
4
None apply
▲
Kind
of
Payer
OMB No. 1545-0008
▲
b
For Official Use Only ▶
501c non-govt.
Third-party
sick pay
X
State/local
non-501c
1 Wages, tips, other compensation
State/local 501c
Federal govt.
2 Federal income tax withheld
117781.50
17667.23
e Employer identification number (EIN)
3 Social security wages
4 Social security tax withheld
f Employer’s name
5 Medicare wages and tips
6 Medicare tax withheld
12-3456789
126181.50
Sanchez Corporation
7823.26
126181.50
1829.63
8 Allocated tips
7 Social security tips
640 San Francisco St., Ste. 6
Sacramento, CA 35123
10 Dependent care benefits
9
1000.00
11 Nonqualified plans
12a Deferred compensation
h Other EIN used this year
13 For third-party sick pay use only
12b
15 State
14 Income tax withheld by payer of third-party sick pay
8400.00
g Employer’s address and ZIP code
CA
Employer’s state ID number
(Check if
applicable)
985-4321
16 State wages, tips, etc.
117781.50
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
5030.17
Employer's contact person
Employer's telephone number
Employer's fax number
Employer's email address
For Official Use Only
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 ▶
Form
W-3
Date ▶
Title ▶
Transmittal of Wage and Tax Statements
2019
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 2019 General Instructions for Forms
W-2 and W-3 for information on completing this form. Do not file Form
W-3 for Form(s) W-2 that were submitted electronically to the SSA.
Purpose of Form
Complete a Form W-3 Transmittal only when filing paper Copy A of
Form(s) W-2, Wage and Tax Statement. Don't file Form W-3 alone. 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.
When To File Paper Forms
E-Filing
Mail Form W-3 with Copy A of Form(s) W-2 by January 31, 2020.
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
January 31, 2020. For more information, go to www.SSA.gov/bso. First
time filers, select “Register”; returning filers select “Log In.”
Where To File Paper Forms
Send this entire page with the entire Copy A page of Form(s) W-2 to:
Social Security Administration
Direct 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 Pub. 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
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59
The Payroll Source
SECTION 9: OTHER DEDUCTIONS FROM
PAY
Review Questions
1. According to Form 668-­W, when determining take-­home pay the employer should allow the payroll
deductions that were in effect when the levy notice was received.
2. Employers that fail to withhold and pay over an amount not exempt from levy after receiving Form
668-­W are liable for the full amount required to be withheld, plus interest from the wage payment date. In
addition, the employer is liable for a penalty equal to 50% of the amount recoverable by the IRS after the
failure to withhold and remit.
3. CCPA stands for Consumer Credit Protection Act. It provides the legal framework around which state
child support withholding laws have been constructed and limits the amount that can be withheld for child
support.
4. When the law of the state where the employee works requires that health insurance be deducted to determine the employee’s disposable earnings.
5. Yes. Payments to independent contractors constitute property subject to a child support withholding order.
6. The federal garnishment maximum applies no matter how many garnishments are received for an
employee.
7. The lesser of the amount stated on the garnishment order up to 15% of an employee’s disposable earnings or the excess of the employee’s disposable earnings over 30 times the federal minimum wage may be
garnished to satisfy a delinquent federal agency loan unless the employee consents in writing to a higher
amount.
8. 50%, because it is more beneficial to the employee.
9. Following are some of the voluntary deductions which are not subtracted from earnings in calculating
disposable pay:
•
•
•
•
•
•
•
Health insurance premiums (unless state law says otherwise)
Life insurance premiums
Union dues
Retirement plan contributions
United Way contributions
Other charitable contributions
Savings plan deductions, etc.
10. Under a medical child support order, a noncustodial parent is required to provide health insurance for the
child by enrolling the child in the parent’s employer-­sponsored health insurance plan. The order may also
provide for automatic enrollment of the child if the parent fails to accomplish the enrollment.
60
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Answer Key
11. Under these requirements, each state’s laws must:
•
•
•
•
•
Prohibit insurers from denying medical insurance under a parent’s coverage to a child because the
child was born out of wedlock, is not a dependent on the parent’s income tax return, or does not live
with the parent or in the insurer’s service area
Where a qualified medical child support order exists, require insurers and employers to allow the
parent to enroll the child without restrictions, and to enroll the child themselves if the parent does not
do it
Where a qualified medical child support order exists, require employers to withhold the employee’s
share of health insurance premiums and pay it to the insurer
Require insurers to make it easier for custodial parents to submit and collect on claims where the noncustodial parent’s insurer carries the child’s coverage
Permit state Medicaid agencies to garnish an employee’s wages so the state can be reimbursed for
payments made to the employee on behalf of a child who is eligible for Medicaid
True or False Questions
1. False
2. False
3. False
4. True
5. True
You must use the table for married filing separate with no dependents if the employee does
not submit a statement of filing status and dependents.
The Consumer Credit Protection Act imposes a lower limit depending on the amount of the
employee’s disposable earnings in relation to the minimum wage, and various state laws also
have more severe restrictions.
The exempt amount is subtracted from the employee’s “take-­home pay.”
6. False
Employers are liable for the full amount required to be withheld.
8. False
Voluntary deductions are not subtracted from gross pay to determine disposable earnings,
which only take into account deductions required by law, but they are subtracted to determine
take-­home pay.
7. True
9. False
10. True
An employer is only required to garnish an employee’s wages by order of a court, not the
creditor.
11. True
12. True
13. True
14. True
15. True
16. True
17. False
18. False
19. False
20. 20. True
Employers must withhold child support from payments made to independent contractors
when required to do so by order of a court or state child support enforcement agency.
Government employees are subject to child and spousal support withholding orders on the
same basis as private sector employees.
Employers are prohibited by the CCPA from terminating an employee because the employee’s earnings have been subjected to garnishment for any one indebtedness.
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61
The Payroll Source
Multiple Choice Questions
1. c
6. d
11. c
2. b
7. c
12. a
3. d
8. c
13. b
4. b
9. a
14. d
5. c
10. b
15. a
Problems
1. Continue withholding according to the order unless and until you receive notification in writing from the
court or issuing agency that a change is necessary.
2. John’s take-­home pay:,
($1,00.00 -­$256.50)
Exempt amount:
(Taken from 2019 table)
Amount subject to levy:
$743.50
-­315.39
$428.11
3. Matthew’s take-­home pay:
($2,500.00 -­$664.40)
Exempt amount:
(Taken from 2019 table)
Amount subject to levy:
$1,835.60
4. a.
$7,828.57
David’s take-­home pay:
($10,500 -­$2,671.43)
Exempt amount:
(Taken from 2019 table)
Amount subject to levy:
b. David’s new take-­home pay:
($10,500 -­$2,853.40 + $210.00)
Exempt amount:
(Taken from 2019 table)
Amount subject to levy:
-­1,716.67
$118.93
-­ 2,733.33
$5,095.24
$7,856.60
-­3,083.33
$4,773.27
Note: David’s §401(k) deduction changed from $210 to $420 when he changed his elective deferral
rate from 2% to 4%. His health insurance deduction increased from $50 to $70 when the premiums
were raised. In figuring David’s take-­home pay, the employer cannot deduct the $210 increase in the
§401(k) deduction because it was the result of a voluntary increase. The $20 increase in the health
insurance deduction may be counted because it was the result of an increase in the cost of coverage,
not a change in coverage chosen by the employee.
c.
62
David’s net pay after changes:
Net pay = Exempt amount -­§401(k) deduction increase
Net pay = $3,083.33 -­$210.00 = $2,873.33
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Answer Key
5. Gross pay ($8.50 x 40):
Federal income tax:
State income tax:
Social security tax:
Medicare tax:
Disposable earnings:
$340.00
-­19.00
-­1.90
-­21.08
-­ 4.93
$293.09
6. Regular pay ($7.50 x 48):
Overtime premium:
Gross pay:
Federal income tax:
State income tax:
Social security tax ($390 x 6.2%):
Medicare tax ($390 x 1.45%):
Disposable earnings:
$360.00
+30.00
390.00
-­24.00
-­4.80
-­24.18
-­ 5.66
$330.74
7. Week one:
Regular pay ($10.00 x 43):
Overtime premium (0.5 x $10 x 3):
Total:
$430.00
+ 15.00
445.00
Week two:
Regular pay ($10.00 x 39):
Total earnings (2 weeks):
Federal income tax:
State income tax:
Social security tax ($835 x 6.2%):
Medicare tax ($835 x 1.45%):
Disposable earnings:
390.00
835.00
-­56.00
-­11.20
-­51.77
-­ 12.11
$703.92
8. The lesser of:
$320.00 x 25% = $80.00 or
$320 -­$217.50 = $102.50
Therefore, the maximum amount of Jane’s disposable earnings that can be garnished is $80.00.
9. Gross pay:
Federal income tax:
State income tax:
Social security tax ($2,570 x 6.2%):
Medicare tax ($2,570 x 1.45%):
Disposable pay:
$2,600.00
-­325.00
-­112.50
-­159.34
-­ 37.27
$1,965.89
The lesser of:
$1,965.89 x 25% = $491.47 or
$1,965.89 -­$471.25 = $1,494.64
Therefore, the maximum amount of Don’s disposable earnings that can be garnished is $491.47. However,
since $150 of Don’s disposable earnings are already subject to a child support withholding order and a
federal tax levy, only $341.47 is subject to garnishment ($491.47 -­$150).
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63
The Payroll Source
SECTION 10: RECORDKEEPING AND
RECORD RETENTION
Review Questions
1. Where employees are exempt from overtime pay requirements for time spent receiving remedial education,
the employer must keep, in addition to other required records, records of the hours spent by each employee
receiving such remedial education and the wages paid for those hours.
2. Willful violations of the recordkeeping requirements can bring a criminal penalty of up to $10,000 and/or
imprisonment for up to 6 months, although a jail sentence can be imposed only for second and subsequent
convictions.
3. These records must be kept for at least four years after the due date of the tax (or the date the tax is paid, if
later) for the return period to which the records relate.
4. 3 days
5. Following is a list of the records that must be kept for three years after the last date of entry for each covered employee under the FLSA:
•
•
•
•
•
•
•
•
•
•
•
•
Name, as it appears on the employee’s social security card
Home address, including apartment number, if any, and Zip code
Date of birth, if under age 19
Sex and occupation (for use in determining Equal Pay Act compliance)
The beginning of the employee’s workweek (time and day)
Regular rate of pay for overtime weeks, the basis for determining the rate, and any payments excluded
from the regular rate
Hours worked each workday and workweek
Straight-­time earnings (including straight-­time pay for overtime hours)
Overtime premium earnings
Additions to and deductions from wages for each pay period
Total wages paid for each pay period
Date of payment and the pay period covered
6. Following is a list of records that must be kept for at least two years from their last date of entry under the
FLSA:
•
•
•
Basic employment and earning records that support the data for each nonexempt employee’s hours of
work, basis for determining wages, and wages paid (e.g., time or production cards)
Order, shipping, and billing records showing customer orders, shipping and delivery records, and customer billings
Records substantiating additions to or deductions from employees’ wages, including purchase orders,
operating cost records, wage assignments, and garnishments
7. In addition to other required records, hospitals and residential care facilities whose employees have a work
period of 14 consecutive days (rather than 7 for other employees) must keep records of the time and day
on which the 14-­day period begins, hours worked each day and each 14-­day period, and straight-­time and
overtime premium earnings paid in each 14-­day period. They also must keep a copy of the written agreement between the hospital and the employee allowing use of the 14-­day work period or a memorandum
summarizing its terms if the agreement is oral.
64
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Answer Key
8. Employers that use the tip credit to pay part of a tipped employee’s minimum wage must keep, in addition
to other required records, the following:
•
•
•
•
•
Some notation of the records showing that the employee’s wages are determined partly by tips
The amount reported by the employee to the employer as tips (weekly or monthly), which may be
taken from IRS Form 4070
The amount of the tip credit taken by the employer
Hours worked and straight-­time earnings for time worked other than as a tipped employee
Hours worked and straight-­time earnings for time worked as a tipped employee
9. The procedures are generally aimed at achieving one goal—­making it easy for the IRS to determine the
employer’s correct tax liability.
10. Employers must retain the completed Form I-­9, Employment Eligibility Verification, for at least three years
after the date of hire or one year after the date of termination, whichever is later.
11. The advantages of micromedia storage over paper storage include:
•
•
•
•
Less space needed for storage
Reduced storage costs
Less chance of losing individual documents
Increased durability
12. The main problem is one of quality control—­the camera may not photograph 100% of every document, the
image may be partially unreadable, and verification of the image after it develops can be a time-­consuming
process.
13. Whatever method an employer uses to create and preserve its employment and payroll records, it should
have a policy governing record retention, retrieval, and destruction. The written policy should clearly state
how long records are to be retained (and how the containers should be labeled), how they can be retrieved
(especially important if records are stored off site), and when and how they should be disposed of.
14. The Privacy Rule.
15. The Department of Health and Human Services.
True or False Questions
1. False
2. True
Payroll records may be retained in any form, including microfilm, microfiche, paper, or
computerized.
3. False
72 hours.
5. False
The employer remains ultimately responsible for the recordkeeping requirements.
7. False
Certain records relating to overtime pay requirements, including hours worked, need not be
kept for exempt “white collar” employees. However, employers must include in their records
the basis on which wages are paid so that each employee’s total earnings for each pay period
can be calculated.
4. True
6. True
8. True
9. True
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The Payroll Source
10. False
11. True
12. False
13. True
14. True
15. False
The records required by the FLSA may be stored by the employer either at the work site or at
a central location where its records are customarily maintained.
Form W-­4 must be retained by the employer for at least four years after the date the last
return was filed using the information on the form (i.e., the employee’s personal income tax
return for the last year during which the Form W-­4 was in effect, which is due the following
April 15).
The various federal and state laws generally do not require that records be kept in any
particular form and often specifically allow record retention on micromedia, digitally, or
electronically.
Multiple Choice Questions
66
1. a
5. d
9. b
2. d
6. b
10. c
3. b
7. b
4. c
8. a
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Answer Key
SECTION 11: PAYROLL ACCOUNTING
Review Questions
1. Management, stockholders, investors, employees, and auditors would be interested in the financial records
of a business.
2. Subsidiary ledgers are used for a single type of account and are subordinate to the general ledger. For
example, entries documenting payroll expenses and liabilities may be contained in a subsidiary ledger
known as the Payroll Register. Other subsidiary ledgers that contain entries for several accounts might
include Accounts Payable, Accounts Receivable, and Fixed Assets.
3. In most companies, a “chart of accounts” lists each account by name and number, with the number being
used to identify accounts in an automated system.
4. Asset, Liability, Expense, Revenue, and Equity.
5. If payroll expenses are recorded functionally, entries must be based on the processes supported by the
expenses (e.g., manufacturing, sales, administration). This means that the payroll would have to be distributed into different labor distribution expense accounts and a separate Labor Distribution Subsidiary
Ledger would have to be kept. Recording payroll expenses by type of pay can be done where the payroll
register breaks down employees’ wages into regular and overtime pay.
6. Internal controls
7. Under accrual accounting, revenue is recognized and recorded when earned and expenses are recognized
and recorded when incurred. Accrual entries are made at the end of an accounting period to estimate payroll expenses and liabilities incurred between the end of the last payroll period and the accounting period
end.
8. Accruals generally are estimates, so they must be corrected by reversing entries during the next accounting
period when the actual expenses and liabilities are recorded.
9. In preparing to file quarterly Forms 941 and annual Form 940, employers should verify the following:
•
•
•
That FUTA, social security, and Medicare tax deposits for the quarter equal the current tax rates for
each, multiplied by the taxable wages for each, taking into account any wages subject to Additional
Medicare tax
The total Form 941 tax deposits for the quarter equal the liability section for Form 941 (Line 13
of Form 941 equals Line 16 of Form 941 or the “Total liability for the quarter” line of Schedule B,
whichever applies), although monthly depositors may pay their lawful $100 or 2% deposit shortfall
with Form 941, in which case total deposits would not equal the liability
Total FUTA tax deposits equal Part 4, Line 13 and Part 5, Line 17 of Form 940
10. Earnings per share show the company’s net income divided by the weighted average number of outstanding shares of stock.
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67
The Payroll Source
11. The purposes of an external audit include:
•
•
•
•
•
To determine the accuracy of financial statements
To depict the company’s financial condition and determine whether the notes to financial statements
accurately summarize the company’s accounting policies and procedures
To guard against any possible conflict of interest
To safeguard the company’s assets
To provide an objective opinion as to the fairness of the financial statements
12. The job of a company’s internal auditor is to review the efficiency of the organization’s internal control
procedures and to identify weaknesses in the controls.
13. A balance sheet is a statement of the financial position of a business at a specific period in time. It is an
itemized list showing the business’s assets, liabilities, and owner’s equity.
14. Revenue has the effect of increasing owner’s equity.
15. Expenses have the effect of decreasing owner’s equity.
16. The journal is used to list all the necessary information about a transaction in one place. The journal is the
first accounting record of business transactions and is therefore referred to as a record of original entry.
True or False Questions
1. True
2. True
3. False
4. False
5. True
Payroll taxes are always reported on a calendar year basis.
The income statement summarizes the organization’s revenues, expenses, and earnings for the
current and preceding fiscal years.
6. False
Accounts payable are liabilities.
8. False
The property owned by a business is known as assets.
7. False
9. True
Assets must equal liabilities plus owner’s equity.
10. True
11. True
12. True
13. True
14. True
15. False
16. True
Revenue appears on the income statement.
17. True
18. True
19. True
20. True
21. False
68
The general ledger is the record of final entry.
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Answer Key
22. False
23. True
24. False
25. True
The payroll expense journal will debit an expense account for the labor costs (salary expense)
and credit a liability account (accrued salaries/wages).
Payroll checks that cannot be delivered should be returned to a department other than payroll
and be locked up until the employee returns and can receive the check.
26. True
Multiple Choice Questions
1. b
8. b
15. c
2. c
9. c
16. b
3. a
10. b
17. b
4. d
11. a
18. b
5. a
12. d
19. d
6. a
13. d
20. d
7. a
14. c
21. d
Problems
1. a.
b.
c.
d.
e.
f.
g.
h.
i.
Cash
b. Loan payable to a bank
c. Delivery equipment
d. Account payable to a creditor
e. Office furniture
f. Owner’s financial interest
g. Petty cash
h. Mortgage payable to a bank
i. FUTA taxes payable
Asset
Liability
Asset
Liability
Asset
Owner’s Equity
Asset
Liability
Liability
2. Accounts
Income Statement
c. a. Accounts payable
d. b. Accounts receivable
e. c. Advertising expense
✓
f. d. Cash
g. e. Salaries payable
h. f. Duplicating equipment
i. g. Paul Morris, capital
j. h. Miscellaneous expense
✓
k. i. Office furniture
l. j. Rent expense
✓
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Balance Sheet
✓
✓
✓
✓
✓
✓
✓
69
The Payroll Source
3. a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Accounts receivable
Social security tax payable
Sales
Sales tax payable
Accounts payable
Wage garnishments payable
Payroll taxes expense
Professional fees payable
Freight expense
Life insurance premiums payable
4.
Date
Jan 4, 2019
5.
Date
Jan 11, 2019
Debit
Credit
Credit
Credit
Credit
Credit
Debit
Credit
Debit
Credit
Item
Debit
Wages/salary expense
$50,000.00
Social security tax payable
Medicare tax payable
Federal income tax payable
State income tax payable
City income tax payable
Life insurance premiums payable
Health insurance premiums payable
Credit union contributions payable
Wages/salaries payable
Item
Debit
Payroll taxes expense
$4,380.00
Social security tax payable
Medicare tax payable
FUTA tax payable
SUTA tax payable
Credit
$3,092.56
723.26
7,500.00
750.00
375.00
200.00
120.00
100.00
37,247.18
Credit
$2,480.00
580.00
240.00
1,080.00
6.
a.
Date
Jan 11, 2019
b.
Date
Jan 11, 2019
Item
Debit
Wages/salaries expense
$30,000.00
Social security tax payable
Medicare tax payable
Federal income tax payable
Wages/salaries payable
Item
Debit
Payroll taxes expense
$3,285.00
Social security tax payable
Medicare tax payable
FUTA tax payable
SUTA tax payable
Credit
$1,860.00
435.00
4,500.00
23,205.00
Creditt
$1,860.00
435.00
180.00
810.00
c. Jan 18, 2019
Wages/salaries payable
$23,205.00
Cash$23,205.00
70
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Answer Key
7.
Date
Jan 4, 2019
Item
Debit
Wages/salaries expense
$16,400.00
Social security tax payable
Medicare tax payable
Federal income tax payable
State income tax payable
Life insurance premiums payable
Health insurance premiums payable
Wages/salaries payable
Credit
$1,016.80
237.80
2,460.00
246.00
30.00
22.00
12,387.40
Jan 4, 2019
Payroll taxes expense
$1,795.80
Social security tax payable
Medicare tax payable
FUTA tax payable
SUTA tax payable
$1,016.80
237.80
98.40
442.80
Jan 4, 2019
Wages/salaries payable
$12,387.40
Cash$12,387.40
8.
a.
Date
Jan 17, 2019
Item
Debit
Accrued payroll expense
$80,000.00
Accrued payroll liability
Credit
$80,000.00
To record the estimated salaries due from Jan. 14 –­Jan. 17.
Date
Jan 17, 2019
Item
Debit
Accrued payroll tax expense
$9,000.00
Accrued social security tax payable
Accrued Medicare tax payable
Accrued FUTA tax payable
Accrued SUTA tax payable
Credit
$4,960.00
1,160.00
480.00
2,400.00
To record the estimated payroll tax expenses on wages from Jan. 14 –­Jan. 17.
Date
Jan 18, 2019
Item
Debit
Accrued payroll liability
$80,000.00
Accrued payroll expense
Credit
$80,000.00
To record the reversal of the estimated salaries from Jan. 14 –­Jan. 17.
b. Date
Jan. 18, 2019
Item
Debit
Accrued social security tax payable
$4,960.00
Accrued Medicare tax payable
$1,160.00
Accrued FUTA tax payable
480.00
Accrued SUTA tax payable
2,400.00
Accrued payroll tax expense
Credit
9,000.00
To record the reversal of the estimated payroll tax expenses from Jan. 14 –­Jan. 17.
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71
The Payroll Source
9.
a.
Item
Debit
Vacation expense
$4,000
Vacation liability payable
Credit
$4,000
To record the employees’ accrual of vacation leave for the month of January.
b.
Item
Debit
Vacation liability payable
$900
Cash
To record the employees’ actual use of vacation leave.
72
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Credit
$900
Answer Key
SECTION 12: PAYROLL SYSTEMS AND
TECHNOLOGY
Review Questions
1. Other company systems that interface with payroll include:
•
•
•
•
•
•
•
Human resources
Benefits
Accounting
Bank reconciliation
Direct deposit
Time and attendance
General ledger
2. Commonly used payroll system edits include:
•
•
•
•
•
•
•
•
Warning that a payment is being generated for a terminated employee
Report for new hires
Error message when no payment is generated for an active employee
Error message for negative net pay
Error message for negative deductions
Report when compensation exceeds certain amounts
Report for excessive overtime (or any overtime in some companies)
Report when rate of pay changes
3. The payroll department’s customers include:
•
•
•
•
Employees
Other departments
Upper management
Federal, state and local government agencies
4. Reasons why an integrated payroll, human resources, and benefits system would benefit a company include:
•
•
•
Streamlining functions that make up the highest percentage of cost in most organizations
Storing complete data in a single separate database, which means that the information needed to make
intelligent business decisions is readily available,
Significant improvements in existing systems are often impossible, because most of their time and
energy is spent supporting necessary interfaces among the existing systems’ databases
5. Representatives of the following departments should be included on the system selection and implementation project team:
•
•
•
•
•
•
•
•
Payroll
Human resources
Benefits
Accounting
Tax
Budget/finance
Data processing/MIS
Facilities
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6. A successful automated payroll system must:
•
•
•
•
•
Provide for compliance with federal, state, and local withholding, depositing, and reporting
requirements
Issue timely and accurate paychecks and/or make accurate direct deposits and payroll card account
deposits
Maintain adequate records of all data and transactions
Prepare internal reports
Guarantee the security of the system
7. Slow response time to needed changes and emergency requirements.
8. Advantages of using an in-­house automated payroll system include:
•
•
•
•
•
•
Control of the system
Convenient access
Downtime can be reduced
System security
Scheduling flexibility
Interactive applications
9. A Current Situation Analysis should include the following components:
•
•
•
•
•
•
•
Documentation of all work flow into/out of the current system
Documentation of the procedures for maintenance, including who is called, response time, and average
downtime
Identify who receives information from the payroll system, how often, and whether they are using it
Along with the end users, identify and prioritize complaints, problems, and restrictions
Identify any actual or potential compliance problems
Document any manual processes that might be eliminated by automation
Identify all costs of the current system—­tax updates, corporate policy changes, computer time, paper,
system shutdowns, etc.
10. A Request for Proposal should include the following:
•
•
•
•
•
•
•
•
•
74
The employer’s purpose in issuing the request
Specific payroll information—­size, frequency, union vs. nonunion, salaried and hourly
Functional requirements of a new system now and in the future
Number of fields required for earnings and deductions
Whether human resources and benefits will be integrated with the payroll system and what interfaces
will be required
Training needs and whether this should be included in the bid
Level of support (maintenance) expected
Contract terms and conditions
Instructions to vendor on how to submit proposal
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Answer Key
11. Common mistakes made during selection of a new payroll system include:
•
•
•
•
•
•
•
•
•
Not including representatives of all the potential user departments
Failing to provide enough time for project team members to work on their system selection duties
Failing to prioritize needs and desires
Making decisions without sufficient input
Failing to consider all the costs associated with a new system
Making on-­site visits only to customers referred by a vendor or service provider
Failing to thoroughly check for signs of obsolescence
Failing to negotiate performance guarantees
Not considering future company needs—­shortsightedness
12. Four environmental concerns that need to be addressed regarding new system hardware are:
•
•
•
•
Need for climate controlled rooms
Power surges or spikes
Dirt
Humidity
True or False Questions
1. True
2. True
3. True
4. True
5. False
6. True
7. True
8. False
9. True
10. False
11. False
12. True
13. False
14. True
Documentation is a very important part of a company’s overall control mechanisms.
An automated time and attendance system can often reduce the errors inherent in a manual
timekeeping system.
An automated time and attendance system should integrate with an employer’s human
resources, payroll, and cost accounting systems.
The initial step in selecting a new payroll system is to put together a project team or task
force.
The final test before going live with a new system is called parallel testing.
15. True
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Multiple Choice Questions
76
1. b
6. b
11. d
2. b
7. b
12. b
3. a
8. d
13. d
4. b
9. a
14. c
5. b
10. c
15. a
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Answer Key
SECTION 13: MANAGING A PAYROLL
DEPARTMENT
Review Questions
1. Tasks and relationships.
2. The fundamental skills that most managers must master to be successful include:
•
•
•
•
•
Strategic planning/organizing
Staffing
Giving directions
Controlling progress
Reporting to upper management
3. Activities that must be defined during the planning and organizing process include:
•
•
•
Goals and objectives
The time frame
The subtasks
4. In developing a job description, the payroll manager must answer the five following questions:
•
•
•
•
•
What are the educational requirements needed to perform the job?
What knowledge/skills must the applicant have before being offered the job?
What training opportunities can be offered to the new employee?
What is the level of supervision required on the job?
How much communication and interaction with other employees will be necessary?
5. Interview questions should be open-­ended and force applicants to explain past behavior rather than questions that call for one word answers.
6. If their delegation is unsuccessful, they must do the work themselves, which tends to result in unfulfilled
employees and burned out managers.
7. Four communication skills managers must possess when directing employees are:
•
•
•
•
Listening
Providing feedback
Coaching
Leading
8. Three qualities that can help make a payroll manager a strong leader include:
•
•
•
Having a vision
Building team support
Seeking partners
9. Often the best performers are driven by a personal need to succeed and be the best rather than by money
or other incentives.
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10. Possible rewards for employees who have demonstrated leadership potential include:
•
•
•
•
Public recognition
Promotion to supervisory positions
Leadership roles (projects, teams or tasks)
Taking them into your confidence (seeking their input)
11. A payroll manager’s report to upper management should have the following characteristics:
•
•
•
Include only the relevant information
The information should be produced in a timely manner
It should be written clearly but briefly
12. There are several things the payroll manager can do to ensure that the lessons a crisis has taught are not
forgotten:
•
•
•
•
•
Conduct a meeting of the team to discuss the crisis and determine which of the problems that
occurred during the crisis are preventable
Initiate a plan to prevent those problems that can be prevented from reoccurring
List the successful results of the crisis management operation and include them in a “Crisis File” for
future reference
List all the issues that were not satisfactorily resolved and formulate procedures to resolve them
Express your appreciation to your staff once again for their hard work during the crisis
13. The four combinations of time categories are:
•
•
•
•
Urgent and important—­crisis management, immediate attention needed
Not urgent but important—­planning and prevention activities
Urgent but not important—­pressing activities that may be easy to accomplish
Not urgent and not important—­easily accomplished, time-­wasting activities
14. Following are the characteristics that define effective teams and team players:
•
•
•
•
•
•
•
•
•
•
•
•
The team has clear and specific goals and objectives.
Team meetings have a relaxed atmosphere where members can offer help and share experiences.
Each member has a role in reaching the team’s goals.
Team members listen without judging and with interest in what others are saying.
There is civilized disagreement among team members, who criticize constructively.
Decisions are reached by a consensus of support, not unanimity, with even disagreeing members pledging to support the final decision.
There is open communication and trust among members.
Each member has a clear assignment.
All members are responsible for the team’s success or failure.
The team builds networks with employees outside the team and asks for their feedback.
The team contains a diversity of employee styles—­contributors, collaborators, communicators, and
challengers.
The team performs a formal or informal self-­assessment.
15. When conducting performance appraisals, managers often make these common mistakes:
•
•
•
78
Guilt over negative evaluations
No accountability for the manager
Improper application of standards
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Answer Key
16. Some of the forms of guidance in interpreting tax laws, other than IRS regulations, include:
•
•
•
•
•
•
Revenue Procedures
Revenue Rulings
Private Letter Rulings
Publications
Announcements, Notices, and News Releases
Field Service Advice, Service Center Advice, Internal Legal Memoranda
17. Union contract obligations can affect the following areas of payroll processing:
•
•
•
•
•
•
Dues checkoffs
Fringe benefit contributions
Upcoming layoffs
Wage increases
Probationary employees
Overtime and other premium pay
18. Once the type of meeting has been determined, the manager leading the meeting should take the following steps:
•
•
•
•
Prepare an agenda
Keep the meeting on track
Promote participation
Keep written records
19. The four stages of team development are:
•
•
•
•
Forming
Storming
Norming
Performing
True or False Questions
1. False
2. True
Most payroll managers achieve their position because of their technical proficiency.
3. True
4. True
5. False
Timely completion of subtasks will lead to attainment of the objectives.
7. False
At all times during the hiring process—­f rom job analysis through interviewing and
orientation—­the payroll manager must keep in mind the legal requirements surrounding the
process.
6. True
8. True
9. False
10. False
11. False
The payroll manager must decide which employee will be assigned the responsibility for each
task or portion of a task in the department.
Use a different training method before resorting to discipline.
Training can improve skills and knowledge, not attitude.
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12. True
13. True
14. True
15. True
16. True
17. True
18. False
19. False
20. True
21. False
22. True
23. False
24. True
25. False
Counseling should not be used by a payroll manager when an employee has a severe personal
problem. The employee should be referred to an appropriate employee counseling program if
the employer has an Employee Assistance Program.
While most payroll managers do not like to think about it, crisis management is one of the
most important leadership tests they will have.
Managers who are constantly moving from crisis to crisis, or who fail to delegate properly,
have no time to focus on the payroll department’s overall mission of quality service or their
own personal goals and objectives.
Performance evaluations are a formal way of giving feedback. They provide a form and written
record of how employees are performing relative to present goals that are designed to help the
department and company meet their overall business goals.
The final stage of team development is performing.
Multiple Choice Questions
80
1. c
8. c
15. d
2. b
9. d
16. b
3. a
10. a
17. a
4. c
11. c
18. d
5. d
12. d
19. c
6. a
13. b
20. b
7. d
14. c
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Answer Key
SECTION 14: PAYROLL FOR U.S. EMPLOYEES
ABROAD AND ALIENS IN THE U.S.
Review Questions
1. Reasonable housing expenses do not include the following:
•
•
•
•
Telephone and cable television charges
Capital expenditures such as mortgage payments or furniture
Cost of domestic labor such as a maid or gardener
Lavish or extravagant expenses under the circumstances
2. An employee’s tax home is the location of his or her regular place of business. If there is none, the employee’s tax home is where the employee regularly lives.
3. Whether an expatriate employee is a bona fide resident of a foreign country depends on the following
factors:
•
•
•
•
•
Whether the employee brings his or her family and they intend to make the foreign country their
home for the duration of the assignment
Purchase of a home or signing a long-­term lease in the foreign country
Involvement in the culture and social life of the foreign country
The terms of the employment agreement regarding the foreign assignment
The type of visa or residence permit secured by the employee
4. This test is met if the expatriate employee has a foreign tax home and is physically present in a foreign
country (or countries) for 330 full days during any consecutive 12-­month period.
5. Foreign earned income is income earned by an employee from sources within a foreign country while that
employee has a foreign tax home and qualifies for the foreign earned income exclusion under the bona fide
residence or physical presence test. Earned income includes all compensation, such as wages, salaries, commissions, bonuses, tax reimbursements, cost of living allowances, educational reimbursements, professional
fees, etc., paid for personal services rendered, including noncash payments.
6. Totalization agreements are agreements between the U.S. and another country under which expatriate
employees working “temporarily” in the foreign country would be subject to U.S. social security tax only.
Wages earned by employees working “permanently” in the foreign country would be subject only to the
foreign country’s social security taxes. The reverse is also true for foreign employees working in the U.S.
7. Income tax treaty benefits include:
•
•
•
•
•
Nondiscrimination clauses allowing resident aliens to qualify for the foreign earned income and housing cost exclusions under the bona fide residence test as well as the physical presence test
A partial or total exemption from taxation by the foreign country for an employee’s wages for personal
services performed in the treaty country if the employee’s stay is short and certain other requirements
are met
Wages received by a U.S. teacher or professor in a treaty country are exempt from foreign taxes under
most treaties for temporary periods of up to 2 or 3 years
Amounts received by U.S. residents for study, research, or business and technical training are generally
exempt from the treaty country’s income tax
To avoid double taxation, tax treaties provide for credits and deductions to reduce taxes imposed by the
foreign country
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8. An education allowance is added compensation for an expatriate employee so the employee can send his or
her children to a private or boarding school.
9. Tax protection plans attempt to guarantee that the employee will be reimbursed by the employer to the
extent that the employee’s combined income and social security taxes in the U.S. and the foreign country
exceed the amount the employee would have paid if living and working in the U.S.
10. Tax equalization plans ensure that all expatriates continue to incur a tax burden equal to what they would
incur if they were living and working in the U.S., regardless of the actual foreign tax liability.
11. The following factors generally indicate an employee’s domicile:
•
•
•
•
•
•
•
Where the employee votes
Where the employee maintains a residence
Where the employee’s immediate family lives and where children attend school
Whether the employee owns a new abode or has a short-­term lease
Where the employee returns after vacations or other leaves from work
The state issuing the employee’s driver’s license
Where bank accounts and business associations are maintained
12. Some of the factors that generally indicate residency include:
•
•
•
•
Physical presence
Where family members live and children attend school
Where the employee works, has business interests, and owns property
Where bank accounts and business interests are maintained
13. Under the Internal Revenue Code, an alien qualifies as a resident if he or she meets either one of two
tests—­the lawful permanent resident test or the substantial presence test. Otherwise, the alien is a nonresident alien.
14. The substantial presence test to determine an alien’s tax status requires the following:
•
•
That the alien be present in the U.S. for at least 31 days during the current calendar year
That the total of the number of days of U.S. presence during the current calendar year, plus one-­third
of the U.S. days during the first preceding calendar year, plus one-­sixth of the U.S. days during the
second preceding calendar year, be at least 183 days (no rounding allowed—­f ractions must be used)
15. The specific conditions that must be satisfied for the “commercial traveler” exemption to apply are as
follows:
•
•
•
The nonresident alien employee is in the U.S. for no more than a total of 90 days during the taxable
year
Compensation received for work performed in the U.S. totals no more than $3,000 during the taxable
year
The nonresident alien is employed by: a U.S. employer in a foreign country or a U.S. possession or by a
foreign employer not engaged in a trade or business in the U.S.
True or False Questions
1. True
2. False
3. True
82
The total exclusion is up to the first $105,900 of foreign earned income in 2019.
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Answer Key
4. False
5. True
6. True
7. False
8. True
9. True
10. False
11. True
12. True
13. False
14. True
For purposes of the §911 exclusions, all territories of the U.S., including Guam, are not considered foreign countries.
Travel and living expense reimbursements for employees on a temporary foreign assignment
may be excluded from income as reimbursed employee business travel expenses if they are
provided under an accountable plan.
Reimbursements for nondeductible moving expenses incurred for a move from the U.S. to a
foreign country are included in foreign earned income.
The foreign earned income exclusion is available to each spouse to the extent that each spouse
actually has foreign earned income.
15. True
16. True
17. True
18. False
19. False
20. True
Employers cannot require nonresident aliens to produce their social security cards as proof
of authorization to work in the U.S. The alien can produce any approved document to show
work authorization.
In general, social security and Medicare taxes apply to all wages paid for work performed in
the U.S., regardless of the citizenship or residency status of the employee (unless exempted by
a totalization agreement).
21. True
22. True
Multiple Choice Questions
1. c
8. b
15. c
2. b
9. d
16. b
3. d
10. b
17. d
4. b
11. a
18. d
5. c
12. c
19. a
6. d
13. c
20. c
7. b
14. a
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SECTION 15: PREPARING FOR THE CPP
EXAM
Practice Test Number 1
1. a
10. b
19. b
2. c
11. b
20. c
3. a
12. d
21. c
4. c
13. c
22. c
5. c
14. b
23. c
6. b
15. d
24. c
7. c
16. c
25. b
8. a
17. a
9. c
18. c
Practice Test Number 2
84
1. c
11. d
21. b
2. a
12. c
22. d
3. b
13. c
23. d
4. d
14. a
24. c
5. b
15. d
25. c
6. d
16. b
7. d
17. a
8. d
18. c
9. d
19. a
10. d
20. a
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Answer Key
Practice Test Number 3
1. c
10. a
19. c
2. b
11. a
20. b
3. b
12. c
21. c
4. c
13. a
22. c
5. c
14. b
23. c
6. b
15. b
24. b
7. d
16. d
25. c
8. d
17. c
9. a
18. c
Practice Test Number 4
1. c
10. a
19. b
2. b
11. c
20. c
3. a
12. c
21. b
4. d
13. a
22. c
5. a
14. d
23. a
6. d
15. c
24. d
7. a
16. c
25. b
8. b
17. a
9. d
18. b
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85
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From: APA Digital Publications (bookshelf.americanpayroll.org)
Bonus CPP Exam Questions and Answers
BONUS CPP EXAM QUESTIONS AND
ANSWERS
_____ 1. Which of the following features is LEAST likely to be considered when looking at the security of a
new payroll system?
a.
b.
c.
d.
regular data back-­up and storage
protection against computer viruses
limited system access
system edits
_____ 2. Company deadlines for payroll data input documents are essential for:
a.
b.
c.
d.
timely processing of the payroll
accurate entry of data
guaranteeing that all information is processed
adequate auditing purposes
_____ 3. An employee earns $9 per hour and an additional 10 cents per hour for hours worked after 7:00 p.m.
If an employee works from 2:00 p.m. to 11:00 p.m., with an unpaid meal break from 6:00 p.m. to 7:00
p.m., Monday through Friday, what is the employee’s weekly gross pay under the Fair Labor Standards
Act?
a.
b.
c.
d.
$360
$361
$362
$364
_____ 4. The BEST reason for tracking pay-­related problem statistics is to enable Payroll to:
a.
b.
c.
d.
identify root causes and take actions to prevent similar recurrences
apologize to clients in a more professional manner
direct problems to those who caused the problem
justify more resources to handle more problems
_____ 5. With regard to employees’ reported tips, the employer must:
a. withhold and pay only the employees’ portion of social security and Medicare taxes on tips
b. report taxes on tips separately when making an employment tax deposit
c. report tips as wages on Form W-­2 and pay the employer portion of social security
and Medicare taxes
d. report and pay the employer portion of social security and Medicare taxes on the
portion of cash tips above the federal minimum wage
_____ 6. Transactions are recorded in chronological order into books of original entry called:
a.
b.
c.
d.
registers
vouchers
invoices
journals
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CPP-1
The Payroll Source
_____ 7. The KEY advantage of using an automated time and attendance system is that it:
a.
b.
c.
d.
identifies phantom employees
reduces errors
interfaces with the payroll system
frees supervisors from having to review hours
_____ 8. As part of the implementation of a new payroll system, all transactions from the most recent actual
payroll are processed in the new system prior to using the system to run payrolls. This is an example
of what type of testing?
a.
b.
c.
d.
compliance
back-­up
ongoing
parallel
_____ 9. To exhibit good customer service skills, payroll staff must understand and be able to explain:
a.
b.
c.
d.
payroll forms
benefits enrollment techniques
systems design decisions
strategic departmental direction
_____ 10. Under the FLSA, what is the compensation due an employee whose rate of pay is $8 per hour and who
is paid for 52 hours during one workweek, including 8 hours of sick pay?
a.
b.
c.
d.
$416
$432
$448
$464
_____ 11. All of the following data elements are required to be maintained in the employee masterfile EXCEPT:
a.
b.
c.
d.
social security number
birth date
marital status
hourly rate of pay
_____ 12. Upward communication involves:
a.
b.
c.
d.
dissemination of management decisions to the staff
interactions between you and your manager
passing information to management
conducting quality circle meetings
_____ 13. The fact that transactions affect two separate accounts of a business is called:
a.
b.
c.
d.
CPP-2
compound-­entry accounting
double-­entry accounting
accrual accounting
T-­accounting
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Bonus CPP Exam Questions and Answers
_____ 14. A company pays all executives semimonthly. The FLSA requires all other employees to be paid on:
a.
b.
c.
d.
a weekly cycle
a biweekly cycle
a semimonthly cycle
any established cycle
_____ 15. Calculate the employee’s gross pay under the FLSA based on the following data:
Rate of pay per hour: $8.00
Production bonus: $25.00
Shift differential per hour: $0.25
Total shift hours in workweek: 44
a.
b.
c.
d.
$380.64
$377.00
$404.50
$405.64
_____ 16. Which of the following answers BEST defines the term nonexempt under the FLSA?
a.
b.
c.
d.
a lower-­paid class of employees
hourly-­paid workers only
employees who must be paid overtime
a special class of employees as determined by the employer
_____ 17. For how many years must the employer’s copy of Form 940 be retained?
a.
b.
c.
d.
2
3
4
5
_____ 18. Copies of the production files and most recent payroll transactions are sent nightly to the parent company in a remote location. This practice is part of what type of plan?
a.
b.
c.
d.
security
control
disaster recovery
maintenance
_____ 19. Employees who are not eligible for direct deposit and receive paychecks sent through the mail are
constructively paid:
a.
b.
c.
d.
on the check date
when the checks were postmarked
when the checks were delivered
when the checks were cashed
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CPP-3
The Payroll Source
_____ 20. Which of the following factors provides system security?
a.
b.
c.
d.
access level authorizations
shared passwords
conducting “physical payouts”
segregation of duties
_____ 21. Under the FLSA, how long are employers required to keep records relating to wages, hours, and conditions of employment?
a.
b.
c.
d.
3 years
4 years or until the file is no longer active
7 years
permanently
_____ 22. What is the payroll department manager responsible for in a company with strong internal controls?
a.
b.
c.
d.
assuring segregation of duties in the department
developing company policy
initiating payroll transactions
writing the internal audit transaction test plan
_____ 23. The process of balancing multiple time sheets within a specified pay period utilizes a
procedure known as:
a.
b.
c.
d.
batch totaling
exception reporting
system documentation
reconciliation
_____ 24. In 2019, an individual worked for three employers during the calendar year, earning $38,000, $47,000,
and $50,000 respectively. What is the total amount of social security and Medicare taxes that should
be withheld from the employee’s wages by the three employers?
a.
b.
c.
d.
$9,065.25
$9,843.90
$9,730.80
$10,327.50
_____ 25. On what form must mistakenly paid wages, for which no repayment is made, be reported?
a.
b.
c.
d.
W-­2
W-­4
1099-­R
1099-­MISC
_____ 26. A report has been requested that is NOT a standard report from the system. This type of report is
called a(n):
a.
b.
c.
d.
CPP-4
ad-­hoc report
integrated report
batch system report
edit report
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Bonus CPP Exam Questions and Answers
_____ 27. A procedure to have a time record signed by an employee indicates:
a.
b.
c.
d.
authorization for payment
confirmation of total hours
hours cannot be challenged
time spent at the establishment
_____ 28. For an employee earning $10.20 per hour and participating in a 401(k) plan with a deferral per pay
period of $50, compute the federal income taxable wages based on the following:
Biweekly pay period
Regular 80 hours
4 hours overtime
3 hours double-­time
a.
b.
c.
d.
$731.40
$888.40
$898.60
$938.40
_____ 29. Which of the following statements is CORRECT regarding a federal tax levy?
a.
b.
c.
d.
It does not have to be honored if any other garnishments have been served.
It requires a new order for each pay period.
It is limited only by the amount of the employee’s net pay.
It is continued each pay period until a release of levy is received.
_____ 30. Penalties for failure to make timely deposits are determined by:
a.
b.
c.
d.
a flat rate of 10% for late deposits
5% of the undeposited amount with a maximum of $100,000
15% of the undeposited amount with a maximum of $100,000
a four-­tiered penalty structure based on the number of days the deposit is late
_____ 31. An employer may exclude a business expense reimbursement from income when the employee’s
expenses meet which of the following requirements?
a. Reimbursements are made with regular payroll.
b. Expenses are substantiated and excess advances are returned timely.
c. Expenses are business-­related, substantiated, and excess advances are retained
for future travel.
d. Expenses are business-­related, substantiated, and excess advances are returned
timely.
_____ 32. Under the FLSA, a workweek is defined as:
a.
b.
c.
d.
any 7 consecutive 24-­hour periods
Sunday through Saturday
a minimum of a 40-­hour/5-­day time frame
stated in a collective bargaining agreement
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
CPP-5
The Payroll Source
_____ 33. At least how often must employers report noncash fringe benefits as income for federal tax withholding purposes?
a.
b.
c.
d.
each pay period
monthly
quarterly
annually
_____ 34. Certain company records must be retained for four years to comply with regulations of which of the
following agencies?
a.
b.
c.
d.
U.S. Citizenship and Immigration Services
Internal Revenue Service
Social Security Administration
Wage and Hour Division, Department of Labor
_____ 35. To build morale and motivate staff, a manager must:
a.
b.
c.
d.
give good reviews and raises
reward “stars” and promote competition within each team
delegate accountability to staff members
be sincere and specific with praise
_____ 36. From which of the following taxes are statutory workers’ compensation payments exempt?
a.
b.
c.
d.
federal income tax only
social security and Medicare taxes only
federal unemployment tax only
federal income, social security, Medicare, and federal unemployment taxes
_____ 37. Which of the following items represents an input interface to the payroll system?
a.
b.
c.
d.
general ledger
time and attendance
benefit payments
material usage records
_____ 38. A company has a gross payroll of $120,589.36 that is taxable for federal income, social security, and
Medicare taxes. Federal income tax withheld is $24,117.87; combined social security and Medicare
taxes withheld are $9,225.09. What is the company’s total payroll tax liability for this pay period?
a.
b.
c.
d.
$33,342.96
$42,568.05
$40,156.26
$66,685.92
_____ 39. One reason many companies use a Zero Balance Checking Account is that:
a.
b.
c.
d.
CPP-6
cash is available for investment until items are presented for payment at the company’s bank
funds do not have to be deposited until the employee cashes the check
the company receives interest on the account
bank reconciliations are not required
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Bonus CPP Exam Questions and Answers
_____ 40. In a customer service situation, Payroll should:
a.
b.
c.
d.
assure the caller everything is okay, even when it is not
get in the last word
avoid addressing stressful issues
remain assertive and stay focused
_____ 41. Each of the following items qualifies as a de minimis fringe benefit EXCEPT:
a.
b.
c.
d.
occasional parties and picnics for employees
occasional supper money for working overtime
traditional holiday gifts, such as food items
group legal services worth less than $100 annually
_____ 42. All of the following steps are required when initiating direct deposit for an employee EXCEPT:
a.
b.
c.
d.
prenotification
receiving financial institution routing number
getting authorization from the employee
receiving employee’s bank account number
_____ 43. When paying supplemental wages along with regular wages WITHOUT specifying the amount of
each, how would a company determine the amount of income tax to withhold from the supplemental
wages if the employee has been paid no supplemental wages so far during the year and the supplemental wage payment is no more than $1,000,000?
a.
Withhold a flat 22% from the supplemental wages and withhold from regular wages using the
appropriate table.
b. Withhold a flat 22% from the supplemental wages.
c. Withhold income tax as if the total were a single wage payment for a regular
payroll period.
d. Compute income tax withholding on the regular wages separate from the supplemental wages.
_____ 44. An employer that deposits payroll taxes semiweekly incurs a tax liability of $55,000 on Tuesday and a
tax liability of $110,000 on Wednesday. When must the taxes be deposited?
a.
b.
c.
d.
$55,000 on Thursday and $110,000 on Friday
$55,000 on Friday and $110,000 on the next Wednesday
$110,000 on Thursday and $55,000 on Friday
$165,000 on Thursday
_____ 45. Documenting payroll policies and procedures will provide all of the following results EXCEPT:
a.
b.
c.
d.
a vehicle for improving processes
a tool for assessing internal business controls
a mechanism for educating payroll partners, suppliers, and customers
assurances of payroll personnel competency and performance
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From: APA Digital Publications (bookshelf.americanpayroll.org)
CPP-7
The Payroll Source
_____ 46. Which of the following records MUST be kept for four years?
a.
b.
c.
d.
hours worked
time cards
OSHA records
voided payroll checks
_____ 47. Techniques for conducting periodic physical payouts:
a.
b.
c.
d.
are the same for all employees
vary by whether the employee is paid by check or direct deposit
vary for some employees such as telecommuters
vary by wage class and compensation level
_____ 48. Which of the following plans describes a cafeteria plan under section 125 of the Internal Revenue
Code?
a. a quantified and accountable expense reimbursement plan
b. a tax-­qualified retirement plan for public educational institutions
c. a plan which permits employees to select from two or more qualified taxable and
nontaxable benefits
d. a plan whereby state government employees may request that pretax dollars be
set aside in a re-­tirement account until age 59
_____ 49. Using federal child support guidelines, calculate the maximum amount of support that can be withheld from an employee’s semimonthly disposable earnings of $1,500.00. The employee is four months
in arrears in making child support payments and has no other dependents.
a.
b.
c.
d.
$750.00
$825.00
$900.00
$975.00
_____ 50. Employers in non-­credit reduction states that pay their state unemployment taxes on time can deduct
up to what percentage from the full FUTA tax rate in calculating their FUTA tax payments?
a.
b.
c.
d.
0.6%
4.5%
5.4%
6.0%
_____ 51. Which of the following items determines the disposition of unclaimed wages?
a.
b.
c.
d.
CPP-8
state law only
federal law only
federal and state law
no recognized procedures exist
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Bonus CPP Exam Questions and Answers
_____ 52. An employee is terminated with 3 workdays remaining in a month. The employee earned an annual
salary of $24,000 and was paid semimonthly. What is the regular compensation due this employee for
the final pay period?
a.
b.
c.
d.
$723.07
$782.61
$800.00
$869.57
_____ 53. Employee deferrals under section 401(k) are subject to which taxes?
a.
b.
c.
d.
federal income, social security, and Medicare taxes
social security and Medicare taxes only
social security, Medicare, and FUTA taxes
federal income, social security, Medicare, and FUTA taxes
_____ 54. What does it mean if, at the end of an accounting period, a company has a debit balance in a liability
account?
a.
b.
c.
d.
The company has underdeposited taxes withheld from employee wages.
The company has not yet paid the third party.
The company has withheld too much from the employee.
The company has paid to a third party more than was withheld from the
employee.
_____ 55. All of the following factors are advantages of having an in-­house developed payroll/HR system
EXCEPT:
a.
b.
c.
d.
scheduling flexibility
user groups
security
control of the system
_____ 56. A payroll department manager should assure:
a.
b.
c.
d.
an independent mission statement
appropriate training and equipment resources for staff members
immediate enactment of employee suggestions
top payment of staff
_____ 57. Which of the following statements describes a self-­insured workers’ compensation plan?
a.
b.
c.
d.
The state pays the workers’ compensation payments.
The employer funds the workers’ compensation payments.
The wages will continue as if the employee is still working.
The individual employee is responsible for his own insurance.
_____ 58. The proper handling of a stop payment includes all of the following steps EXCEPT:
a.
b.
c.
d.
reversing the direct deposit
canceling the payment in the payroll system
notifying the bank account reconciliation employees
documenting the reason for the transaction
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
CPP-9
The Payroll Source
_____ 59. An employee is paid $10 per hour plus a 10% differential for evening shifts. During the past week, the
employee worked 24 hours on the day shift and 24 hours on the evening shift. Under the FLSA, what
are the employee’s gross wages for the week?
a.
b.
c.
d.
$572.00
$522.64
$520.00
$546.00
_____ 60. Using the 2019 percentage method withholding tables, calculate the employee’s withheld federal
income tax based on the following data:
Weekly pay frequency
Vacation earnings: $360.62
Regular compensation: $339.38
401(k) pre-­tax deferral: $48.50
Married, 0 allowances
a.
b.
c.
d.
$44.22
$34.97
$55.12
$43.48
_____ 61. A request for proposal (RFP) can be used to:
a.
b.
c.
d.
provide vendors with technical and functional system requirements
request funds during a budget process
analyze needs for the system
assign programming resources to enhance functionality
_____ 62. The Family and Medical Leave Act requires employers to maintain records for at least:
a.
b.
c.
d.
12 weeks
1 year
2 years
3 years
_____ 63. A nonexempt employee earns $400 per week for a normal schedule of 35 hours. Under the FLSA, how
much would this employee be due if 48 hours were worked?
a.
b.
c.
d.
$400.00
$594.40
$548.64
$433.32
_____ 64. How may federal income tax be withheld from separation pay and accrued vacation wages totaling
$20,000 that are paid at the time of termination and identified separately on the employee’s pay stub,
if the employee has been paid $25,000 so far this year and had income tax withheld from her most
recent wage payment?
a.
b.
c.
d.
CPP-10
using the aggregate method only
using the prior 12 months’ tax rate
at the optional flat rate for all payouts at termination only
at the optional flat rate or using the aggregate method
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Bonus CPP Exam Questions and Answers
_____ 65. A payroll register for the pay period shows gross earnings of $300,000 and deductions of $120,000.
The entry to the payroll expense account would be:
a.
b.
c.
d.
$120,000
$180,000
$300,000
$420,000
_____ 66. Payroll system user documentation should include:
a.
b.
c.
d.
a copy of the RFP
copies of project development documents
details of disaster recovery procedures
the history of the payroll system conversion
_____ 67. When checking for phantom employees, which of the following actions should be taken?
a. Notify the employees of an impending physical payout.
b. Have the managers hand checks out to their employees.
c. Have employees pick up checks and direct deposit/paycard advices and show
identification.
d. Mail checks directly to employees’ homes.
_____ 68. An employee is to be awarded a net bonus of $2,000 as supplemental wages in 2019. Year-­to-­date regular and supplemental earnings are $15,000. Using the current optional flat tax rate and social security
and Medicare tax rates, what should be the gross amount of the payment if the employee lives and
works in a state with no income tax?
a.
b.
c.
d.
$2,842.93
$2,906.98
$2,666.67
$2,883.92
_____ 69. Which form is used to request an employer identification number?
a.
b.
c.
d.
I-­9
SS-­4
SS-­5
SS-­8
_____ 70. One element of a payroll calendar is:
a.
b.
c.
d.
pay frequency
hire dates
total remuneration
social security numbers
_____ 71. With online input, what is the BEST way to control miscellaneous payments?
a.
b.
c.
d.
verification of a sample of entered data
a visual audit of the online activity report
an auditor’s comparison of each input source document to the data base record
a comparison of the online report totals to predetermined totals taken from the
source documents
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
CPP-11
The Payroll Source
_____ 72. All of the following actions demonstrate a strong customer service orientation EXCEPT:
a.
b.
c.
d.
exhibiting a customer friendly attitude
viewing customers as the most important part of the job
using voice mail to answer phone calls from customers
establishing relationships with people
_____ 73. Employer-­sponsored athletic facilities may be nontaxable fringe benefits if the:
a. employer requires substantiation of the amount, time, and business purpose of the facilities’ use
b. employer incurs no substantial additional cost, except labor, to provide the
facilities
c. facilities are on the employer’s premises
d. facilities qualify as a de minimis fringe
_____ 74. When an employer is advised by the IRS that an employee’s Form W-­4 is invalid, what action must
the employer take?
a. All future Forms W-­4 must be sent to the IRS as long as the employee is being paid.
b. Employers have no obligation to change exemptions unless notified by the
employee through a new Form W-­4.
c. Withhold on the basis of information provided by the IRS.
d. The employer should send notice at the end of the quarter, requesting that the
employee contact the IRS to clear up the problem.
_____ 75. A team comprised of members of a department’s staff with the intention of improving their own process is a:
a.
b.
c.
d.
cross-­functional team
conversion team
functional team
management team
_____ 76. An employee who works for more than one employer and has exceeded the social security wage base
may:
a.
b.
c.
d.
take a credit against federal income tax on Form 1040
demand that the employer refund the overage
apply the social security tax to next year’s withholdings
apply the overage to benefits paid at age 65
_____ 77. When determining the value of employer-­provided parking, which of the following valuation methods is allowed?
a.
b.
c.
d.
CPP-12
employer’s cost
employee’s cost
lower of employee’s cost or fair market value
fair market value
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From: APA Digital Publications (bookshelf.americanpayroll.org)
Bonus CPP Exam Questions and Answers
_____ 78. What is the purpose of the payroll accrual entry?
a.
b.
c.
d.
to recognize expenses in the period in which they were incurred
to reverse an entry made in error
to recognize expenses in the period in which they were paid
to reverse an entry from a previous period
_____ 79. Which of the following steps is LEAST important during the parallel testing phase of a new payroll
system?
a.
b.
c.
d.
the testing of employee earnings and deductions accuracy
the verification of employees transferred to the new system from the old system
the verification of tax withholding calculations for employees
testing the functionality of a wage attachment process
_____ 80. All of the following practices are acceptable to an external auditor EXCEPT:
a.
b.
c.
d.
the accounting department reconciling the payroll checking account
the payroll supervisor verifying that deposits are made timely
storage of blank payroll checks in the payroll department
the treasury department being responsible for the signature of payroll checks
_____ 81. All of the following types of compensation are subject to social security tax EXCEPT:
a.
b.
c.
d.
tips under $100
deferred bonus
third-­party sick pay up to $3,000
workers’ compensation benefits
_____ 82. Which of the following outcomes is the PRIMARY advantage of developing an in-­house system?
a.
b.
c.
d.
Outsiders are not involved in a firm’s daily operations.
Costs are reduced and can be distributed on an equitable basis.
The employer controls the entire computer system.
Time is saved by not having to explain business policies and practices.
_____ 83. An employee covered by group health insurance at the time his employment terminates to return to
school is entitled to COBRA continuation rights for:
a.
b.
c.
d.
12 months
18 months
24 months
30 months
_____ 84. How often are Form 940 taxable wages reported?
a.
b.
c.
d.
annually
semi-­annually
quarterly
monthly
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
CPP-13
The Payroll Source
_____ 85. An employee claims married and two withholding allowances on her 2019 Form W-­4, is paid $1,700
biweekly, and defers $50 per pay period to a 401(k) plan. Using the percentage method, what is the
total of the biweekly deductions from the employee’s pay for federal income, social security, and Medicare taxes?
a.
b.
c.
d.
$219.89
$252.51
$299.66
$225.89
_____ 86. On a company’s financial statements, payroll tax expense appears in the:
a.
b.
c.
d.
balance sheet
accrued payroll
salaries expense
income statement
_____ 87. What is the chief advantage of a vendor payroll package?
a.
b.
c.
d.
reduced processing time
inexpensiveness and ease of installation
no required major in-­house system development
lower cost than a service provider contract
_____ 88. Which of the following elements is essential to a disaster recovery plan?
a.
b.
c.
d.
an excess supply of checks and direct deposit stubs
a compatible off-­site remote location to produce payrolls
detailed documentation of current company policies
a procedure for limiting security system access
_____ 89. Which of the following practices is a strong internal control procedure?
a.
b.
c.
d.
Have the payroll bank account reconciled in the payroll department.
Have the payroll manager distribute paychecks.
Place payroll checks under the personal control of the payroll manager.
Have a person other than the person who requested and authorized the payments prepare the payroll checks.
_____ 90. During 2019, an employee worked for company A and quit after earning $135,000. Later in the same
year the employee was hired by company B. With respect to social security, Medicare and FUTA, how
should company B treat the employee’s earnings as of the first wage payment?
a.
Start accumulating social security, Medicare, and FUTA wages, and withhold both social security
and Medicare taxes.
b. Start accumulating Medicare wages only, and withhold only Medicare tax.
c. Start accumulating social security, Medicare, and FUTA wages, but withhold
Medicare tax only.
d. Start accumulating Medicare wages only, but withhold both social security and
Medicare taxes.
CPP-14
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Bonus CPP Exam Questions and Answers
_____ 91. Which of the following documents proves an employee’s identity and authorization to work?
a.
b.
c.
d.
social security card
unexpired U.S. passport
birth certificate
Form I-­9
_____ 92. How are salaries reflected on the income statement?
a.
b.
c.
d.
income
assets
accruals
expenses
_____ 93. An employee is paid a bonus of $1,500 with a regular biweekly wage payment of $2,000 in 2019 that
is indicated separately on the employee’s pay stub. The employee has received no supplemental wages
so far this year. The employee has an elective deferral of 5% of regular wages made to the 401(k) plan
each pay period. For federal income tax withholding purposes, the company uses the optional flat rate
for all bonuses and the percentage method for regular wage payments. The employee’s W-­4 claims
married with 2 allowances. The employee has no state or local income taxes or any other deductions.
What is the employee’s net pay?
a.
b.
c.
d.
$2,670.41
$2,689.79
$2,682.41
$2,623.54
_____ 94. All of the following techniques would enhance the level of customer service EXCEPT:
a.
b.
c.
d.
adding more customer service personnel
publishing payroll customer service procedures, calendars, and directories
utilizing automated call processing tools to take and process caller inquiries
training company management on pay calculation and tax withholding rules
_____ 95. The KEY difference between user guides and payroll policies and procedures is:
a.
b.
c.
d.
User guides focus on tasks associated with automated tools.
Payroll policies and procedures set company policies and standards.
User guides help payroll personnel interpret company policy.
Payroll policies and procedures permit human resources to design new compensation and benefits programs.
_____ 96. A local national is defined as an employee:
a.
b.
c.
d.
from another country working in the U.S.
from the U.S. working in a foreign country
from a foreign company working in the U.S.
from a foreign country working in his or her home country location
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
CPP-15
The Payroll Source
_____ 97. What is the effect of failing to record salaries that are earned but not paid at the end of an accounting
period?
a.
b.
c.
d.
understatement of expenses for the period
overstatement of expenses for the period
understatement of assets for the period
overstatement of liabilities for the period
_____ 98. One employment data element in the masterfile is:
a.
b.
c.
d.
hourly rate of pay
marital status
birthdate
occupation
_____ 99. Which of the following authorities dictates the information provided on a payroll check stub?
a.
b.
c.
d.
individual states
Federal Unemployment Tax Act
Federal Wage and Hour Division
Social Security Administration
_____ 100.Which of the following forms may be submitted to the IRS in order to receive a written determination of a worker’s status as an employee or independent contractor?
a.
b.
c.
d.
CPP-16
Form W-­5
Form SS-­5
Form SS-­8
Form W-­9
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Bonus CPP Exam Questions and Answers
BONUS CPP EXAM QUESTIONS AND
ANSWERS —­ANSWER KEY
Question Number
Answer
2
A
1
3
4
5
D
Payroll Source Section Reference
C
(40 x $9) + (20 x $.10) = $362
A
12.5-­3
2.6
13.2-­4
C
3.4-­27
B
12.7
6
D
8
D
12.4-­5
10
B
(52 x $8) + ($8 x .5 x 4) = $432
2.6-­2
7
9
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
A
11.2
13.3-­7
C
10.8-­1
B
11.2
C
D
D
(44 x $8) + (44 x $.25) +$25 = $388
$388 ÷ 44 = $8.82
$388 + ($8.82 x .5 x 4)
$388 + $17.64 = $405.64
C
13.2-­5
2.1
2.6-­3
2.4
C
10.2
C
6.1
C
12.6
A
12.5-­3
A
11.8
A
A
D
($38,000 + $47,000 + $50,000) x 7.65% = $10,327.50
A
A
B
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
10.1
11.6-­1
6.7-­3
8.8-­3
12.4-­4
11.8
CPP-17
The Payroll Source
Question Number
28
29
30
31
32
B
Payroll Source Section Reference
(80 x $10.20) + (4 x $10.20 x 1.5) + (3 x $10.20 x 2) -­$50 = $888.40
4.6-­2
D
9.1-­1
D
3.3-­5
D
A
8.2-­3
2.6-­1
33
D
35
D
13.2-­3
37
B
12.2-­1
34
36
38
39
B
D
B
$24,117.87 + $9,225.09 + $9,225.09 = $42,568.05
3.5-­2
10.2
4.4-­1
8.2
A
11.6-­2
D
3.2-­1
40
D
42
A
41
13.3-­7
5.3-­2
43
C
45
D
12.5-­2
47
A
11.8
44
46
48
49
50
51
52
53
C
D
C
D
$1,500 x 65% = $975
6.4-­4
8.2-­1
10.2
4.5
9.1-­2
C
7.1-­6
A
2.6-­4
C
4.6-­2
A
($24,000 ÷ 24) -­(($24,000 ÷ 260) x 3) = $723.07
5.5
54
D
11.1-­2
56
B
13.2
55
57
58
CPP-18
Answer
B
B
A
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
12.3-­2
4.4-­2
5.3
Bonus CPP Exam Questions and Answers
Question Number
59
60
61
62
63
64
65
66
67
68
69
70
Answer
D
D
6.4-­2
A
12.4-­3
B
2.6-­4
$360.62 + $339.38 -­$48.50 = $651.50
$651.50 -­$600 = ($51.50 x 12%) +37.30 = $43.48
D
D
6.4-­4
C
12.5-­2
A
3.4-­11
B
8.1
C
11.2
C
11.8
$2,000 ÷ (100% -­(22% + 6.2% + 1.45%)) = $2,000 ÷ 70.35% = $2,842.93
A
2.6-­1, 5.1
C
13.3-­7
73
C
75
10.3-­5
400 ÷ 35 = $11.43
(48 x $11.43) + ($11.43 x .5 x 8) = $594.40
D
74
2.6-­4
(48 x $10) + (24 x $10 x 10%) = $504.00
$504.00 ÷ 48 = $10.50
($504.00 + ($10.50 x .5 x 8)) = $546.00
71
72
Payroll Source Section Reference
C
11.6-­1
3.2-­1
6.3-­1
C
13.3-­5
77
D
3.2-­1
79
D
12.4-­5
81
D
4.4-­1
83
B
76
78
80
82
84
85
86
A
A
C
6.7-­3
11.5
11.8
C
12.3-­2
A
7.1-­7
A
FIT: $1,700 -­$50 = $1,650 -­(2 X $161.50) -­$1,200 = $127 x 12% + 74.60 = $89.84
FICA: $1,700 x 7.65% = $130.05
$89.84 + $130.05 = $219.89
D
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From: APA Digital Publications (bookshelf.americanpayroll.org)
4.1-­5
6.4-­2
11.7-­2
CPP-19
The Payroll Source
Question Number
Answer
88
B
87
89
D
91
B
90
92
93
12.3-­2
12.6
11.8
A
6.7-­3
D
11.7-­2
1.8
C
4.6-­2, 6.4-­2, 6.4-­4, 6.7-­3
D
13.3-7
96
D
14.2
98
A
10.8-­1
C
1.2-­2
94
95
97
99
100
CPP-20
C
Payroll Source Section Reference
FIT: $2,000 -­$100 = $1,900 -­(2 x $161.50) = $1,577
$1,577-­$1,200 = (377 x 12%) + $74.60 = $119.84
$1,500 x 22% = $330
FICA: $3,500 x 7.65% = $267.75
$2,000 + $1,500 -­$100 -­$119.84 -­$330 -­$267.75 = $2,682.41
A
A
A
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From: APA Digital Publications (bookshelf.americanpayroll.org)
12.5-­2
11.3
5.4
APPENDIX—FEDERAL WITHHOLDING
TABLES, FORMS, AND INSTRUCTIONS
TABLE OF CONTENTS
Document Name
Page
Federal Withholding Tables
Percentage Method Allowance Table....................................................................................................A-3
Percentage Method Withholding Tables...............................................................................................A-4
Wage-­Bracket Withholding Tables.......................................................................................................A-6
Federal Forms and Instructions
Form I-­9—­Employment Eligibility Verification.................................................................................A-26
Form SS-­4—­Application for Employer Identification Number..........................................................A-44
Form SS-­5—­Application for a Social Security Card...........................................................................A-52
Form SS-­8—­Determination of Worker Status for Purposes of Federal
Employment Taxes and Income Tax Withholding.......................................................................A-57
Form SSA-­131—­Employer Report of Special Wage Payments..........................................................A-64
Form SSA-­1945—­Statement Concerning Your Employment in a Job Not Covered by Social
Security.........................................................................................................................................A-66
Form W-­2—­Wage and Tax Statement................................................................................................A-68
Form W-­3—­Transmittal of Wage and Tax Statements.......................................................................A-73
Form W-­2c—­Corrected Wage and Tax Statement.............................................................................A-74
Form W-­3c—­Transmittal of Corrected Wage and Tax Statements.....................................................A-76
General Instructions for Forms W-­2 and W-­3....................................................................................A-77
Form W-­4—­Employee’s Withholding Allowance Certificate...........................................................A-111
Form W-­4P—­W ithholding Certificate for Pension or Annuity Payments.......................................A-115
Form W-­4S—­Request for Federal Income Tax Withholding From Sick Pay...................................A-121
Form W-­7—­Application for IRS Individual Taxpayer Identification Number.................................A-123
Form W-­8BEN—­Certificate of Foreign Status of Beneficial Owner for United States Tax
Withholding and Reporting (Individuals)..................................................................................A-138
Form W-­9—­Request for Taxpayer Identification Number and Certification....................................A-146
Form 668-­D—­Release of Levy.........................................................................................................A-156
Form 668-­W—­Notice of Levy on Wages, Salary, and Other Income...............................................A-162
Form 673—­Statement for Claiming Exemption From Withholding on Foreign Earned
Income Eligible for the Exclusion(s) Provided by Section 911...................................................A-173
Form 843—­Claim for Refund and Request for Abatement..............................................................A-175
Form 940—­Employer’s Annual Federal Unemployment (FUTA) Tax Return.................................A-182
Schedule A (Form 940)—­Multi-­State Employer and Credit Reduction Information......................A-202
Schedule R (Form 940)—­Allocation Schedule for Aggregate Form 940 Filers................................A-204
Form 941—­Employer’s Quarterly Federal Tax Return......................................................................A-207
Schedule B (Form 941)—­Report of Tax Liability for Semiweekly Schedule Depositors..................A-223
Schedule D (Form 941)—­Report of Discrepancies Caused by Acquisitions, Statutory
Mergers, or Consolidations.........................................................................................................A-227
Schedule R (Form 941)—­Allocation Schedule for Aggregate Form 941 Filers................................A-233
Form 941-­X—­Adjusted Employer’s Quarterly Federal Tax Return or Claim for Refund................A-236
Form 943—­Employer’s Annual Federal Tax Return for Agricultural Employees.............................A-256
Form 943-­A—­Agricultural Employer’s Record of Federal Tax Liability...........................................A-268
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A-1
Form 944—­Employer’s Annual Federal Tax Return.........................................................................A-272
Form 945—­Annual Return of Withheld Federal Income Tax..........................................................A-288
Form 945-­A—­Annual Record of Federal Tax Liability....................................................................A-297
Notice 972CG—­Notice of Proposed Civil Penalty...........................................................................A-301
Form 1042—­Annual Withholding Tax Return for U.S. Source Income of Foreign Persons.............A-307
Form 1042-­S—­Foreign Person’s U.S. Source Income Subject to Withholding.................................A-320
Form 1042-­T—­Annual Summary and Transmittal of Forms 1042-­S...............................................A-359
Form 1094-­C—­Transmittal of Employer-­Provided Health Insurance Offer and Coverage
Information Returns...................................................................................................................A-361
Form 1095-­C—­Employer-­Provided Health Insurance Offer and Coverage.....................................A-364
Instructions for Forms 1094-­C and 1095-­C.....................................................................................A-367
Form 1096—­Annual Summary and Transmittal of U.S. Information Returns.................................A-384
Form 1099-­MISC—­Miscellaneous Income......................................................................................A-386
Form 1099-­R—­Distributions From Pensions, Annuities, Retirement or Profit-­Sharing Plans,
IRAs, Insurance Contracts, Etc...................................................................................................A-399
Form 2032—­Contract Coverage Under Title II of the Social Security Act......................................A-420
Form 2159—­Payroll Deduction Agreement......................................................................................A-422
Form 2555—­Foreign Earned Income...............................................................................................A-428
Form 2555-­EZ—­Foreign Earned Income Exclusion........................................................................A-443
Form 2678—­Employer/Payer Appointment of Agent......................................................................A-449
Form 2848—­Power of Attorney and Declaration of Representative.................................................A-454
Form 3921—­Exercise of an Incentive Stock Option Under Section 422(b).....................................A-462
Form 3922—­Transfer of Stock Acquired Through an Employee Stock Purchase Plan Under
Section 423(c).............................................................................................................................A-464
Instructions for Forms 3921 and 3922..............................................................................................A-466
Form 4070—­Employee’s Report of Tips to Employer......................................................................A-468
Form 4419—­Application for Filing Information Returns Electronically (FIRE).............................A-470
Form 7004—­Application for Automatic Extension of Time to File Certain Business Income
Tax, Information, and Other Returns..........................................................................................A-472
Form 8027—­Employer’s Annual Information Return of Tip Income and Allocated Tips...............A-477
Form 8027-­T—­Transmittal of Employer’s Annual Information Return of Tip Income and
Allocated Tips.............................................................................................................................A-488
Form 8233—­Exemption From Withholding on Compensation for Independent (and Certain
Dependent) Personal Services of a Nonresident Alien Individual...............................................A-489
Form 8508—­Request for Waiver From Filing Information Returns Electronically..........................A-496
Form 8655—­Reporting Agent Authorization...................................................................................A-498
Form 8809—­Application for Extension of Time to File Information Returns.................................A-501
Form 8846—­Credit for Employer Social Security and Medicare Taxes Paid on Certain
Employee Tips............................................................................................................................A-503
Form 8919—­Uncollected Social Security and Medicare Tax on Wages............................................A-505
Form 8922—­Third-­Party Sick Pay Recap..........................................................................................A-507
Form 8952—­Application for Voluntary Classification Settlement Program (VCSP).......................A-509
Form 14196—­Filing Statement.........................................................................................................A-514
Income Withholding for Support.....................................................................................................A-515
National Medical Support Notice.....................................................................................................A-526
Standard Response to Verification of Employment...........................................................................A-536
A-2
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Appendix
ALLOWANCE TABLE FOR WAGES PAID IN 2019
And wages are paid –
If the number
of withholding
allowances is:
WEEKLY
BIWEEKLY
$
$
SEMIMONTHLY
MONTHLY
QUARTERLY
SEMIANNUALLY
ANNUALLY
DAILY
OR
MISC.
$
$
The total amount of withholding allowances for the payroll period is:
0
—
—
$
—
$
—
$
—
$
—
—
—
1
80.80
161.50
175.00
350.00
1,050.00
2,100.00
4,200.00
16.20
2
161.60
323.00
350.00
700.00
2,100.00
4,200.00
8,400.00
32.40
3
242.40
484.50
525.00
1,050.00
3,150.00
6,300.00
12,600.00
48.60
4
323.20
646.00
700.00
1,400.00
4,200.00
8,400.00
16,800.00
64.80
5
404.00
807.50
875.00
1,750.00
5,250.00
10,500.00
21,000.00
81.00
6
484.80
969.00
1,050.00
2,100.00
6,300.00
12,600.00
25,200.00
97.20
7
565.60
1,130.50
1,225.00
2,450.00
7,350.00
14,700.00
29,400.00
113.40
8
646.40
1,292.00
1,400.00
2,800.00
8,400.00
16,800.00
33,600.00
129.60
9
727.20
1,453.50
1,575.00
3,150.00
9,450.00
18,900.00
37,800.00
145.80
10
808.00
1,615.00
1,750.00
3,500.00
10,500.00
21,000.00
42,000.00
162.00
Page 1 of 1
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A-3
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
The Payroll Source
Percentage Method Tables for Income Tax Withholding
(For Wages Paid in 2019)
TABLE 1—WEEKLY Payroll Period
(a) SINGLE person (including head of household)—
If the amount of wages
(after subtracting
The amount of income tax
withholding allowances) is: to withhold is:
Not over $73 . . . . . . . . . . $0
Over—
But not over—
of excess over—
$73
—$260 . . $0.00 plus 10%
—$73
—$260
$260
—$832 . . $18.70 plus 12%
$832
—$1,692 . . $87.34 plus 22%
—$832
$1,692
—$3,164 . . $276.54 plus 24%
—$1,692
$3,164
—$3,998 . . $629.82 plus 32%
—$3,164
$3,998
—$9,887 . . $896.70 plus 35%
—$3,998
—$9,887
$9,887 . . . . . . . . . . . . $2,957.85 plus 37%
(b) MARRIED person—
If the amount of wages
(after subtracting
withholding allowances) is:
Not over $227 . . . . . . . . .
Over—
But not over—
$227
—$600 . .
$600
—$1,745 . .
$1,745
—$3,465 . .
$3,465
—$6,409 . .
$6,409
—$8,077 . .
$8,077
—$12,003 . .
$12,003 . . . . . . . . . . .
TABLE 2—BIWEEKLY Payroll Period
(a) SINGLE person (including head of household)—
(b) MARRIED person—
If the amount of wages
If the amount of wages
(after subtracting
(after subtracting
The amount of income tax
withholding allowances) is:
withholding allowances) is: to withhold is:
Not over $146 . . . . . . . . . $0
Not over $454 . . . . . . . . .
Over—
But not over—
of excess over— Over—
But not over—
$146
—$519 . . $0.00 plus 10%
—$146
$454
—$1,200 . .
—$519
$1,200
—$3,490 . .
$519
—$1,664 . . $37.30 plus 12%
$1,664
—$3,385 . . $174.70 plus 22%
—$1,664
$3,490
—$6,931 . .
—$3,385
$6,931
—$12,817 . .
$3,385
—$6,328 . . $553.32 plus 24%
$6,328
—$7,996 . . $1,259.64 plus 32%
—$6,328 $12,817
—$16,154 . .
$7,996
—$19,773 . . $1,793.40 plus 35%
—$7,996 $16,154
—$24,006 . .
$19,773 . . . . . . . . . . . . $5,915.35 plus 37%
—$19,773 $24,006 . . . . . . . . . . .
TABLE 3—SEMIMONTHLY Payroll Period
The amount of income tax
to withhold is:
$0
of excess over—
$0.00 plus 10%
—$454
$74.60 plus 12%
—$1,200
$349.40 plus 22%
—$3,490
$1,106.42 plus 24%
—$6,931
$2,519.06 plus 32%
—$12,817
$3,586.90 plus 35%
—$16,154
$6,335.10 plus 37%
—$24,006
(a) SINGLE person (including head of household)—
(b) MARRIED person—
If the amount of wages
If the amount of wages
(after subtracting
(after subtracting
The amount of income tax
withholding allowances) is:
withholding allowances) is: to withhold is:
Not over $158 . . . . . . . . . $0
Not over $492 . . . . . . . . .
Over—
But not over—
of excess over— Over—
But not over—
$158
—$563 . . $0.00 plus 10%
—$158
$492
—$1,300 . .
$563
—$1,803 . . $40.50 plus 12%
—$563
$1,300
—$3,781 . .
—$1,803
$3,781
—$7,508 . .
$1,803
—$3,667 . . $189.30 plus 22%
$3,667
—$6,855 . . $599.38 plus 24%
—$3,667
$7,508
—$13,885 . .
$6,855
—$8,663 . . $1,364.50 plus 32%
—$6,855 $13,885
—$17,500 . .
$8,663
—$21,421 . . $1,943.06 plus 35%
—$8,663 $17,500
—$26,006 . .
$21,421 . . . . . . . . . . . . $6,408.36 plus 37%
—$21,421 $26,006 . . . . . . . . . . .
TABLE 4—MONTHLY Payroll Period
The amount of income tax
to withhold is:
$0
of excess over—
$0.00 plus 10%
—$492
$80.80 plus 12%
—$1,300
$378.52 plus 22%
—$3,781
$1,198.46 plus 24%
—$7,508
$2,728.94 plus 32%
—$13,885
$3,885.74 plus 35%
—$17,500
$6,862.84 plus 37%
—$26,006
(a) SINGLE person (including head of household)—
If the amount of wages
(after subtracting
The amount of income tax
withholding allowances) is: to withhold is:
Not over $317 . . . . . . . . . $0
Over—
But not over—
of excess over—
$317
—$1,125 . . $0.00 plus 10%
—$317
$1,125
—$3,606 . . $80.80 plus 12%
—$1,125
$3,606
—$7,333 . . $378.52 plus 22%
—$3,606
$7,333
—$13,710 . . $1,198.46 plus 24%
—$7,333
$13,710
—$17,325 . . $2,728.94 plus 32%
—$13,710
$17,325
—$42,842 . . $3,885.74 plus 35%
—$17,325
$42,842 . . . . . . . . . . . . $12,816.69 plus 37%
—$42,842
(b) MARRIED person—
If the amount of wages
(after subtracting
withholding allowances) is:
Not over $983 . . . . . . . . .
Over—
But not over—
$983
—$2,600 . .
$2,600
—$7,563 . .
$7,563
—$15,017 . .
$15,017
—$27,771 . .
$27,771
—$35,000 . .
$35,000
—$52,013 . .
$52,013 . . . . . . . . . . .
Page 46
A-4
The amount of income tax
to withhold is:
$0
of excess over—
$0.00 plus 10%
—$227
$37.30 plus 12%
—$600
$174.70 plus 22%
—$1,745
$553.10 plus 24%
—$3,465
$1,259.66 plus 32%
—$6,409
$1,793.42 plus 35%
—$8,077
$3,167.52 plus 37%
—$12,003
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
The amount of income tax
to withhold is:
$0
of excess over—
$0.00 plus 10%
—$983
$161.70 plus 12%
—$2,600
$757.26 plus 22%
—$7,563
$2,397.14 plus 24%
—$15,017
$5,458.10 plus 32%
—$27,771
$7,771.38 plus 35%
—$35,000
$13,725.93 plus 37%
—$52,013
Publication 15 (2019)
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
Percentage Method Tables for Income Tax Withholding (continued)
(For Wages Paid in 2019)
TABLE 5—QUARTERLY Payroll Period
(a) SINGLE person (including head of household)—
If the amount of wages
(after subtracting
The amount of income tax
withholding allowances) is: to withhold is:
Not over $950 . . . . . . . . . $0
Over—
But not over—
of excess over—
$950
—$3,375 . . $0.00 plus 10%
—$950
$3,375
—$10,819 . . $242.50 plus 12%
—$3,375
$10,819
—$22,000 . . $1,135.78 plus 22%
—$10,819
$22,000
—$41,131 . . $3,595.60 plus 24%
—$22,000
$41,131
—$51,975 . . $8,187.04 plus 32%
—$41,131
$51,975 —$128,525 . . $11,657.12 plus 35%
—$51,975
—$128,525
$128,525 . . . . . . . . . . . $38,449.62 plus 37%
(b) MARRIED person—
If the amount of wages
(after subtracting
withholding allowances) is:
Not over $2,950 . . . . . . .
Over—
But not over—
$2,950
—$7,800 . .
$7,800
—$22,688 . .
$22,688
—$45,050 . .
$45,050
—$83,313 . .
$83,313 —$105,000 . .
$105,000 —$156,038 . .
$156,038 . . . . . . . . . . .
TABLE 6—SEMIANNUAL Payroll Period
The amount of income tax
to withhold is:
$0
of excess over—
$0.00 plus 10%
—$2,950
$485.00 plus 12%
—$7,800
$2,271.56 plus 22%
—$22,688
$7,191.20 plus 24%
—$45,050
$16,374.32 plus 32%
—$83,313
$23,314.16 plus 35%
—$105,000
$41,177.46 plus 37%
—$156,038
(a) SINGLE person (including head of household)—
(b) MARRIED person—
If the amount of wages
If the amount of wages
(after subtracting
(after subtracting
The amount of income tax
withholding allowances) is:
withholding allowances) is: to withhold is:
Not over $1,900 . . . . . . . . $0
Not over $5,900 . . . . . . .
Over—
But not over—
of excess over— Over—
But not over—
$1,900
—$6,750 . . $0.00 plus 10%
—$1,900
$5,900
—$15,600 . .
—$6,750 $15,600
—$45,375 . .
$6,750
—$21,638 . . $485.00 plus 12%
$21,638
—$44,000 . . $2,271.56 plus 22%
—$21,638 $45,375
—$90,100 . .
—$44,000 $90,100 —$166,625 . .
$44,000
—$82,263 . . $7,191.20 plus 24%
$82,263 —$103,950 . . $16,374.32 plus 32%
—$82,263 $166,625 —$210,000 . .
$103,950 —$257,050 . . $23,314.16 plus 35%
—$103,950 $210,000 —$312,075 . .
—$257,050 $312,075 . . . . . . . . . . .
$257,050 . . . . . . . . . . . $76,899.16 plus 37%
TABLE 7—ANNUAL Payroll Period
The amount of income tax
to withhold is:
$0
of excess over—
$0.00 plus 10%
—$5,900
$970.00 plus 12%
—$15,600
$4,543.00 plus 22%
—$45,375
$14,382.50 plus 24%
—$90,100
$32,748.50 plus 32%
—$166,625
$46,628.50 plus 35%
—$210,000
$82,354.75 plus 37%
—$312,075
(a) SINGLE person (including head of household)—
(b) MARRIED person—
If the amount of wages
If the amount of wages
(after subtracting
(after subtracting
The amount of income tax
withholding allowances) is:
withholding allowances) is: to withhold is:
Not over $3,800 . . . . . . . . $0
Not over $11,800 . . . . . .
Over—
But not over—
of excess over— Over—
But not over—
$3,800
—$13,500 . . $0.00 plus 10%
—$3,800 $11,800
—$31,200 . .
$13,500
—$43,275 . . $970.00 plus 12%
—$13,500 $31,200
—$90,750 . .
—$43,275 $90,750 —$180,200 . .
$43,275
—$88,000 . . $4,543.00 plus 22%
$88,000 —$164,525 . . $14,382.50 plus 24%
—$88,000 $180,200 —$333,250 . .
$164,525 —$207,900 . . $32,748.50 plus 32%
—$164,525 $333,250 —$420,000 . .
$207,900 —$514,100 . . $46,628.50 plus 35%
—$207,900 $420,000 —$624,150 . .
$514,100 . . . . . . . . . . . $153,798.50 plus 37%
—$514,100 $624,150 . . . . . . . . . . .
TABLE 8—DAILY or MISCELLANEOUS Payroll Period
The amount of income tax
to withhold is:
$0
of excess over—
$0.00 plus 10%
—$11,800
$1,940.00 plus 12%
—$31,200
$9,086.00 plus 22%
—$90,750
$28,765.00 plus 24%
—$180,200
$65,497.00 plus 32%
—$333,250
$93,257.00 plus 35%
—$420,000
$164,709.50 plus 37%
—$624,150
(a) SINGLE person (including head of household)—
If the amount of wages
(after subtracting
withholding allowances)
divided by the number of
The amount of income tax
days in the payroll period is: to withhold per day is:
Not over $14.60 . . . . . . . . $0
Over—
But not over—
of excess over—
$14.60
—$51.90 . . $0.00 plus 10%
—$14.60
$51.90
—$166.40 . . $3.73 plus 12%
—$51.90
$166.40
—$338.50 . . $17.47 plus 22%
—$166.40
$338.50
—$632.80 . . $55.33 plus 24%
—$338.50
—$632.80
$632.80
—$799.60 . . $125.96 plus 32%
$799.60 —$1,977.30 . . $179.34 plus 35%
—$799.60
$1,977.30 . . . . . . . . . . . $591.54 plus 37%
—$1,977.30
(b) MARRIED person—
If the amount of wages
(after subtracting
withholding allowances)
divided by the number of
days in the payroll period is:
Not over $45.40 . . . . . . .
Over—
But not over—
$45.40
—$120.00 . .
$120.00
—$349.00 . .
$349.00
—$693.10 . .
$693.10 —$1,281.70 . .
$1,281.70 —$1,615.40 . .
$1,615.40 —$2,400.60 . .
$2,400.60 . . . . . . . . . . .
Publication 15 (2019)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
The amount of income tax
to withhold per day is:
$0
of excess over—
$0.00 plus 10%
—$45.40
$7.46 plus 12%
—$120.00
$34.94 plus 22%
—$349.00
$110.64 plus 24%
—$693.10
$251.90 plus 32%
—$1,281.70
$358.68 plus 35%
—$1,615.40
$633.50 plus 37%
—$2,400.60
Page 47
A-5
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
The Payroll Source
Wage Bracket Method Tables for Income Tax Withholding
SINGLE Persons—WEEKLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
$ 0
73
84
95
106
117
128
139
150
161
172
183
194
205
216
227
238
249
260
271
282
293
304
315
326
337
348
359
370
381
392
403
414
425
436
447
458
469
480
491
502
513
524
535
546
557
568
579
590
601
612
623
634
645
656
667
678
689
700
711
722
733
744
755
766
777
788
799
810
821
But less
than
$73
84
95
106
117
128
139
150
161
172
183
194
205
216
227
238
249
260
271
282
293
304
315
326
337
348
359
370
381
392
403
414
425
436
447
458
469
480
491
502
513
524
535
546
557
568
579
590
601
612
623
634
645
656
667
678
689
700
711
722
733
744
755
766
777
788
799
810
821
832
And the number of withholding allowances claimed is—
0
1
$0
1
2
3
4
5
6
7
8
9
10
12
13
14
15
16
17
18
19
21
22
23
25
26
27
29
30
31
33
34
35
37
38
39
40
42
43
44
46
47
48
50
51
52
54
55
56
58
59
60
62
63
64
66
67
68
70
71
72
73
75
76
77
79
80
81
83
84
85
87
2
$0
0
0
0
0
0
0
0
0
1
2
3
5
6
7
8
9
10
11
12
13
14
16
17
18
19
20
22
23
24
26
27
28
29
31
32
33
35
36
37
39
40
41
43
44
45
47
48
49
51
52
53
55
56
57
59
60
61
62
64
65
66
68
69
70
72
73
74
76
77
3
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
7
9
10
11
12
13
14
15
16
17
18
20
21
22
24
25
26
28
29
30
32
33
34
36
37
38
40
41
42
44
45
46
47
49
50
51
53
54
55
57
58
59
61
62
63
65
66
67
4
5
6
52
54
55
56
58
43
44
45
47
48
33
34
36
37
38
Page 48
A-6
7
The amount of income tax to be withheld is—
$0
$0
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
2
0
0
0
3
0
0
0
4
0
0
0
5
0
0
0
6
0
0
0
7
0
0
0
8
0
0
0
9
1
0
0
10
2
0
0
12
3
0
0
13
5
0
0
14
6
0
0
15
7
0
0
16
8
0
0
17
9
1
0
18
10
2
0
19
11
3
0
21
12
4
0
22
13
5
0
23
14
6
0
25
16
7
0
26
17
9
0
27
18
10
2
29
19
11
3
30
20
12
4
31
22
13
5
33
23
14
6
34
24
15
7
35
25
16
8
36
27
17
9
38
28
18
10
39
29
20
11
40
31
21
13
42
32
22
14
43
33
24
15
44
35
25
16
46
36
26
17
47
37
28
18
48
39
29
19
50
40
30
21
51
41
32
22
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
23
25
26
27
29
8
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
5
6
7
8
9
10
11
12
13
14
16
17
18
19
9
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
7
9
10
11
10
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
3
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Publication 15 (2019)
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
Wage Bracket Method Tables for Income Tax Withholding
SINGLE Persons—WEEKLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
But less
than
832
843
854
865
876
887
898
909
920
931
942
953
964
975
986
997
1,008
1,019
1,030
1,041
1,052
1,063
1,074
1,085
1,096
And the number of withholding allowances claimed is—
0
843
854
865
876
887
898
909
920
931
942
953
964
975
986
997
1,008
1,019
1,030
1,041
1,052
1,063
1,074
1,085
1,096
1,107
1
89
91
93
96
98
101
103
105
108
110
113
115
118
120
122
125
127
130
132
135
137
139
142
144
147
2
78
80
81
82
84
85
86
88
90
93
95
97
100
102
105
107
109
112
114
117
119
122
124
126
129
3
69
70
71
73
74
75
77
78
79
80
82
83
84
86
87
89
92
94
97
99
101
104
106
109
111
4
59
60
62
63
64
66
67
68
69
71
72
73
75
76
77
79
80
81
83
84
85
87
88
91
93
1,107
1,118
1,129
1,140
1,151
1,118
1,129
1,140
1,151
1,162
149
151
154
156
159
131
134
136
139
141
113
116
118
121
123
96
98
101
103
105
1,217
1,228
1,239
1,250
1,261
1,228
1,239
1,250
1,261
1,272
173
176
178
180
183
155
158
160
163
165
138
140
143
145
147
120
122
125
127
130
1,162
1,173
1,184
1,195
1,206
1,272
1,283
1,294
1,305
1,316
1,327
1,338
1,349
1,360
1,371
1,382
1,393
1,404
1,415
1,426
1,437
1,448
1,459
1,470
1,481
1,492
1,503
1,514
1,525
1,536
1,173
1,184
1,195
1,206
1,217
1,283
1,294
1,305
1,316
1,327
1,338
1,349
1,360
1,371
1,382
1,393
1,404
1,415
1,426
1,437
1,448
1,459
1,470
1,481
1,492
1,503
1,514
1,525
1,536
1,547
1,547 and over
161
164
166
168
171
185
188
190
193
195
197
200
202
205
207
210
212
214
217
219
222
224
226
229
231
234
236
239
241
243
143
146
148
151
153
168
170
172
175
177
180
182
184
187
189
192
194
197
199
201
204
206
209
211
214
216
218
221
223
226
126
128
130
133
135
150
152
155
157
159
162
164
167
169
172
174
176
179
181
184
186
189
191
193
196
198
201
203
205
208
5
6
7
The amount of income tax to be withheld is—
108
110
113
115
118
132
134
137
139
142
144
147
149
151
154
156
159
161
163
166
168
171
173
176
178
180
183
185
188
190
49
51
52
53
55
56
57
58
60
61
62
64
65
66
68
69
70
72
73
74
76
77
78
80
81
40
41
42
43
45
46
47
49
50
51
53
54
55
57
58
59
61
62
63
65
66
67
69
70
71
30
31
32
34
35
36
38
39
40
42
43
44
46
47
48
50
51
52
54
55
56
58
59
60
62
8
20
21
23
24
25
27
28
29
31
32
33
35
36
37
39
40
41
43
44
45
47
48
49
51
52
9
12
13
14
15
16
17
18
20
21
22
24
25
26
28
29
30
32
33
34
36
37
38
40
41
42
10
4
5
6
7
8
9
10
11
13
14
15
16
17
18
19
21
22
23
25
26
27
28
30
31
32
0
0
0
0
0
1
2
3
4
6
7
8
9
10
11
12
13
14
15
17
18
19
20
21
23
82
84
85
86
88
73
74
75
76
78
63
64
65
67
68
53
54
56
57
58
43
45
46
47
49
34
35
36
38
39
24
25
27
28
29
102
105
107
109
112
86
87
89
92
94
76
77
79
80
81
66
68
69
70
72
57
58
59
61
62
47
48
50
51
52
37
39
40
41
43
90
92
95
97
100
114
117
119
122
124
126
129
131
134
136
138
141
143
146
148
151
153
155
158
160
163
165
167
170
172
79
80
82
83
84
96
99
101
104
106
109
111
113
116
118
121
123
126
128
130
133
135
138
140
142
145
147
150
152
155
69
71
72
73
75
83
84
85
87
88
91
93
96
98
100
103
105
108
110
113
115
117
120
122
125
127
130
132
134
137
60
61
62
64
65
73
74
76
77
78
80
81
82
84
85
86
88
90
92
95
97
100
102
105
107
109
112
114
117
119
50
51
53
54
55
63
65
66
67
69
70
71
73
74
75
76
78
79
80
82
83
84
86
87
89
92
94
96
99
101
40
42
43
44
46
54
55
56
58
59
60
61
63
64
65
67
68
69
71
72
73
75
76
77
79
80
81
83
84
85
31
32
33
35
36
44
45
47
48
49
50
52
53
54
56
57
58
60
61
62
64
65
66
68
69
70
72
73
74
76
Use Table 1(a) for a SINGLE person on page 46. Also see the instructions on page 44.
Publication 15 (2019)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Page 49
A-7
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
The Payroll Source
Wage Bracket Method Tables for Income Tax Withholding
MARRIED Persons—WEEKLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
$ 0
227
238
249
260
271
282
293
304
315
326
337
348
359
370
381
392
403
414
425
436
447
458
469
480
491
502
513
524
535
546
557
568
579
590
601
612
623
634
645
656
667
678
689
700
711
722
733
744
755
766
777
788
799
810
821
832
843
854
865
876
887
898
909
920
931
942
953
964
975
But less
than
$227
238
249
260
271
282
293
304
315
326
337
348
359
370
381
392
403
414
425
436
447
458
469
480
491
502
513
524
535
546
557
568
579
590
601
612
623
634
645
656
667
678
689
700
711
722
733
744
755
766
777
788
799
810
821
832
843
854
865
876
887
898
909
920
931
942
953
964
975
986
And the number of withholding allowances claimed is—
0
1
$0
1
2
3
4
5
6
7
8
9
10
12
13
14
15
16
17
18
19
20
21
23
24
25
26
27
28
29
30
31
32
34
35
36
37
38
39
41
42
43
45
46
47
49
50
51
53
54
55
57
58
59
61
62
63
64
66
67
68
70
71
72
74
75
76
78
79
80
82
83
2
$0
0
0
0
0
0
0
0
0
1
2
3
5
6
7
8
9
10
11
12
13
14
16
17
18
19
20
21
22
23
24
25
27
28
29
30
31
32
33
34
35
36
38
39
40
42
43
44
46
47
48
50
51
52
53
55
56
57
59
60
61
63
64
65
67
68
69
71
72
73
3
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
8
9
10
11
12
13
14
15
16
17
19
20
21
22
23
24
25
26
27
28
30
31
32
33
34
35
36
37
39
40
41
42
44
45
46
48
49
50
52
53
54
56
57
58
60
61
62
64
4
5
6
49
50
51
53
54
39
40
42
43
44
31
32
33
34
35
Page 50
A-8
7
The amount of income tax to be withheld is—
$0
$0
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
2
0
0
0
3
0
0
0
4
0
0
0
5
0
0
0
6
0
0
0
7
0
0
0
8
0
0
0
9
1
0
0
10
2
0
0
12
3
0
0
13
5
0
0
14
6
0
0
15
7
0
0
16
8
0
0
17
9
1
0
18
10
2
0
19
11
3
0
20
12
4
0
21
13
5
0
23
14
6
0
24
16
7
0
25
17
9
0
26
18
10
2
27
19
11
3
28
20
12
4
29
21
13
5
30
22
14
6
31
23
15
7
32
24
16
8
34
25
17
9
35
27
18
10
36
28
20
11
37
29
21
13
38
30
22
14
39
31
23
15
41
32
24
16
42
33
25
17
43
34
26
18
45
35
27
19
46
36
28
20
47
38
29
21
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
22
24
25
26
27
8
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
5
6
7
8
9
10
11
12
13
14
16
17
18
19
9
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
7
9
10
11
10
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
3
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Publication 15 (2019)
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
Wage Bracket Method Tables for Income Tax Withholding
MARRIED Persons—WEEKLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
But less
than
986
997
1,008
1,019
1,030
1,041
1,052
1,063
1,074
1,085
1,096
1,107
1,118
1,129
1,140
1,151
1,162
1,173
1,184
1,195
1,206
1,217
1,228
1,239
1,250
And the number of withholding allowances claimed is—
0
997
1,008
1,019
1,030
1,041
1,052
1,063
1,074
1,085
1,096
1,107
1,118
1,129
1,140
1,151
1,162
1,173
1,184
1,195
1,206
1,217
1,228
1,239
1,250
1,261
1
84
86
87
88
90
91
92
94
95
96
97
99
100
101
103
104
105
107
108
109
111
112
113
115
116
2
75
76
77
79
80
81
83
84
85
86
88
89
90
92
93
94
96
97
98
100
101
102
104
105
106
3
65
66
68
69
70
72
73
74
75
77
78
79
81
82
83
85
86
87
89
90
91
93
94
95
97
1,261
1,272
1,283
1,294
1,305
1,272
1,283
1,294
1,305
1,316
117
119
120
121
123
108
109
110
112
113
98
99
101
102
103
1,371
1,382
1,393
1,404
1,415
1,382
1,393
1,404
1,415
1,426
130
132
133
134
136
121
122
123
125
126
111
112
114
115
116
1,316
1,327
1,338
1,349
1,360
1,426
1,437
1,448
1,459
1,470
1,481
1,492
1,503
1,514
1,525
1,536
1,547
1,558
1,569
1,580
1,327
1,338
1,349
1,360
1,371
1,437
1,448
1,459
1,470
1,481
1,492
1,503
1,514
1,525
1,536
1,547
1,558
1,569
1,580
1,591
124
125
127
128
129
137
138
140
141
142
144
145
146
148
149
150
152
153
154
156
114
116
117
118
119
127
129
130
131
133
134
135
137
138
139
141
142
143
145
146
105
106
107
108
110
118
119
120
122
123
124
126
127
128
130
131
132
134
135
136
4
5
6
7
The amount of income tax to be withheld is—
55
57
58
59
60
62
63
64
66
67
68
70
71
72
74
75
76
78
79
80
82
83
84
86
87
46
47
48
49
51
52
53
55
56
57
59
60
61
63
64
65
67
68
69
71
72
73
75
76
77
36
37
38
40
41
42
44
45
46
48
49
50
52
53
54
56
57
58
60
61
62
64
65
66
68
28
29
30
31
32
33
35
36
37
38
39
41
42
43
45
46
47
49
50
51
53
54
55
56
58
34
35
36
37
38
20
21
22
24
25
26
27
28
29
30
7
8
9
10
11
12
13
14
15
17
18
19
20
21
22
40
41
42
44
45
31
32
33
35
36
23
24
25
26
28
101
103
104
105
107
92
93
94
96
97
82
83
85
86
87
72
74
75
76
78
63
64
65
67
68
53
54
56
57
58
43
45
46
47
49
34
35
36
38
39
95
96
97
99
100
108
109
111
112
113
115
116
117
119
120
121
123
124
125
126
85
86
88
89
90
98
100
101
102
104
105
106
108
109
110
112
113
114
115
117
75
77
78
79
81
89
90
91
93
94
95
97
98
99
101
102
103
104
106
107
66
67
68
70
71
79
80
82
83
84
86
87
88
89
91
92
93
95
96
97
128
129
130
132
133
118
119
121
122
123
108
110
111
112
114
99
100
101
103
104
1,701
1,711
170
160
151
141
131
122
112
1,711 and over
43
44
45
47
48
28
29
31
32
33
15
16
17
18
19
1
2
3
4
6
49
51
52
53
55
138
139
140
141
143
144
145
147
148
149
36
38
39
40
42
23
24
25
26
27
9
10
11
13
14
0
0
0
0
0
59
60
62
63
64
147
149
150
151
152
154
155
156
158
159
31
32
33
34
35
17
18
20
21
22
4
5
6
7
8
69
70
71
73
74
157
158
160
161
162
163
165
166
167
169
25
27
28
29
30
12
13
14
15
16
10
79
80
81
82
84
1,602
1,613
1,624
1,635
1,646
1,657
1,668
1,679
1,690
1,701
20
21
22
23
24
9
88
90
91
92
93
1,591
1,602
1,613
1,624
1,635
1,646
1,657
1,668
1,679
1,690
8
134
136
137
138
140
125
126
127
129
130
115
116
118
119
120
105
107
108
109
111
56
57
59
60
61
69
71
72
73
75
76
77
78
80
81
82
84
85
86
88
46
48
49
50
52
60
61
62
64
65
66
67
69
70
71
73
74
75
77
78
37
38
39
41
42
50
51
52
54
55
56
58
59
60
62
63
64
66
67
68
29
30
31
32
33
40
41
43
44
45
47
48
49
51
52
53
55
56
57
59
89
90
92
93
94
79
81
82
83
85
70
71
72
74
75
60
61
63
64
65
102
92
83
73
96
97
98
100
101
86
87
89
90
91
76
78
79
80
82
67
68
69
71
72
Use Table 1(b) for a MARRIED person on page 46. Also see the instructions on page 44.
Publication 15 (2019)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Page 51
A-9
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
The Payroll Source
Wage Bracket Method Tables for Income Tax Withholding
SINGLE Persons—BIWEEKLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
$ 0
146
157
168
179
190
201
212
223
234
245
256
267
278
289
300
311
322
333
344
355
366
377
388
399
410
421
432
443
454
465
476
487
498
509
529
549
569
589
609
629
649
669
689
709
729
749
769
789
809
829
849
869
889
909
929
949
969
989
1,009
1,029
1,049
1,069
1,089
1,109
1,129
1,149
1,169
1,189
1,209
But less
than
$146
157
168
179
190
201
212
223
234
245
256
267
278
289
300
311
322
333
344
355
366
377
388
399
410
421
432
443
454
465
476
487
498
509
529
549
569
589
609
629
649
669
689
709
729
749
769
789
809
829
849
869
889
909
929
949
969
989
1,009
1,029
1,049
1,069
1,089
1,109
1,129
1,149
1,169
1,189
1,209
1,229
And the number of withholding allowances claimed is—
0
1
$0
1
2
3
4
5
6
7
8
9
10
12
13
14
15
16
17
18
19
20
21
23
24
25
26
27
28
29
30
31
32
34
35
36
37
40
42
44
47
49
52
54
56
59
61
64
66
68
71
73
76
78
80
83
85
88
90
92
95
97
100
102
104
107
109
112
114
116
119
121
2
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
7
9
10
11
12
13
14
15
16
17
18
20
21
23
25
27
29
31
33
35
37
39
42
44
47
49
51
54
56
59
61
63
66
68
71
73
75
78
80
83
85
87
90
92
95
97
99
102
3
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
5
7
9
11
13
15
17
19
21
23
25
27
29
31
33
35
37
39
42
44
47
49
51
54
56
59
61
63
66
68
71
73
75
78
80
83
4
5
6
54
56
58
61
63
35
37
39
41
44
19
21
23
25
27
Page 52
A-10
7
The amount of income tax to be withheld is—
$0
$0
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
3
0
0
0
5
0
0
0
7
0
0
0
9
0
0
0
11
0
0
0
13
0
0
0
15
0
0
0
17
1
0
0
19
3
0
0
21
5
0
0
23
7
0
0
25
9
0
0
27
11
0
0
29
13
0
0
31
15
0
0
33
17
1
0
35
19
3
0
37
21
5
0
39
23
7
0
42
25
9
0
44
27
11
0
46
29
13
0
49
31
15
0
51
33
17
0
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
2
4
6
8
10
8
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
9
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Publication 15 (2019)
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
Wage Bracket Method Tables for Income Tax Withholding
SINGLE Persons—BIWEEKLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
But less
than
1,229
1,249
1,269
1,289
1,309
1,329
1,349
1,369
1,389
1,409
1,429
1,449
1,469
1,489
1,509
1,529
1,549
1,569
1,589
1,609
1,629
1,649
1,669
1,689
1,709
And the number of withholding allowances claimed is—
0
1,249
1,269
1,289
1,309
1,329
1,349
1,369
1,389
1,409
1,429
1,449
1,469
1,489
1,509
1,529
1,549
1,569
1,589
1,609
1,629
1,649
1,669
1,689
1,709
1,729
1
124
126
128
131
133
136
138
140
143
145
148
150
152
155
157
160
162
164
167
169
172
174
178
182
187
2
104
107
109
111
114
116
119
121
123
126
128
131
133
135
138
140
143
145
147
150
152
155
157
159
162
3
85
87
90
92
95
97
99
102
104
107
109
111
114
116
119
121
123
126
128
131
133
135
138
140
143
4
5
66
68
70
73
75
78
80
82
85
87
90
92
94
97
99
102
104
106
109
111
114
116
118
121
123
46
49
51
53
56
58
61
63
65
68
70
73
75
77
80
82
85
87
89
92
94
97
99
101
104
1,729
1,749
1,769
1,789
1,809
1,749
1,769
1,789
1,809
1,829
191
196
200
204
209
164
167
169
171
174
145
147
150
152
155
126
128
130
133
135
106
109
111
113
116
1,929
1,949
1,969
1,989
2,009
1,949
1,969
1,989
2,009
2,029
235
240
244
248
253
200
204
208
213
217
169
171
174
177
182
150
152
154
157
159
130
133
135
137
140
1,829
1,849
1,869
1,889
1,909
2,029
2,049
2,069
2,089
2,109
2,129
2,149
2,169
2,189
2,209
2,229
2,249
2,269
2,289
2,309
2,329
2,349
2,369
2,389
2,409
2,429
2,449
2,469
2,489
2,509
1,849
1,869
1,889
1,909
1,929
2,049
2,069
2,089
2,109
2,129
2,149
2,169
2,189
2,209
2,229
2,249
2,269
2,289
2,309
2,329
2,349
2,369
2,389
2,409
2,429
2,449
2,469
2,489
2,509
2,529
2,529 and over
213
218
222
226
231
257
262
266
270
275
279
284
288
292
297
301
306
310
314
319
323
328
332
336
341
345
350
354
358
363
178
182
186
191
195
222
226
230
235
239
244
248
252
257
261
266
270
274
279
283
288
292
296
301
305
310
314
318
323
327
157
159
162
164
167
186
190
195
199
204
208
212
217
221
226
230
234
239
243
248
252
256
261
265
270
274
278
283
287
292
6
7
The amount of income tax to be withheld is—
138
140
142
145
147
162
164
166
169
171
174
177
181
186
190
195
199
203
208
212
217
221
225
230
234
239
243
247
252
256
118
121
123
125
128
142
145
147
149
152
154
157
159
161
164
166
169
171
173
177
181
185
190
194
199
203
207
212
216
221
29
31
33
35
37
39
41
44
46
48
51
53
56
58
60
63
65
68
70
72
75
77
80
82
84
12
14
16
18
20
22
24
26
28
30
32
34
36
39
41
43
46
48
51
53
55
58
60
63
65
8
0
0
0
2
4
6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
41
43
46
9
0
0
0
0
0
0
0
0
0
0
0
2
4
6
8
10
12
14
16
18
20
22
24
26
28
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
4
6
8
10
12
87
89
92
94
96
67
70
72
75
77
48
50
53
55
58
30
32
34
36
38
14
16
18
20
22
111
113
116
118
120
91
94
96
99
101
72
74
77
79
82
53
55
57
60
62
34
36
38
40
43
99
101
104
106
108
123
125
128
130
132
135
137
140
142
144
147
149
152
154
156
159
161
164
166
168
171
173
176
181
185
79
82
84
87
89
103
106
108
111
113
115
118
120
123
125
127
130
132
135
137
139
142
144
147
149
151
154
156
159
161
60
62
65
67
70
84
86
89
91
94
96
98
101
103
106
108
110
113
115
118
120
122
125
127
130
132
134
137
139
142
41
43
45
48
50
65
67
69
72
74
77
79
81
84
86
89
91
93
96
98
101
103
105
108
110
113
115
117
120
122
24
26
28
30
32
45
48
50
52
55
57
60
62
64
67
69
72
74
76
79
81
84
86
88
91
93
96
98
100
103
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
4
6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
40
43
45
47
50
52
55
57
59
62
64
67
69
71
74
76
79
81
83
Use Table 2(a) for a SINGLE person on page 46. Also see the instructions on page 44.
Publication 15 (2019)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Page 53
A-11
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
The Payroll Source
Wage Bracket Method Tables for Income Tax Withholding
MARRIED Persons—BIWEEKLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
$ 0
454
464
474
484
494
504
524
544
564
584
604
624
644
664
684
704
724
744
764
784
804
824
844
864
884
904
924
944
964
984
1,004
1,024
1,044
1,064
1,084
1,104
1,124
1,144
1,164
1,184
1,204
1,224
1,244
1,264
1,284
1,304
1,324
1,344
1,364
1,384
1,404
1,424
1,444
1,464
1,484
1,504
1,524
1,544
1,564
1,584
1,604
1,624
1,644
1,664
1,684
1,704
1,724
1,744
1,764
But less
than
$454
464
474
484
494
504
524
544
564
584
604
624
644
664
684
704
724
744
764
784
804
824
844
864
884
904
924
944
964
984
1,004
1,024
1,044
1,064
1,084
1,104
1,124
1,144
1,164
1,184
1,204
1,224
1,244
1,264
1,284
1,304
1,324
1,344
1,364
1,384
1,404
1,424
1,444
1,464
1,484
1,504
1,524
1,544
1,564
1,584
1,604
1,624
1,644
1,664
1,684
1,704
1,724
1,744
1,764
1,784
And the number of withholding allowances claimed is—
0
1
$0
1
2
3
4
5
6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
40
42
44
46
48
50
52
54
56
58
60
62
64
66
68
70
72
74
76
79
81
83
86
88
91
93
95
98
100
103
105
107
110
112
115
117
119
122
124
127
129
131
134
136
139
141
143
2
$0
0
0
0
0
0
0
0
0
0
0
0
2
4
6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
40
42
44
46
48
50
52
54
56
58
60
62
64
66
68
70
72
74
76
79
81
83
86
88
91
93
95
98
100
103
105
107
110
112
115
117
119
122
124
3
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
4
6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
40
42
44
46
48
50
52
54
56
58
60
62
64
66
68
70
72
74
76
78
81
83
86
88
90
93
95
98
100
102
105
4
5
6
76
78
81
83
85
59
61
63
65
67
43
45
47
49
51
Page 54
A-12
7
The amount of income tax to be withheld is—
$0
$0
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
4
0
0
0
6
0
0
0
8
0
0
0
10
0
0
0
12
0
0
0
14
0
0
0
16
0
0
0
18
1
0
0
20
3
0
0
22
5
0
0
24
7
0
0
26
9
0
0
28
11
0
0
30
13
0
0
32
15
0
0
34
17
1
0
36
19
3
0
38
21
5
0
40
23
7
0
42
25
9
0
44
27
11
0
46
29
13
0
48
31
15
0
50
33
17
1
52
35
19
3
54
37
21
5
56
39
23
7
58
41
25
9
60
43
27
11
62
45
29
13
64
47
31
15
66
49
33
17
68
51
35
19
70
53
37
21
72
55
39
23
74
57
41
25
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
27
29
31
33
35
8
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
3
5
7
9
11
13
15
17
19
9
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
3
10
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Publication 15 (2019)
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
Wage Bracket Method Tables for Income Tax Withholding
MARRIED Persons—BIWEEKLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
But less
than
1,784
1,804
1,824
1,844
1,864
1,884
1,904
1,924
1,944
1,964
1,984
2,004
2,024
2,044
2,064
2,084
2,104
2,124
2,144
2,164
2,184
2,204
2,224
2,244
2,264
And the number of withholding allowances claimed is—
0
1,804
1,824
1,844
1,864
1,884
1,904
1,924
1,944
1,964
1,984
2,004
2,024
2,044
2,064
2,084
2,104
2,124
2,144
2,164
2,184
2,204
2,224
2,244
2,264
2,284
1
146
148
151
153
155
158
160
163
165
167
170
172
175
177
179
182
184
187
189
191
194
196
199
201
203
2
127
129
131
134
136
139
141
143
146
148
151
153
155
158
160
163
165
167
170
172
175
177
179
182
184
3
107
110
112
114
117
119
122
124
126
129
131
134
136
138
141
143
146
148
150
153
155
158
160
162
165
4
5
6
88
90
93
95
97
100
102
105
107
109
112
114
117
119
121
124
126
129
131
133
136
138
141
143
145
69
71
73
76
78
80
83
85
88
90
92
95
97
100
102
104
107
109
112
114
116
119
121
124
126
53
55
57
59
61
63
65
67
69
71
73
75
78
80
83
85
87
90
92
95
97
99
102
104
107
2,284
2,304
2,324
2,344
2,364
2,304
2,324
2,344
2,364
2,384
206
208
211
213
215
187
189
191
194
196
167
170
172
174
177
148
150
153
155
157
128
131
133
136
138
109
111
114
116
119
2,484
2,504
2,524
2,544
2,564
2,504
2,524
2,544
2,564
2,584
230
232
235
237
239
211
213
215
218
220
191
194
196
198
201
172
174
177
179
181
152
155
157
160
162
133
135
138
140
143
2,384
2,404
2,424
2,444
2,464
2,584
2,604
2,624
2,644
2,664
2,684
2,704
2,724
2,744
2,764
2,784
2,804
2,824
2,844
2,864
2,404
2,424
2,444
2,464
2,484
2,604
2,624
2,644
2,664
2,684
2,704
2,724
2,744
2,764
2,784
2,804
2,824
2,844
2,864
2,884
218
220
223
225
227
242
244
247
249
251
254
256
259
261
263
266
268
271
273
275
199
201
203
206
208
223
225
227
230
232
235
237
239
242
244
247
249
251
254
256
179
182
184
186
189
203
206
208
210
213
215
218
220
222
225
227
230
232
234
237
7
The amount of income tax to be withheld is—
160
162
165
167
169
184
186
189
191
193
196
198
201
203
205
208
210
213
215
217
140
143
145
148
150
164
167
169
172
174
176
179
181
184
186
188
191
193
196
198
121
123
126
128
131
145
147
150
152
155
157
159
162
164
167
169
171
174
176
179
37
39
41
43
45
47
49
51
53
55
57
59
61
63
65
67
69
71
73
75
78
80
82
85
87
8
21
23
25
27
29
31
33
35
37
39
41
43
45
47
49
51
53
55
57
59
61
63
65
67
69
9
5
7
9
11
13
15
17
19
21
23
25
27
29
31
33
35
37
39
41
43
45
47
49
51
53
10
0
0
0
0
0
0
1
3
5
7
9
11
13
15
17
19
21
23
25
27
29
31
33
35
37
22
24
26
28
30
114
116
118
121
123
94
97
99
101
104
75
77
80
82
84
59
61
63
65
67
42
44
46
48
50
102
104
106
109
111
126
128
130
133
135
138
140
142
145
147
150
152
154
157
159
82
85
87
89
92
106
109
111
113
116
118
121
123
125
128
130
133
135
137
140
65
67
69
71
73
87
89
92
94
96
99
101
104
106
108
111
113
116
118
120
49
51
53
55
57
69
71
73
75
77
79
82
84
87
89
91
94
96
99
101
239
242
244
246
249
220
222
225
227
229
200
203
205
208
210
181
183
186
188
191
162
164
166
169
171
142
145
147
149
152
123
125
128
130
132
103
106
108
111
113
3,084
3,104
302
283
263
244
224
205
186
166
147
127
3,104 and over
251
254
256
258
261
232
234
237
239
241
212
215
217
220
222
193
195
198
200
203
12
14
16
18
20
39
41
43
45
47
259
261
263
266
268
271
273
275
278
280
2
4
6
8
10
55
57
59
61
63
278
280
283
285
287
290
292
295
297
299
0
0
0
0
0
71
73
75
77
80
2,904
2,924
2,944
2,964
2,984
3,004
3,024
3,044
3,064
3,084
0
0
0
0
0
90
92
94
97
99
2,884
2,904
2,924
2,944
2,964
2,984
3,004
3,024
3,044
3,064
0
0
0
0
0
174
176
178
181
183
154
157
159
161
164
135
137
140
142
144
115
118
120
123
125
32
34
36
38
40
52
54
56
58
60
62
64
66
68
70
72
74
77
79
82
84
86
89
91
94
96
98
101
103
106
108
Use Table 2(b) for a MARRIED person on page 46. Also see the instructions on page 44.
Publication 15 (2019)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Page 55
A-13
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
The Payroll Source
Wage Bracket Method Tables for Income Tax Withholding
SINGLE Persons—SEMIMONTHLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
$ 0
158
169
180
191
202
213
224
235
246
257
268
279
290
301
312
323
334
345
356
367
378
389
400
411
422
433
444
455
466
477
488
499
510
530
550
570
590
610
630
650
670
690
710
730
750
770
790
810
830
850
870
890
910
930
950
970
990
1,010
1,030
1,050
1,070
1,090
1,110
1,130
1,150
1,170
1,190
1,210
1,230
But less
than
$158
169
180
191
202
213
224
235
246
257
268
279
290
301
312
323
334
345
356
367
378
389
400
411
422
433
444
455
466
477
488
499
510
530
550
570
590
610
630
650
670
690
710
730
750
770
790
810
830
850
870
890
910
930
950
970
990
1,010
1,030
1,050
1,070
1,090
1,110
1,130
1,150
1,170
1,190
1,210
1,230
1,250
And the number of withholding allowances claimed is—
0
1
$0
1
2
3
4
5
6
7
8
9
10
12
13
14
15
16
17
18
19
20
21
23
24
25
26
27
28
29
30
31
32
34
35
36
38
40
43
45
47
50
52
55
57
59
62
64
67
69
71
74
76
79
81
83
86
88
91
93
95
98
100
103
105
107
110
112
115
117
119
122
2
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
7
8
9
11
12
13
14
15
16
17
19
21
23
25
27
29
31
33
35
37
39
41
43
46
48
50
53
55
58
60
62
65
67
70
72
74
77
79
82
84
86
89
91
94
96
98
101
3
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
3
5
7
9
11
13
15
17
19
21
23
25
27
29
31
33
35
37
39
41
44
46
49
51
53
56
58
61
63
65
68
70
73
75
77
80
4
5
6
49
52
54
56
59
30
32
34
36
38
13
15
17
19
21
Page 56
A-14
7
The amount of income tax to be withheld is—
$0
$0
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
4
0
0
0
6
0
0
0
8
0
0
0
10
0
0
0
12
0
0
0
14
0
0
0
16
0
0
0
18
0
0
0
20
2
0
0
22
4
0
0
24
6
0
0
26
8
0
0
28
10
0
0
30
12
0
0
32
14
0
0
34
16
0
0
36
18
1
0
38
20
3
0
40
22
5
0
42
24
7
0
44
26
9
0
47
28
11
0
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
0
0
0
1
3
8
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
9
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Publication 15 (2019)
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
Wage Bracket Method Tables for Income Tax Withholding
SINGLE Persons—SEMIMONTHLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
But less
than
1,250
1,270
1,290
1,310
1,330
1,350
1,370
1,390
1,410
1,430
1,450
1,470
1,490
1,510
1,530
1,550
1,570
1,590
1,610
1,630
1,650
1,670
1,690
1,710
1,730
And the number of withholding allowances claimed is—
0
1,270
1,290
1,310
1,330
1,350
1,370
1,390
1,410
1,430
1,450
1,470
1,490
1,510
1,530
1,550
1,570
1,590
1,610
1,630
1,650
1,670
1,690
1,710
1,730
1,750
1
124
127
129
131
134
136
139
141
143
146
148
151
153
155
158
160
163
165
167
170
172
175
177
179
182
2
103
106
108
110
113
115
118
120
122
125
127
130
132
134
137
139
142
144
146
149
151
154
156
158
161
3
82
85
87
89
92
94
97
99
101
104
106
109
111
113
116
118
121
123
125
128
130
133
135
137
140
4
5
61
64
66
68
71
73
76
78
80
83
85
88
90
92
95
97
100
102
104
107
109
112
114
116
119
40
43
45
47
50
52
55
57
59
62
64
67
69
71
74
76
79
81
83
86
88
91
93
95
98
1,750
1,770
1,790
1,810
1,830
1,770
1,790
1,810
1,830
1,850
184
187
189
193
197
163
166
168
170
173
142
145
147
149
152
121
124
126
128
131
100
103
105
107
110
1,950
1,970
1,990
2,010
2,030
1,970
1,990
2,010
2,030
2,050
224
228
233
237
241
187
190
194
199
203
166
169
171
173
176
145
148
150
152
155
124
127
129
131
134
1,850
1,870
1,890
1,910
1,930
2,050
2,070
2,090
2,110
2,130
2,150
2,170
2,190
2,210
2,230
2,250
2,270
2,290
2,310
2,330
2,350
2,370
2,390
2,410
2,430
2,450
2,470
2,490
2,510
2,530
1,870
1,890
1,910
1,930
1,950
2,070
2,090
2,110
2,130
2,150
2,170
2,190
2,210
2,230
2,250
2,270
2,290
2,310
2,330
2,350
2,370
2,390
2,410
2,430
2,450
2,470
2,490
2,510
2,530
2,550
2,550 and over
202
206
211
215
219
246
250
255
259
263
268
272
277
281
285
290
294
299
303
307
312
316
321
325
329
334
338
343
347
351
175
178
180
182
185
207
212
216
221
225
229
234
238
243
247
251
256
260
265
269
273
278
282
287
291
295
300
304
309
313
154
157
159
161
164
178
181
183
185
188
191
195
200
204
208
213
217
222
226
230
235
239
244
248
252
257
261
266
270
274
6
7
The amount of income tax to be withheld is—
133
136
138
140
143
157
160
162
164
167
169
172
174
176
179
181
184
186
188
192
196
201
205
210
214
218
223
227
232
236
112
115
117
119
122
136
139
141
143
146
148
151
153
155
158
160
163
165
167
170
172
175
177
179
182
184
187
189
193
197
23
25
27
29
31
33
35
37
39
41
43
46
48
50
53
55
58
60
62
65
67
70
72
74
77
5
7
9
11
13
15
17
19
21
23
25
27
29
31
33
35
37
39
41
44
46
49
51
53
56
8
0
0
0
0
0
0
0
2
4
6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
9
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
4
6
8
10
12
14
16
18
79
82
84
86
89
58
61
63
65
68
38
40
42
44
47
20
22
24
26
28
103
106
108
110
113
82
85
87
89
92
61
64
66
68
71
40
43
45
47
50
91
94
96
98
101
115
118
120
122
125
127
130
132
134
137
139
142
144
146
149
151
154
156
158
161
163
166
168
170
173
70
73
75
77
80
94
97
99
101
104
106
109
111
113
116
118
121
123
125
128
130
133
135
137
140
142
145
147
149
152
49
52
54
56
59
73
76
78
80
83
85
88
90
92
95
97
100
102
104
107
109
112
114
116
119
121
124
126
128
131
30
32
34
36
38
52
55
57
59
62
64
67
69
71
74
76
79
81
83
86
88
91
93
95
98
100
103
105
107
110
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
5
7
9
11
0
0
0
0
0
23
25
27
29
31
5
7
9
11
13
13
15
17
19
21
33
35
37
39
41
43
46
48
50
53
55
58
60
62
65
67
70
72
74
77
79
82
84
86
89
0
0
0
1
3
15
17
19
21
23
25
27
29
31
33
35
37
39
41
44
46
49
51
53
56
58
61
63
65
68
Use Table 3(a) for a SINGLE person on page 46. Also see the instructions on page 44.
Publication 15 (2019)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Page 57
A-15
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
The Payroll Source
Wage Bracket Method Tables for Income Tax Withholding
MARRIED Persons—SEMIMONTHLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
$ 0
492
502
512
522
532
542
552
562
572
582
592
602
612
622
632
642
652
662
672
682
692
702
712
722
732
742
752
762
772
782
792
802
812
822
832
842
852
862
872
882
892
902
912
922
932
942
952
962
972
982
992
1,002
1,022
1,042
1,062
1,082
1,102
1,122
1,142
1,162
1,182
1,202
1,222
1,242
1,262
1,282
1,302
1,322
1,342
But less
than
$492
502
512
522
532
542
552
562
572
582
592
602
612
622
632
642
652
662
672
682
692
702
712
722
732
742
752
762
772
782
792
802
812
822
832
842
852
862
872
882
892
902
912
922
932
942
952
962
972
982
992
1,002
1,022
1,042
1,062
1,082
1,102
1,122
1,142
1,162
1,182
1,202
1,222
1,242
1,262
1,282
1,302
1,322
1,342
1,362
And the number of withholding allowances claimed is—
0
1
$0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
54
56
58
60
62
64
66
68
70
72
74
76
78
80
82
85
87
2
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
35
37
39
41
43
45
47
49
51
53
55
57
59
61
63
65
67
69
3
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
19
21
23
25
27
29
31
33
35
37
39
41
43
45
47
49
51
4
5
6
26
28
30
32
34
8
10
12
14
16
0
0
0
0
0
Page 58
A-16
7
The amount of income tax to be withheld is—
$0
$0
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
4
0
0
0
6
0
0
0
8
0
0
0
10
0
0
0
12
0
0
0
14
0
0
0
16
0
0
0
18
0
0
0
20
2
0
0
22
4
0
0
24
6
0
0
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
0
0
0
0
0
8
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
9
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Publication 15 (2019)
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
Wage Bracket Method Tables for Income Tax Withholding
MARRIED Persons—SEMIMONTHLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
But less
than
1,362
1,382
1,402
1,422
1,442
1,462
1,482
1,502
1,522
1,542
1,562
1,582
1,602
1,622
1,642
1,662
1,682
1,702
1,722
1,742
1,762
1,782
1,802
1,822
1,842
And the number of withholding allowances claimed is—
0
1,382
1,402
1,422
1,442
1,462
1,482
1,502
1,522
1,542
1,562
1,582
1,602
1,622
1,642
1,662
1,682
1,702
1,722
1,742
1,762
1,782
1,802
1,822
1,842
1,862
1
89
92
94
97
99
101
104
106
109
111
113
116
118
121
123
125
128
130
133
135
137
140
142
145
147
2
71
73
75
77
79
81
83
85
88
90
92
95
97
100
102
104
107
109
112
114
116
119
121
124
126
3
53
55
57
59
61
63
65
67
69
71
73
75
77
79
81
83
86
88
91
93
95
98
100
103
105
1,862
1,882
1,902
1,922
1,942
1,882
1,902
1,922
1,942
1,962
149
152
154
157
159
128
131
133
136
138
107
110
112
115
117
2,062
2,082
2,102
2,122
2,142
2,082
2,102
2,122
2,142
2,162
173
176
178
181
183
152
155
157
160
162
131
134
136
139
141
1,962
1,982
2,002
2,022
2,042
2,162
2,182
2,202
2,222
2,242
2,262
2,282
2,302
2,322
2,342
2,362
2,382
2,402
2,422
2,442
1,982
2,002
2,022
2,042
2,062
2,182
2,202
2,222
2,242
2,262
2,282
2,302
2,322
2,342
2,362
2,382
2,402
2,422
2,442
2,462
161
164
166
169
171
185
188
190
193
195
197
200
202
205
207
209
212
214
217
219
140
143
145
148
150
164
167
169
172
174
176
179
181
184
186
188
191
193
196
198
119
122
124
127
129
143
146
148
151
153
155
158
160
163
165
167
170
172
175
177
4
5
6
7
The amount of income tax to be withheld is—
36
38
40
42
44
46
48
50
52
54
56
58
60
62
64
66
68
70
72
74
76
78
80
82
84
18
20
22
24
26
28
30
32
34
36
38
40
42
44
46
48
50
52
54
56
58
60
62
64
66
1
3
5
7
9
11
13
15
17
19
21
23
25
27
29
31
33
35
37
39
41
43
45
47
49
0
0
0
0
0
0
0
0
0
1
3
5
7
9
11
13
15
17
19
21
23
25
27
29
31
8
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
4
6
8
10
12
14
86
89
91
94
96
68
70
72
74
76
51
53
55
57
59
33
35
37
39
41
16
18
20
22
24
110
113
115
118
120
89
92
94
97
99
71
73
75
77
79
53
55
57
59
61
36
38
40
42
44
98
101
103
106
108
122
125
127
130
132
134
137
139
142
144
146
149
151
154
156
78
80
82
85
87
101
104
106
109
111
113
116
118
121
123
125
128
130
133
135
61
63
65
67
69
81
83
85
88
90
92
95
97
100
102
104
107
109
112
114
43
45
47
49
51
63
65
67
69
71
73
75
77
79
81
83
86
88
91
93
26
28
30
32
34
46
48
50
52
54
56
58
60
62
64
66
68
70
72
74
9
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
4
6
0
0
0
0
0
0
0
0
0
0
18
20
22
24
26
1
3
5
7
9
0
0
0
0
0
8
10
12
14
16
28
30
32
34
36
38
40
42
44
46
48
50
52
54
56
0
0
0
0
0
11
13
15
17
19
21
23
25
27
29
31
33
35
37
39
0
0
0
0
0
0
0
0
0
1
3
5
7
9
11
13
15
17
19
21
2,462
2,482
2,502
2,522
2,542
2,482
2,502
2,522
2,542
2,562
221
224
226
229
231
200
203
205
208
210
179
182
184
187
189
158
161
163
166
168
137
140
142
145
147
116
119
121
124
126
95
98
100
103
105
76
78
80
82
84
58
60
62
64
66
41
43
45
47
49
23
25
27
29
31
2,662
2,682
245
224
203
182
161
140
119
98
78
61
43
2,562
2,582
2,602
2,622
2,642
2,582
2,602
2,622
2,642
2,662
2,682 and over
233
236
238
241
243
212
215
217
220
222
191
194
196
199
201
170
173
175
178
180
149
152
154
157
159
128
131
133
136
138
107
110
112
115
117
86
89
91
94
96
68
70
72
74
76
51
53
55
57
59
33
35
37
39
41
Use Table 3(b) for a MARRIED person on page 46. Also see the instructions on page 44.
Publication 15 (2019)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Page 59
A-17
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
The Payroll Source
Wage Bracket Method Tables for Income Tax Withholding
SINGLE Persons—MONTHLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
$ 0
317
327
337
347
357
367
377
387
397
407
417
427
437
447
457
467
477
487
497
507
517
527
537
547
557
567
577
587
597
607
617
627
637
647
657
667
677
687
697
707
717
727
737
747
757
767
777
787
797
807
817
827
837
847
857
867
877
887
897
907
917
927
937
947
957
967
977
987
997
But less
than
$317
327
337
347
357
367
377
387
397
407
417
427
437
447
457
467
477
487
497
507
517
527
537
547
557
567
577
587
597
607
617
627
637
647
657
667
677
687
697
707
717
727
737
747
757
767
777
787
797
807
817
827
837
847
857
867
877
887
897
907
917
927
937
947
957
967
977
987
997
1,007
And the number of withholding allowances claimed is—
0
1
$0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
2
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
3
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
5
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Page 60
A-18
7
The amount of income tax to be withheld is—
$0
$0
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
0
0
0
0
0
8
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
9
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Publication 15 (2019)
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
Wage Bracket Method Tables for Income Tax Withholding
SINGLE Persons—MONTHLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
But less
than
1,007
1,027
1,047
1,067
1,087
1,107
1,127
1,147
1,167
1,187
1,207
1,227
1,247
1,267
1,287
1,307
1,327
1,347
1,367
1,387
1,407
1,427
1,447
1,467
1,487
And the number of withholding allowances claimed is—
0
1,027
1,047
1,067
1,087
1,107
1,127
1,147
1,167
1,187
1,207
1,227
1,247
1,267
1,287
1,307
1,327
1,347
1,367
1,387
1,407
1,427
1,447
1,467
1,487
1,507
1
70
72
74
76
78
80
82
85
87
89
92
94
97
99
101
104
106
109
111
113
116
118
121
123
125
1,507
1,527
1,547
1,567
1,587
1,527
1,547
1,567
1,587
1,607
128
130
133
135
137
1,707
1,727
1,747
1,767
1,787
1,727
1,747
1,767
1,787
1,807
152
154
157
159
161
1,607
1,627
1,647
1,667
1,687
1,807
1,827
1,847
1,867
1,887
1,907
1,927
1,947
1,967
1,987
2,007
2,047
2,087
2,127
2,167
1,627
1,647
1,667
1,687
1,707
1,827
1,847
1,867
1,887
1,907
1,927
1,947
1,967
1,987
2,007
2,047
2,087
2,127
2,167
2,207
140
142
145
147
149
164
166
169
171
173
176
178
181
183
185
189
194
199
203
208
2
35
37
39
41
43
45
47
49
51
53
55
57
59
61
63
65
67
69
71
73
75
77
79
81
83
3
0
2
4
6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
40
42
44
46
48
4
5
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
3
5
7
9
11
13
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
110
112
115
117
119
70
72
74
76
78
35
37
39
41
43
0
2
4
6
8
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
98
100
103
105
107
122
124
127
129
131
134
136
139
141
143
147
152
157
161
166
60
62
64
66
68
80
82
85
87
89
92
94
97
99
101
105
110
115
119
124
25
27
29
31
33
45
47
49
51
53
55
57
59
61
63
66
70
74
78
82
0
0
0
0
0
10
12
14
16
18
20
22
24
26
28
31
35
39
43
47
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
8
12
171
176
181
185
190
129
134
139
143
148
87
92
97
101
106
51
55
59
63
67
16
20
24
28
32
2,607
2,647
261
219
177
135
93
56
2,647 and over
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
15
17
19
21
23
213
218
223
227
232
237
242
247
251
256
0
0
0
0
0
0
0
0
0
0
9
50
52
54
56
58
2,247
2,287
2,327
2,367
2,407
2,447
2,487
2,527
2,567
2,607
0
0
0
0
0
8
86
88
91
93
95
2,207
2,247
2,287
2,327
2,367
2,407
2,447
2,487
2,527
2,567
7
The amount of income tax to be withheld is—
195
200
205
209
214
153
158
163
167
172
111
116
121
125
130
71
75
79
83
88
36
40
44
48
52
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
21
0
0
0
0
1
5
9
13
17
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Use Table 4(a) for a SINGLE person on page 46. Also see the instructions on page 44.
Publication 15 (2019)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Page 61
A-19
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
The Payroll Source
Wage Bracket Method Tables for Income Tax Withholding
MARRIED Persons—MONTHLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
$ 0
983
994
1,005
1,016
1,027
1,038
1,049
1,060
1,071
1,082
1,093
1,104
1,115
1,126
1,137
1,148
1,159
1,170
1,181
1,192
1,203
1,214
1,225
1,236
1,247
1,258
1,269
1,280
1,291
1,302
1,313
1,324
1,335
1,346
1,357
1,368
1,379
1,390
1,401
1,412
1,423
1,434
1,445
1,456
1,467
1,478
1,489
1,500
1,511
1,522
1,533
1,544
1,555
1,566
1,577
1,588
1,599
1,610
1,621
1,632
1,643
1,654
1,665
1,676
1,687
1,698
1,709
1,720
1,731
But less
than
$983
994
1,005
1,016
1,027
1,038
1,049
1,060
1,071
1,082
1,093
1,104
1,115
1,126
1,137
1,148
1,159
1,170
1,181
1,192
1,203
1,214
1,225
1,236
1,247
1,258
1,269
1,280
1,291
1,302
1,313
1,324
1,335
1,346
1,357
1,368
1,379
1,390
1,401
1,412
1,423
1,434
1,445
1,456
1,467
1,478
1,489
1,500
1,511
1,522
1,533
1,544
1,555
1,566
1,577
1,588
1,599
1,610
1,621
1,632
1,643
1,654
1,665
1,676
1,687
1,698
1,709
1,720
1,731
1,742
And the number of withholding allowances claimed is—
0
1
$0
1
2
3
4
5
6
7
8
9
10
12
13
14
15
16
17
18
19
20
21
23
24
25
26
27
28
29
30
31
32
34
35
36
37
38
39
40
41
42
43
45
46
47
48
49
50
51
52
53
54
56
57
58
59
60
61
62
63
64
65
67
68
69
70
71
72
73
74
75
2
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
7
8
10
11
12
13
14
15
16
17
18
19
21
22
23
24
25
26
27
28
29
30
32
33
34
35
36
37
38
39
40
3
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
4
5
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Page 62
A-20
7
The amount of income tax to be withheld is—
$0
$0
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
0
0
0
0
0
8
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
9
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Publication 15 (2019)
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
Wage Bracket Method Tables for Income Tax Withholding
MARRIED Persons—MONTHLY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
But less
than
1,742
1,753
1,773
1,793
1,813
1,833
1,853
1,873
1,893
1,913
1,933
1,953
1,973
1,993
2,013
2,033
2,053
2,073
2,093
2,113
2,133
2,153
2,173
2,193
2,213
And the number of withholding allowances claimed is—
0
1,753
1,773
1,793
1,813
1,833
1,853
1,873
1,893
1,913
1,933
1,953
1,973
1,993
2,013
2,033
2,053
2,073
2,093
2,113
2,133
2,153
2,173
2,193
2,213
2,233
1
76
78
80
82
84
86
88
90
92
94
96
98
100
102
104
106
108
110
112
114
116
118
120
122
124
2,233
2,253
2,273
2,293
2,313
2,253
2,273
2,293
2,313
2,333
126
128
130
132
134
2,433
2,453
2,473
2,493
2,513
2,453
2,473
2,493
2,513
2,553
146
148
150
152
155
2,333
2,353
2,373
2,393
2,413
2,553
2,593
2,633
2,673
2,713
2,753
2,793
2,833
2,873
2,913
2,953
2,993
3,033
3,073
3,113
2,353
2,373
2,393
2,413
2,433
2,593
2,633
2,673
2,713
2,753
2,793
2,833
2,873
2,913
2,953
2,993
3,033
3,073
3,113
3,153
136
138
140
142
144
159
163
168
173
178
182
187
192
197
202
206
211
216
221
226
2
41
43
45
47
49
51
53
55
57
59
61
63
65
67
69
71
73
75
77
79
81
83
85
87
89
3
6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
40
42
44
46
48
50
52
54
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
3
5
7
9
11
13
15
17
19
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
9
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
111
113
115
117
120
76
78
80
82
85
41
43
45
47
50
6
8
10
12
15
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
101
103
105
107
109
124
128
132
136
140
144
148
152
156
160
164
169
174
179
184
66
68
70
72
74
89
93
97
101
105
109
113
117
121
125
129
133
137
141
145
31
33
35
37
39
54
58
62
66
70
74
78
82
86
90
94
98
102
106
110
188
193
198
203
208
149
153
157
161
166
114
118
122
126
130
3,553
3,593
278
236
194
154
3,593 and over
0
0
0
0
0
8
21
23
25
27
29
230
235
240
245
250
254
259
264
269
274
7
56
58
60
62
64
3,193
3,233
3,273
3,313
3,353
3,393
3,433
3,473
3,513
3,553
6
91
93
95
97
99
3,153
3,193
3,233
3,273
3,313
3,353
3,393
3,433
3,473
3,513
5
The amount of income tax to be withheld is—
212
217
222
227
232
170
175
180
185
190
134
138
142
146
150
0
0
0
2
4
19
23
27
31
35
39
43
47
51
55
59
63
67
71
75
0
0
0
0
0
0
0
0
0
0
4
8
12
16
20
24
28
32
36
40
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
5
79
83
87
91
95
44
48
52
56
60
9
13
17
21
25
119
84
49
99
103
107
111
115
64
68
72
76
80
29
33
37
41
45
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
14
0
0
0
0
0
2
6
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Use Table 4(b) for a MARRIED person on page 46. Also see the instructions on page 44.
Publication 15 (2019)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Page 63
A-21
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
The Payroll Source
Wage Bracket Method Tables for Income Tax Withholding
SINGLE Persons—DAILY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
$ 0
15
25
35
45
55
65
75
85
95
105
115
125
135
145
155
165
175
185
195
205
215
225
235
245
255
265
275
285
295
305
315
325
335
345
360
375
390
405
420
435
450
465
480
495
510
525
540
555
570
585
600
615
630
645
660
675
690
705
720
735
750
765
780
795
810
825
840
855
870
But less
than
$15
25
35
45
55
65
75
85
95
105
115
125
135
145
155
165
175
185
195
205
215
225
235
245
255
265
275
285
295
305
315
325
335
345
360
375
390
405
420
435
450
465
480
495
510
525
540
555
570
585
600
615
630
645
660
675
690
705
720
735
750
765
780
795
810
825
840
855
870
885
And the number of withholding allowances claimed is—
0
1
$0
1
2
3
4
5
6
7
8
10
11
12
13
14
16
17
18
20
23
25
27
29
31
34
36
38
40
42
45
47
49
51
53
56
59
62
66
69
73
77
80
84
87
91
95
98
102
105
109
113
116
120
123
127
132
137
142
147
151
156
161
166
171
175
180
186
191
196
201
207
2
$0
0
0
1
2
3
4
5
6
8
9
10
11
12
14
15
16
17
19
21
24
26
28
30
32
35
37
39
41
43
46
48
50
52
55
58
62
66
69
73
76
80
84
87
91
94
98
102
105
109
112
116
120
123
127
132
137
141
146
151
156
161
165
170
175
180
185
190
196
201
3
$0
0
0
0
0
1
2
3
4
6
7
8
9
10
12
13
14
15
16
18
20
22
24
27
29
31
33
35
38
40
42
44
46
49
51
55
58
62
65
69
73
76
80
83
87
91
94
98
101
105
109
112
116
119
123
127
132
136
141
146
151
156
160
165
170
175
180
185
190
195
4
5
6
170
174
179
184
190
164
169
174
179
184
159
164
169
174
178
Page 64
A-22
7
The amount of income tax to be withheld is—
$0
$0
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
2
0
0
0
3
1
0
0
4
2
0
0
5
3
1
0
6
4
2
1
7
5
3
2
8
7
5
3
10
8
6
4
11
9
7
5
12
10
8
6
13
11
9
7
14
13
11
9
16
14
12
10
17
15
13
11
19
16
14
12
21
17
15
13
23
19
17
15
25
22
18
16
27
24
20
17
30
26
22
19
32
28
25
21
34
30
27
23
36
33
29
26
38
35
31
28
41
37
33
30
43
39
36
32
45
41
38
34
48
44
41
37
51
47
44
40
54
51
47
44
58
54
51
47
61
58
54
50
65
61
57
54
69
65
61
57
72
68
65
61
76
72
68
64
79
76
72
68
83
79
75
71
87
83
79
75
90
86
83
79
94
90
86
82
97
94
90
86
101
97
93
89
105
101
97
93
108
104
101
97
112
108
104
100
115
112
108
104
119
115
111
107
123
119
115
111
126
122
119
115
131
126
122
118
136
131
126
122
141
136
130
125
146
140
135
130
150
145
140
135
155
150
145
140
160
155
150
144
165
160
154
149
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
154
159
164
168
173
8
$0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
6
7
8
9
10
12
13
14
15
16
18
20
22
24
26
29
31
34
37
40
43
47
50
53
57
60
64
68
71
75
78
82
86
89
93
96
100
104
107
111
114
118
122
125
130
134
139
144
149
154
158
163
168
9
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
7
8
10
11
12
13
14
16
17
18
21
23
25
27
30
33
37
40
43
46
50
53
56
60
64
67
71
74
78
82
85
89
92
96
100
103
107
110
114
118
121
125
129
134
139
144
149
153
158
163
10
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
8
9
10
11
12
14
15
16
17
19
21
24
26
30
33
36
40
43
46
50
53
56
60
63
67
71
74
78
81
85
89
92
96
99
103
107
110
114
117
121
125
129
134
139
143
148
153
158
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
5
6
7
8
9
11
12
13
14
15
17
18
20
23
26
29
33
36
39
43
46
49
53
56
60
63
67
70
74
78
81
85
88
92
96
99
103
106
110
114
117
121
124
129
133
138
143
148
153
Publication 15 (2019)
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
Wage Bracket Method Tables for Income Tax Withholding
SINGLE Persons—DAILY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
But less
than
885
900
915
930
945
960
975
990
1,005
1,020
1,035
1,050
1,065
1,080
1,095
1,110
1,125
1,140
1,155
1,170
1,185
1,200
1,215
1,230
1,245
And the number of withholding allowances claimed is—
0
900
915
930
945
960
975
990
1,005
1,020
1,035
1,050
1,065
1,080
1,095
1,110
1,125
1,140
1,155
1,170
1,185
1,200
1,215
1,230
1,245
1,260
1
212
217
222
228
233
238
243
249
254
259
264
270
275
280
285
291
296
301
306
312
317
322
327
333
338
2
206
211
217
222
227
232
238
243
248
253
259
264
269
274
280
285
290
295
301
306
311
316
322
327
332
3
201
206
211
216
222
227
232
237
243
248
253
258
264
269
274
279
285
290
295
300
306
311
316
321
327
4
5
6
7
The amount of income tax to be withheld is—
195
200
205
211
216
221
226
232
237
242
247
253
258
263
268
274
279
284
289
295
300
305
310
316
321
189
194
200
205
210
215
221
226
231
236
242
247
252
257
263
268
273
278
284
289
294
299
305
310
315
184
189
194
199
205
210
215
220
226
231
236
241
247
252
257
262
268
273
278
283
289
294
299
304
310
178
183
188
194
199
204
209
215
220
225
230
236
241
246
251
257
262
267
272
278
283
288
293
299
304
8
173
178
183
188
193
199
204
209
214
220
225
230
235
241
246
251
256
262
267
272
277
283
288
293
298
9
168
173
177
182
188
193
198
203
209
214
219
224
230
235
240
245
251
256
261
266
272
277
282
287
293
10
163
167
172
177
182
187
192
198
203
208
213
219
224
229
234
240
245
250
255
261
266
271
276
282
287
157
162
167
172
177
182
187
192
197
203
208
213
218
224
229
234
239
245
250
255
260
266
271
276
281
1,260
1,275
1,290
1,305
1,320
1,275
1,290
1,305
1,320
1,335
343
348
354
359
364
337
343
348
353
358
332
337
342
348
353
326
331
337
342
347
320
326
331
336
341
315
320
325
331
336
309
314
320
325
330
304
309
314
319
325
298
303
308
314
319
292
297
303
308
313
287
292
297
302
308
1,410
1,425
1,440
1,455
1,470
1,425
1,440
1,455
1,470
1,485
396
401
406
411
417
390
395
400
406
411
384
390
395
400
405
379
384
389
394
400
373
378
383
389
394
367
373
378
383
388
362
367
372
377
383
356
361
367
372
377
350
356
361
366
371
345
350
355
360
366
339
344
350
355
360
1,335
1,350
1,365
1,380
1,395
1,485
1,500
1,515
1,530
1,545
1,560
1,575
1,590
1,605
1,620
1,635
1,650
1,665
1,680
1,695
1,350
1,365
1,380
1,395
1,410
1,500
1,515
1,530
1,545
1,560
1,575
1,590
1,605
1,620
1,635
1,650
1,665
1,680
1,695
1,710
369
375
380
385
390
422
427
432
438
443
448
453
459
464
469
474
480
485
490
495
364
369
374
379
385
416
421
427
432
437
442
448
453
458
463
469
474
479
484
490
358
363
369
374
379
411
416
421
426
432
437
442
447
453
458
463
468
474
479
484
352
358
363
368
373
405
410
415
421
426
431
436
442
447
452
457
463
468
473
478
347
352
357
362
368
399
404
410
415
420
425
431
436
441
446
452
457
462
467
473
341
346
352
357
362
394
399
404
409
415
420
425
430
436
441
446
451
457
462
467
335
341
346
351
356
388
393
398
404
409
414
419
425
430
435
440
446
451
456
461
330
335
340
346
351
382
388
393
398
403
409
414
419
424
430
435
440
445
451
456
324
329
335
340
345
377
382
387
392
398
403
408
413
419
424
429
434
440
445
450
318
324
329
334
339
371
376
381
387
392
397
402
408
413
418
423
429
434
439
444
313
318
323
329
334
365
371
376
381
386
392
397
402
407
413
418
423
428
434
439
1,710
1,725
1,740
1,755
1,770
1,725
1,740
1,755
1,770
1,785
501
506
511
516
522
495
500
505
511
516
489
495
500
505
510
484
489
494
499
505
478
483
488
494
499
472
478
483
488
493
467
472
477
482
488
461
466
472
477
482
455
461
466
471
476
450
455
460
465
471
444
449
455
460
465
1,860
1,862
551
545
540
534
528
523
517
511
506
500
494
1,785
1,800
1,815
1,830
1,845
1,800
1,815
1,830
1,845
1,860
1,862 and over
527
532
537
543
548
521
526
532
537
542
516
521
526
531
537
510
515
520
526
531
504
509
515
520
525
499
504
509
514
520
493
498
503
509
514
487
493
498
503
508
482
487
492
497
503
476
481
486
492
497
470
476
481
486
491
Use Table 8(a) for a SINGLE person on page 47. Also see the instructions on page 44.
Publication 15 (2019)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Page 65
A-23
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
The Payroll Source
Wage Bracket Method Tables for Income Tax Withholding
MARRIED Persons—DAILY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
$ 0
46
56
66
76
86
96
106
116
126
136
146
156
166
176
186
196
206
216
226
236
246
256
266
276
286
296
306
316
326
336
346
361
376
391
406
421
436
451
466
481
496
511
526
541
556
571
586
601
616
631
646
661
676
691
706
721
736
751
766
781
796
811
826
841
856
871
886
901
916
But less
than
$46
56
66
76
86
96
106
116
126
136
146
156
166
176
186
196
206
216
226
236
246
256
266
276
286
296
306
316
326
336
346
361
376
391
406
421
436
451
466
481
496
511
526
541
556
571
586
601
616
631
646
661
676
691
706
721
736
751
766
781
796
811
826
841
856
871
886
901
916
931
And the number of withholding allowances claimed is—
0
1
$0
1
2
3
4
5
6
7
8
9
10
11
12
14
15
16
17
18
20
21
22
23
24
26
27
28
29
30
32
33
34
36
39
43
46
49
52
56
59
62
66
69
72
76
79
82
85
89
92
95
99
102
105
109
112
116
119
123
126
130
134
137
141
144
148
152
155
159
162
166
2
$0
0
0
1
2
3
4
5
6
7
8
9
10
12
13
14
15
16
18
19
20
21
22
24
25
26
27
28
30
31
32
34
36
39
42
46
49
52
55
59
62
65
69
72
75
79
82
85
88
92
95
98
102
105
108
112
115
119
122
126
130
133
137
140
144
148
151
155
158
162
3
$0
0
0
0
0
1
2
3
4
5
6
7
9
10
11
12
13
15
16
17
18
19
21
22
23
24
25
27
28
29
30
32
33
35
39
42
45
49
52
55
59
62
65
68
72
75
78
82
85
88
92
95
98
101
105
108
111
115
119
122
126
129
133
137
140
144
147
151
155
158
4
5
6
140
144
147
151
154
136
140
143
147
150
132
136
139
143
147
Page 66
A-24
7
The amount of income tax to be withheld is—
$0
$0
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
2
0
0
0
3
1
0
0
4
2
0
0
5
3
1
0
6
4
2
1
7
5
3
2
8
6
4
3
9
7
5
4
10
8
6
5
11
9
7
6
13
11
9
7
14
12
10
8
15
13
11
9
16
14
12
10
17
15
13
12
19
17
15
13
20
18
16
14
21
19
17
15
22
20
18
16
23
21
19
18
25
23
21
19
26
24
22
20
27
25
23
21
28
26
24
22
30
28
26
24
31
30
28
26
33
31
29
27
35
33
31
29
38
35
33
31
42
38
35
33
45
42
38
35
48
45
41
38
52
48
45
41
55
51
48
44
58
55
51
48
62
58
54
51
65
61
58
54
68
65
61
58
71
68
64
61
75
71
68
64
78
75
71
67
81
78
74
71
85
81
78
74
88
84
81
77
91
88
84
81
95
91
87
84
98
94
91
87
101
98
94
91
104
101
97
94
108
104
101
97
111
108
104
100
115
111
107
104
118
114
111
107
122
118
114
110
126
122
118
114
129
125
121
117
133
129
125
121
136
132
129
125
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
128
132
135
139
143
8
$0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
7
8
10
11
12
13
14
16
17
18
19
20
22
24
26
27
29
31
33
35
37
41
44
47
51
54
57
61
64
67
70
74
77
80
84
87
90
94
97
100
103
107
110
114
117
121
124
128
132
135
139
9
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
7
8
9
10
11
12
14
15
16
17
18
20
22
24
25
27
29
31
33
34
37
40
44
47
50
54
57
60
64
67
70
73
77
80
83
87
90
93
97
100
103
106
110
113
117
121
124
128
131
135
10
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
7
8
9
11
12
13
14
15
17
18
20
22
23
25
27
29
31
32
34
37
40
44
47
50
53
57
60
63
67
70
73
77
80
83
86
90
93
96
100
103
106
110
113
117
120
124
127
131
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
3
4
5
6
7
9
10
11
12
13
15
16
18
20
21
23
25
27
29
30
32
34
37
40
43
47
50
53
56
60
63
66
70
73
76
80
83
86
89
93
96
99
103
106
109
113
116
120
124
127
Publication 15 (2019)
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
Wage Bracket Method Tables for Income Tax Withholding
MARRIED Persons—DAILY Payroll Period
(For Wages Paid through December 2019)
And the wages are–
At least
But less
than
931
946
961
976
991
1,006
1,021
1,036
1,051
1,066
1,081
1,096
1,111
1,126
1,141
1,156
1,171
1,186
1,201
1,216
1,231
1,246
1,261
1,276
1,291
And the number of withholding allowances claimed is—
0
946
961
976
991
1,006
1,021
1,036
1,051
1,066
1,081
1,096
1,111
1,126
1,141
1,156
1,171
1,186
1,201
1,216
1,231
1,246
1,261
1,276
1,291
1,306
1
170
173
177
180
184
188
191
195
198
202
206
209
213
216
220
224
227
231
234
238
242
245
249
252
257
2
166
169
173
176
180
184
187
191
194
198
202
205
209
212
216
220
223
227
230
234
238
241
245
248
252
3
162
165
169
173
176
180
183
187
191
194
198
201
205
209
212
216
219
223
227
230
234
237
241
245
248
4
5
6
7
The amount of income tax to be withheld is—
158
162
165
169
172
176
180
183
187
190
194
198
201
205
208
212
216
219
223
226
230
234
237
241
244
154
158
161
165
168
172
176
179
183
186
190
194
197
201
204
208
212
215
219
222
226
230
233
237
240
150
154
157
161
165
168
172
175
179
183
186
190
193
197
201
204
208
211
215
219
222
226
229
233
237
146
150
153
157
161
164
168
171
175
179
182
186
189
193
197
200
204
207
211
215
218
222
225
229
233
8
142
146
150
153
157
160
164
168
171
175
178
182
186
189
193
196
200
204
207
211
214
218
222
225
229
9
139
142
146
149
153
157
160
164
167
171
175
178
182
185
189
193
196
200
203
207
211
214
218
221
225
10
135
138
142
145
149
153
156
160
163
167
171
174
178
181
185
189
192
196
199
203
207
210
214
217
221
131
134
138
142
145
149
152
156
160
163
167
170
174
178
181
185
188
192
196
199
203
206
210
214
217
1,306
1,321
1,336
1,351
1,366
1,321
1,336
1,351
1,366
1,381
262
267
272
276
281
257
262
267
271
276
252
257
261
266
271
248
252
256
261
266
244
248
251
256
261
240
244
247
251
255
236
240
243
247
251
232
236
240
243
247
229
232
236
239
243
225
228
232
235
239
221
224
228
232
235
1,456
1,471
1,486
1,501
1,516
1,471
1,486
1,501
1,516
1,531
310
315
320
324
329
305
310
315
319
324
300
305
309
314
319
295
299
304
309
314
289
294
299
304
309
284
289
294
299
303
279
284
289
293
298
274
279
283
288
293
269
274
278
283
288
264
268
273
278
283
258
263
268
273
278
1,381
1,396
1,411
1,426
1,441
1,531
1,546
1,561
1,576
1,591
1,606
1,621
1,636
1,651
1,666
1,681
1,696
1,711
1,726
1,741
1,396
1,411
1,426
1,441
1,456
1,546
1,561
1,576
1,591
1,606
1,621
1,636
1,651
1,666
1,681
1,696
1,711
1,726
1,741
1,756
286
291
296
300
305
334
339
344
348
353
358
363
369
374
379
384
390
395
400
405
281
286
291
295
300
329
334
339
343
348
353
358
363
368
373
379
384
389
394
400
276
281
285
290
295
324
329
333
338
343
348
353
357
362
368
373
378
383
389
394
271
275
280
285
290
319
323
328
333
338
343
347
352
357
362
367
373
378
383
388
265
270
275
280
285
313
318
323
328
333
337
342
347
352
357
362
367
372
377
383
260
265
270
275
279
308
313
318
323
327
332
337
342
347
351
356
361
367
372
377
255
260
265
269
274
303
308
313
317
322
327
332
337
341
346
351
356
361
366
371
250
255
259
264
269
298
303
307
312
317
322
327
331
336
341
346
351
355
360
366
247
250
254
259
264
293
298
302
307
312
317
322
326
331
336
341
346
350
355
360
243
246
250
254
259
288
292
297
302
307
312
316
321
326
331
336
340
345
350
355
239
242
246
250
254
282
287
292
297
302
306
311
316
321
326
330
335
340
345
350
1,756
1,771
1,786
1,801
1,816
1,771
1,786
1,801
1,816
1,831
411
416
421
426
432
405
410
415
421
426
399
404
410
415
420
394
399
404
409
415
388
393
398
404
409
382
388
393
398
403
377
382
387
392
398
371
376
381
387
392
365
371
376
381
386
360
365
370
375
381
354
359
364
370
375
1,906
1,908
461
455
449
444
438
432
427
421
416
410
404
1,831
1,846
1,861
1,876
1,891
1,846
1,861
1,876
1,891
1,906
1,908 and over
437
442
447
453
458
431
436
442
447
452
425
431
436
441
446
420
425
430
436
441
414
419
425
430
435
409
414
419
424
430
403
408
413
419
424
397
402
408
413
418
392
397
402
407
413
386
391
396
402
407
380
385
391
396
401
Use Table 8(b) for a MARRIED person on page 47. Also see the instructions on page 44.
Publication 15 (2019)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Page 67
A-25
The Payroll Source
USCIS
Form I-9
Employment Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services
OMB No. 1615-0047
Expires 08/31/2019
►START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,
during completion of this form. Employers are liable for errors in the completion of this form.
ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which
document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ
an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.
Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later
than the first day of employment, but not before accepting a job offer.)
Last Name (Family Name)
Apt. Number
Address (Street Number and Name)
Date of Birth (mm/dd/yyyy)
Middle Initial
First Name (Given Name)
U.S. Social Security Number
-
Other Last Names Used (if any)
State
City or Town
ZIP Code
Employee's Telephone Number
Employee's E-mail Address
-
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in
connection with the completion of this form.
I attest, under penalty of perjury, that I am (check one of the following boxes):
1. A citizen of the United States
2. A noncitizen national of the United States (See instructions)
3. A lawful permanent resident
(Alien Registration Number/USCIS Number):
4. An alien authorized to work
until (expiration date, if applicable, mm/dd/yyyy):
Some aliens may write "N/A" in the expiration date field. (See instructions)
QR Code - Section 1
Do Not Write In This Space
Aliens authorized to work must provide only one of the following document numbers to complete Form I-9:
An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.
1. Alien Registration Number/USCIS Number:
OR
2. Form I-94 Admission Number:
OR
3. Foreign Passport Number:
Country of Issuance:
Signature of Employee
Today's Date (mm/dd/yyyy)
Preparer and/or Translator Certification (check one):
I did not use a preparer or translator.
A preparer(s) and/or translator(s) assisted the employee in completing Section 1.
(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my
knowledge the information is true and correct.
Today's Date (mm/dd/yyyy)
Signature of Preparer or Translator
Last Name (Family Name)
Address (Street Number and Name)
First Name (Given Name)
City or Town
State
ZIP Code
Employer Completes Next Page
Form I-9 07/17/17 N
A-26
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Page 1 of 3
Appendix
USCIS
Form I-9
Employment Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services
OMB No. 1615-0047
Expires 08/31/2019
Section 2. Employer or Authorized Representative Review and Verification
(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You
must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists
of Acceptable Documents.")
Employee Info from Section 1
Last Name (Family Name)
List A
Identity and Employment Authorization
First Name (Given Name)
OR
List B
M.I.
AND
Identity
Citizenship/Immigration Status
List C
Employment Authorization
Document Title
Document Title
Document Title
Issuing Authority
Issuing Authority
Issuing Authority
Document Number
Document Number
Document Number
Expiration Date (if any)(mm/dd/yyyy)
Expiration Date (if any)(mm/dd/yyyy)
Expiration Date (if any)(mm/dd/yyyy)
Document Title
QR Code - Sections 2 & 3
Do Not Write In This Space
Additional Information
Issuing Authority
Document Number
Expiration Date (if any)(mm/dd/yyyy)
Document Title
Issuing Authority
Document Number
Expiration Date (if any)(mm/dd/yyyy)
Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee,
(2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the
employee is authorized to work in the United States.
The employee's first day of employment (mm/dd/yyyy):
Signature of Employer or Authorized Representative
Last Name of Employer or Authorized Representative
(See instructions for exemptions)
Today's Date (mm/dd/yyyy)
Title of Employer or Authorized Representative
First Name of Employer or Authorized Representative
Employer's Business or Organization Address (Street Number and Name)
City or Town
Employer's Business or Organization Name
State
ZIP Code
Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)
A. New Name (if applicable)
Last Name (Family Name)
B. Date of Rehire (if applicable)
First Name (Given Name)
Middle Initial
Date (mm/dd/yyyy)
C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes
continuing employment authorization in the space provided below.
Document Title
Document Number
Expiration Date (if any) (mm/dd/yyyy)
I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if
the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
Signature of Employer or Authorized Representative
Today's Date (mm/dd/yyyy)
Name of Employer or Authorized Representative
Form I-9 07/17/17 N
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Page 2 of 3
A-27
The Payroll Source
LISTS OF ACCEPTABLE DOCUMENTS
All documents must be UNEXPIRED
Employees may present one selection from List A
or a combination of one selection from List B and one selection from List C.
LIST A
Documents that Establish
Both Identity and
Employment Authorization
1. U.S. Passport or U.S. Passport Card
2. Permanent Resident Card or Alien
Registration Receipt Card (Form I-551)
3. Foreign passport that contains a
temporary I-551 stamp or temporary
I-551 printed notation on a machinereadable immigrant visa
4. Employment Authorization Document
that contains a photograph (Form
I-766)
5. For a nonimmigrant alien authorized
to work for a specific employer
because of his or her status:
a. Foreign passport; and
b. Form I-94 or Form I-94A that has
the following:
(1) The same name as the passport;
and
(2) An endorsement of the alien's
nonimmigrant status as long as
that period of endorsement has
not yet expired and the
proposed employment is not in
conflict with any restrictions or
limitations identified on the form.
6. Passport from the Federated States of
Micronesia (FSM) or the Republic of
the Marshall Islands (RMI) with Form
I-94 or Form I-94A indicating
nonimmigrant admission under the
Compact of Free Association Between
the United States and the FSM or RMI
LIST B
OR
Documents that Establish
Identity
LIST C
Documents that Establish
Employment Authorization
AND
1. Driver's license or ID card issued by a
State or outlying possession of the
United States provided it contains a
photograph or information such as
name, date of birth, gender, height, eye
color, and address
2. ID card issued by federal, state or local
government agencies or entities,
provided it contains a photograph or
information such as name, date of birth,
gender, height, eye color, and address
3. School ID card with a photograph
4. Voter's registration card
5. U.S. Military card or draft record
6. Military dependent's ID card
7. U.S. Coast Guard Merchant Mariner
Card
8. Native American tribal document
9. Driver's license issued by a Canadian
government authority
For persons under age 18 who are
unable to present a document
listed above:
1. A Social Security Account Number
card, unless the card includes one of
the following restrictions:
(1) NOT VALID FOR EMPLOYMENT
(2) VALID FOR WORK ONLY WITH
INS AUTHORIZATION
(3) VALID FOR WORK ONLY WITH
DHS AUTHORIZATION
2. Certification of report of birth issued
by the Department of State (Forms
DS-1350, FS-545, FS-240)
3. Original or certified copy of birth
certificate issued by a State,
county, municipal authority, or
territory of the United States
bearing an official seal
4. Native American tribal document
5. U.S. Citizen ID Card (Form I-197)
6. Identification Card for Use of
Resident Citizen in the United
States (Form I-179)
7. Employment authorization
document issued by the
Department of Homeland Security
10. School record or report card
11. Clinic, doctor, or hospital record
12. Day-care or nursery school record
Examples of many of these documents appear in Part 13 of the Handbook for Employers (M-274).
Refer to the instructions for more information about acceptable receipts.
Form I-9 07/17/17 N
A-28
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Page 3 of 3
Appendix
Instructions for Form I-9,
Employment Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-9
OMB No. 1615-0047
Expires 08/31/2019
Anti-Discrimination Notice. It is illegal to discriminate against work-authorized individuals in hiring, firing, recruitment or
referral for a fee, or in the employment eligibility verification (Form I-9 and E-Verify) process based on that individual's
citizenship status, immigration status or national origin. Employers CANNOT specify which document(s) the employee may
present to establish employment authorization and identity. The employer must allow the employee to choose the documents to
be presented from the Lists of Acceptable Documents, found on the last page of Form I-9. The refusal to hire or continue to
employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.
For more information, call the Immigrant and Employee Rights Section (IER) in the Department of Justice's Civil Rights
Division at 1-800-255-7688 (employees), 1-800-255-8155 (employers), or 1-800-237-2515 (TTY), or visit
https://www.justice.gov/crt/immigrant-and-employee-rights-section.
What is the Purpose of This Form?
Employers must complete Form I-9 to document verification of the identity and employment authorization of each new
employee (both citizen and noncitizen) hired after November 6, 1986, to work in the United States. In the Commonwealth of the
Northern Mariana Islands (CNMI), employers must complete Form I-9 to document verification of the identity and employment
authorization of each new employee (both citizen and noncitizen) hired after November 27, 2011.
General Instructions
Both employers and employees are responsible for completing their respective sections of Form I-9. For the purpose of
completing this form, the term “employer” means all employers, including those recruiters and referrers for a fee who are
agricultural associations, agricultural employers, or farm labor contractors, as defined in section 3 of the Migrant and Seasonal
Agricultural Worker Protection Act, Public Law 97-470 (29 U.S.C. 1802). An “employee” is a person who performs labor or
services in the United States for an employer in return for wages or other remuneration. The term “Employee” does not include
those who do not receive any form of remuneration (volunteers), independent contractors or those engaged in certain casual
domestic employment. Form I-9 has three sections. Employees complete Section 1. Employers complete Section 2 and, when
applicable, Section 3. Employers may be fined if the form is not properly completed. See 8 USC § 1324a and 8 CFR § 274a.10.
Individuals may be prosecuted for knowingly and willfully entering false information on the form. Employers are responsible for
retaining completed forms. Do not mail completed forms to U.S. Citizenship and Immigration Services (USCIS) or
Immigration and Customs Enforcement (ICE).
These instructions will assist you in properly completing Form I-9. The employer must ensure that all pages of the instructions
and Lists of Acceptable Documents are available, either in print or electronically, to all employees completing this form. When
completing the form on a computer, the English version of the form includes specific instructions for each field and drop-down
lists for universally used abbreviations and acceptable documents. To access these instructions, move the cursor over each field
or click on the question mark symbol ( ) within the field. Employers and employees can also access this full set of
instructions at any time by clicking the Instructions button at the top of each page when completing the form on a computer that
is connected to the Internet.
Employers and employees may choose to complete any or all sections of the form on paper or using a computer, or a
combination of both. Forms I-9 obtained from the USCIS website are not considered electronic Forms I-9 under DHS
regulations and, therefore, cannot be electronically signed. Therefore, regardless of the method you used to enter information
into each field, you must print a hard copy of the form, then sign and date the hard copy by hand where required.
Employers can obtain a blank copy of Form I-9 from the USCIS website at https://www.uscis.gov/sites/default/files/files/form/
i-9.pdf. This form is in portable document format (.pdf) that is fillable and savable. That means that you may download it, or
simply print out a blank copy to enter information by hand. You may also request paper Forms I-9 from USCIS.
Certain features of Form I-9 that allow for data entry on personal computers may make the form appear to be more than two
pages. When using a computer, Form I-9 has been designed to print as two pages. Using more than one preparer and/or
translator will add an additional page to the form, regardless of your method of completion. You are not required to print, retain
or store the page containing the Lists of Acceptable Documents.
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The form will also populate certain fields with N/A when certain user choices ensure that particular fields will not be
completed. The Print button located at the top of each page that will print any number of pages the user selects. Also, the Start
Over button located at the top of each page will clear all the fields on the form.
The Spanish version of Form I-9 does not include the additional instructions and drop-down lists described above. Employers
in Puerto Rico may use either the Spanish or English version of the form. Employers outside of Puerto Rico must retain the
English version of the form for their records, but may use the Spanish form as a translation tool.
Handbook for Employers: Guidance for Completing Form I-9 (M-274) and on USCIS
Form I-9 website, I-9 Central.
Completing Section I: Employee Information and Attestation
You, the employee, must complete each field in Section 1 as described below. Newly hired employees must complete and sign
Section 1 no later than the first day of employment. Section 1 should never be completed before you have accepted a job offer.
Entering Your Employee Information
Last Name (Family Name): Enter your full legal last name. Your last name is your family name or surname. If you
have two last names or a hyphenated last name, include both names in the Last Name field. Examples of correctly entered
last names include De La Cruz, O’Neill, Garcia Lopez, Smith-Johnson, Nguyen. If you only have one name, enter it in
this field, then enter “Unknown” in the First Name field. You may not enter “Unknown” in both the Last Name field and
the First Name field.
First Name (Given Name): Enter your full legal first name. Your first name is your given name. Some examples of
correctly entered first names include Jessica, John-Paul, Tae Young, D’Shaun, Mai. If you only have one name, enter it
in the Last Name field, then enter “Unknown” in this field. You may not enter “Unknown” in both the First Name field
and the Last Name field.
Middle Initial: Your middle initial is the first letter of your second given name, or the first letter of your middle name, if
any. If you have more than one middle name, enter the first letter of your first middle name. If you do not have a middle
name, enter N/A in this field.
Other Last Names Used: Provide all other last names used, if any (e.g., maiden name). Enter N/A if you have not used
other last names. For example, if you legally changed your last name from Smith to Jones, you should enter the name
Smith in this field.
Address (Street Name and Number): Enter the street name and number of the current address of your residence. If
you are a border commuter from Canada or Mexico, you may enter your Canada or Mexico address in this field. If your
residence does not have a physical address, enter a description of the location of your residence, such as “3 miles
southwest of Anytown post office near water tower.”
Apartment: Enter the number(s) or letter(s) that identify(ies) your apartment. If you do not live in an apartment, enter N/A.
City or Town: Enter your city, town or village in this field. If your residence is not located in a city, town or village, enter
your county, township, reservation, etc., in this field. If you are a border commuter from Canada, enter your city and
province in this field. If you are a border commuter from Mexico, enter your city and state in this field.
State: Enter the abbreviation of your state or territory in this field. If you are a border commuter from Canada or Mexico,
enter your country abbreviation in this field.
ZIP Code: Enter your 5-digit ZIP code. If you are a border commuter from Canada or Mexico, enter your
5- or 6-digit postal code in this field.
Date of Birth: Enter your date of birth as a 2-digit month, 2-digit day, and 4-digit year (mm/dd/yyyy). For example,
enter January 8, 1980 as 01/08/1980.
U.S. Social Security Number: Providing your 9-digit Social Security number is voluntary on Form I-9 unless your
employer participates in E-Verify. If your employer participates in E-Verify and:
1. You have been issued a Social Security number, you must provide it in this field; or
2. You have applied for, but have not yet received a Social Security number, leave this field blank until you receive
a Social Security number.
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Employee’s Telephone Number (Optional):
Attesting to Your Citizenship or Immigration Status
You must select one box to attest to your citizenship or immigration status.
1.
A citizen of the United States.
2.
A noncitizen national of the United States: An individual born in American Samoa, certain former citizens of the
former Trust Territory of the Pacific Islands, and certain children of noncitizen nationals born abroad.
3.
A lawful permanent resident:
If you select “lawful permanent resident,” enter your 7- to 9-digit Alien Registration Number (A-Number), including the
“A,” or USCIS Number in the space provided. When completing this field using a computer, use the dropdown provided
to indicate whether you have entered an Alien Number or a USCIS Number. At this time, the USCIS Number is the same
as the A-Number without the “A” prefix.
4.
An alien authorized to work: An individual who is not a citizen or national of the United States, or a lawful permanent
resident, but is authorized to work in the United States.
Aliens authorized to work must enter one of the following to complete Section1:
1. Alien Registration Number (A-Number)/USCIS Number; or
2. Form I-94 Admission Number; or
3. Foreign Passport Number and the Country of Issuance
Your employer may not ask you to present the document from which you supplied this information.
Alien Registration Number/USCIS Number: Enter your 7- to 9-digit Alien Registration Number (A-Number),
including the “A,” or your USCIS Number in this field. At this time, the USCIS Number is the same as your
A-Number without the “A” prefix. When completing this field using a computer, use the dropdown provided to indicate
whether you have entered an Alien Number or a USCIS Number. If you do not provide an A-Number or USCIS Number,
enter N/A in this field then enter either a Form I-94 Admission Number, or a Foreign Passport and Country of Issuance in
the fields provided.
Form I-94 Admission Number: Enter your 11-digit I-94 Admission Number in this field. If you do not provide an I-94
Admission Number, enter N/A in this field, then enter either an Alien Registration Number/USCIS Number or a Foreign
Passport Number and Country of Issuance in the fields provided.
Foreign Passport Number: Enter your Foreign Passport Number in this field. If you do not provide a Foreign Passport
Number, enter N/A in this field, then enter either an Alien Number/USCIS Number or a I-94 Admission Number in the
fields provided.
you did not enter your Foreign Passport Number, enter N/A.
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Signature of Employee: After completing Section 1, sign your name in this field. If you used a form obtained from the
USCIS website, you must print the form to sign your name in this field. By signing this form, you attest under penalty of
perjury (28 U.S.C. § 1746) that the information you provided, along with the citizenship or immigration status you selected,
and all information and documentation you provide to your employer, is complete, true and correct, and you are aware that you
may face severe penalties provided by law and may be subject to criminal prosecution for knowingly and willfully making
false statements or using false documentation when completing this form. Further, falsely attesting to U.S. citizenship may
subject employees to penalties, removal proceedings and may adversely affect an employee's ability to seek future immigration
benefits. If you cannot sign your name, you may place a mark in this field to indicate your signature. Employees who use a
preparer or translator to help them complete the form must still sign or place a mark in the Signature of Employee field on the
printed form.
If you used a preparer, translator, and other individual to assist you in completing Form I-9:
› Both you and your preparer(s) and/or translator(s) must complete the appropriate areas of Section 1, and then sign
Section 1. If Section 1 was completed on a form obtained from the USCIS website, the form must be printed to sign
these fields. You and your preparer(s) and/or translator(s) also should review the instructions for Completing the
Preparer and/or Translator Certification below.
› If the employee is a minor (individual under 18) who cannot present an identity document, the employee's parent or
legal guardian can complete Section 1 for the employee and enter “minor under age 18” in the signature field. If Section
1 was completed on a form obtained from the USCIS website, the form must be printed to enter this information. The
minor's parent or legal guardian should review the instructions for Completing the Preparer and/or Translator
Certification below. Refer to the Handbook for Employers: Guidance for Completing Form I-9 (M-274) for more
guidance on completion of Form I-9 for minors. If the minor's employer participates in E-Verify, the employee must
present a list B identity document with a photograph to complete Form I-9.
› If the employee is a person with a disability (who is placed in employment by a nonprofit organization, association or as
part of a rehabilitation program) who cannot present an identity document, the employee's parent, legal guardian or a
representative of the nonprofit organization, association or rehabilitation program can complete Section 1 for the
employee and enter “Special Placement” in this field. If Section 1 was completed on a form obtained from the USCIS
website, the form must be printed to enter this information. The parent, legal guardian or representative of the nonprofit
organization, association or rehabilitation program completing Section 1 for the employee should review the
instructions for Completing the Preparer and/or Translator Certification below. Refer to the Handbook for Employers:
Guidance for Completing Form I-9 (M-274) for more guidance on completion of Form I-9 for certain employees with
disabilities.
Today's Date: Enter the date you signed Section 1 in this field. Do not backdate this field. Enter the date as a 2-digit month,
2-digit day and 4-digit year (mm/dd/yyyy). For example, enter January 8, 2014 as 01/08/2014. A preparer or translator who
assists the employee in completing Section 1 may enter the date the employee signed or made a mark to sign Section 1 in this
field. Parents or legal guardians assisting minors (individuals under age 18) and parents, legal guardians or representatives of a
nonprofit organization, association or rehabilitation program assisting certain employees with disabilities must enter the date
they completed Section 1 for the employee.
Completing the Preparer and/or Translator Certification
If you did not use a preparer or translator to assist you in completing Section 1, you, the employee, must check the box marked
I did not use a Preparer or Translator. If you check this box, leave the rest of the fields in this area blank.
If one or more preparers and/or translators assist the employee in completing the form using a computer, the preparer and/or
translator must check the box marked “A preparer(s) and/or translator(s) assisted the employee in completing Section 1” ,
then select the number of Certification areas needed from the dropdown provided. Any additional Certification areas generated
will result in an additional page. Form I-9 Supplement, Section 1 Preparer and/or Translator Certification can be separately
downloaded from the USCIS Form I-9 webpage, which provides additional Certification areas for those completing Form I-9
using a computer who need more Certification areas than the 5 provided or those who are completing Form I-9 on paper. The
first preparer and/or translator must complete all the fields in the Certification area on the same page the employee has signed.
There is no limit to the number of preparers and/or translators an employee can use, but each additional preparer and/or
translator must complete and sign a separate Certification area. Ensure the employee's last name, first name and middle initial
are entered at the top of any additional pages. The employer must ensure that any additional pages are retained with the
employee's completed Form I-9.
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Signature of Preparer or Translator: Any person who helped to prepare or translate Section 1of Form I-9 must sign his or
her name in this field. If you used a form obtained from the USCIS website, you must print the form to sign your name in this
field. The Preparer and/or Translator Certification must also be completed if “Individual under Age 18” or “Special Placement”
is entered in lieu of the employee’s signature in Section 1.
Today's Date: The person who signs the Preparer and/or Translator Certification must enter the date he or she signs in this
field on the printed form. Do not backdate this field. Enter the date as a 2-digit month, 2-digit day, and 4-digit year (mm/dd/
yyyy). For example, enter January 8, 2014 as 01/08/2014.
Last Name (Family Name): Enter the full legal last name of the person who helped the employee in preparing or translating
Section 1 in this field. The last name is also the family name or surname. If the preparer or translator has two last names or a
hyphenated last name, include both names in this field.
First Name (Given Name): Enter the full legal first name of the person who helped the employee in preparing or translating
Section 1 in this field. The first name is also the given name.
Address (Street Name and Number): Enter the street name and number of the current address of the residence of the person
who helped the employee in preparing or translating Section 1 in this field. Addresses for residences in Canada or Mexico may
be entered in this field. If the residence does not have a physical address, enter a description of the location of the residence,
such as “3 miles southwest of Anytown post office near water tower.” If the residence is an apartment, enter the apartment
number in this field.
City or Town: Enter the city, town or village of the residence of the person who helped the employee in preparing or
translating Section 1 in this field. If the residence is not located in a city, town or village, enter the name of the county,
township, reservation, etc., in this field. If the residence is in Canada, enter the city and province in this field. If the residence is
in Mexico, enter the city and state in this field.
State: Enter the abbreviation of the state, territory or country of the preparer or translator’s residence in this field.
ZIP Code: Enter the 5-digit ZIP code of the residence of the person who helped the employee in preparing or translating
Section 1 in this field. If the preparer or translator's residence is in Canada or Mexico, enter the 5- or 6-digit postal code.
Presenting Form I-9 Documents
Within 3 business days of starting work for pay, you must present to your employer documentation that establishes your
identity and employment authorization. For example, if you begin employment on Monday, you must present documentation
on or before Thursday of that week. However, if you were hired to work for less than 3 business days, you must present
documentation no later than the first day of employment.
Choose which unexpired document(s) to present to your employer from the Lists of Acceptable Documents. An employer
cannot specify which document(s) you may present from the Lists of Acceptable Documents. You may present either one
selection from List A or a combination of one selection from List B and one selection from List C. Some List A documents,
which show both identity and employment authorization, are combination documents that must be presented together to be
considered a List A document: for example, the foreign passport together with a Form I-94 containing an endorsement of the
alien’s nonimmigrant status and employment authorization with a specific employer incident to such status. List B documents
show identity only and List C documents show employment authorization only. If your employer participates in E-Verify and
you present a List B document, the document must contain a photograph. If you present acceptable List A documentation, you
should not be asked to present, nor should you provide, List B and List C documentation. If you present acceptable List B and
List C documentation, you should not be asked to present, nor should you provide, List A documentation. If you are unable to
present a document(s) from these lists, you may be able to present an acceptable receipt. Refer to the Receipts section below.
Your employer must review the document(s) you present to complete Form I-9. If your document(s) reasonably appears to be
genuine and to relate to you, your employer must accept the documents. If your document(s) does not reasonably appear to be
genuine or to relate to you, your employer must reject it and provide you with an opportunity to present other documents from
the Lists of Acceptable Documents. Your employer may choose to make copies of your document(s), but must return the
original(s) to you. Your employer must review your documents in your physical presence.
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Your employer will complete the other parts of this form, as well as review your entries in Section 1. Your employer may ask
you to correct any errors found. Your employer is responsible for ensuring all parts of Form I-9 are properly completed and is
subject to penalties under federal law if the form is not completed correctly.
Minors (individuals under age 18) and certain employees with disabilities whose parent, legal guardian or representative
completed Section 1 for the employee are only required to present an employment authorization document from List C. Refer to
the Handbook for Employers: Guidance for Completing Form I-9 (M-274) for more guidance on minors and certain individuals
with disabilities.
Receipts
If you do not have unexpired documentation from the Lists of Acceptable Documents, you may be able to present a receipt(s) in
lieu of an acceptable document(s). New employees who choose to present a receipt(s) must do so within three business days of
their first day of employment. If your employer is reverifying your employment authorization, and you choose to present a
receipt for reverification, you must present the receipt by the date your employment authorization expires. Receipts are not
acceptable if employment lasts fewer than three business days.
There are three types of acceptable receipts:
1. A receipt showing that you have applied to replace a document that was lost, stolen or damaged. You must present the
actual document within 90 days from the date of hire or, in the case of reverification, within 90 days from the date your
original employment authorization expires.
2. The arrival portion of Form I-94/I-94A containing a temporary I-551 stamp and a photograph of the individual. You must
present the actual Permanent Resident Card (Form I-551) by the expiration date of the temporary I-551 stamp, or, if there is
no expiration date, within 1 year from the date of admission.
3. The departure portion of Form I-94/I-94A with a refugee admission stamp. You must present an unexpired Employment
Authorization Document (Form I-766) or a combination of a List B document and an unrestricted Social Security Card
within 90 days from the date of hire or, in the case of reverification, within 90 days from the date your original employment
authorization expires.
Receipts showing that you have applied for an initial grant of employment authorization, or for renewal of your expiring or
expired employment authorization, are not acceptable.
Completing Section 2: Employer or Authorized Representative Review and Verification
You, the employer, must ensure that all parts of Form I-9 are properly completed and may be subject to penalties under federal
law if the form is not completed correctly. Section 1 must be completed no later than the employee’s first day of employment.
You may not ask an individual to complete Section 1 before he or she has accepted a job offer. Before completing Section 2,
you should review Section 1 to ensure the employee completed it properly. If you find any errors in Section 1, have the
employee make corrections, as necessary and initial and date any corrections made.
You or your authorized representative must complete Section 2 by examining evidence of identity and employment
authorization within 3 business days of the employee’s first day of employment. For example, if an employee begins
employment on Monday, you must review the employee's documentation and complete Section 2 on or before Thursday of that
week. However, if you hire an individual for less than 3 business days, Section 2 must be completed no later than the first day
of employment.
Entering Employee Information from Section 1
This area, titled, “Employee Info from Section 1” contains fields to enter the employee's last name, first name, middle initial
exactly as he or she entered them in Section 1. This area also includes a Citizenship/Immigration Status field to enter the
number of the citizenship or immigration status checkbox the employee selected in Section 1. These fields help to ensure that
the two pages of an employee's Form I-9 remain together. When completing Section 2 using a computer, the number entered in
the Citizenship/Immigration Status field provides drop-downs that directly relate to the employee's selected citizenship or
immigration status.
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Entering Documents the Employee Presents
You, the employer or authorized representative, must physically examine, in the employee's physical presence, the unexpired
document(s) the employee presents from the Lists of Acceptable Documents to complete the Document fields in Section 2.
You cannot specify which document(s) an employee may present from these lists. If you discriminate in the Form I-9 process
based on an individual's citizenship status, immigration status, or national origin, you may be in violation of the law and subject
to sanctions such as civil penalties and be required to pay back pay to discrimination victims. A document is acceptable as long
as it reasonably appears to be genuine and to relate to the person presenting it. Employees must present one selection from List
A or a combination of one selection from List B and one selection from List C.
List A documents show both identity and employment authorization. Some List A documents are combination documents that
must be presented together to be considered a List A document, such as a foreign passport together with a Form I-94 containing
an endorsement of the alien’s nonimmigrant status.
If an employee presents a receipt for the application to replace a lost, stolen or damaged document, the employee must present
the replacement document to you within 90 days of the first day of work for pay, or in the case of reverification, within 90 days
of the date the employee's employment authorization expired. Enter the word “Receipt” followed by the title of the receipt in
Section 2 under the list that relates to the receipt.
When your employee presents the replacement document, draw a line through the receipt, then enter the information from the
new document into Section 2. Other receipts may be valid for longer or shorter periods, such as the arrival portion of Form I-94/
I-94A containing a temporary I-551 stamp and a photograph of the individual, which is valid until the expiration date of the
temporary I-551 stamp or, if there is no expiration date, valid for one year from the date of admission.
Ensure that each document is an unexpired, original (no photocopies, except for certified copies of birth certificates) document.
Certain employees may present an expired employment authorization document, which may be considered unexpired, if the
employee's employment authorization has been extended by regulation or a Federal Register Notice. Refer to the Handbook for
Employers: Guidance for Completing Form I-9 (M-274) or I-9 Central for more guidance on these special situations.
Refer to the M-274 for guidance on how to handle special situations, such as students (who may present additional documents
not specified on the Lists) and H-1B and H-2A nonimmigrants changing employers.
Minors (individuals under age 18) and certain employees with disabilities whose parent, legal guardian or representative
completed Section 1 for the employee are only required to present an employment authorization document from List C. Refer to
the M-274 for more guidance on minors and certain persons with disabilities. If the minor's employer participates in E-Verify,
the minor employee also must present a List B identity document with a photograph to complete Form I-9.
You must return original document(s) to the employee, but may make photocopies of the document(s) reviewed. Photocopying
documents is voluntary unless you participate in E-Verify. E-Verify employers are only required to photocopy certain
documents. If you are an E-Verify employer who chooses to photocopy documents other than those you are required to
photocopy, you should apply this policy consistently with respect to Form I-9 completion for all employees. For more
information on the types of documents that an employer must photocopy if the employer uses E-Verify, visit E-Verify’s website
at www.dhs.gov/e-verify. For non-E-Verify employers, if photocopies are made, they should be made consistently for ALL new
hires and reverified employees.
Photocopies must be retained and presented with Form I-9 in case of an inspection by DHS or another federal government
agency. You must always complete Section 2 by reviewing original documentation, even if you photocopy an employee’s
document(s) after reviewing the documentation. Making photocopies of an employee’s document(s) cannot take the place of
completing Form I-9. You are still responsible for completing and retaining Form I-9.
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List A - Identity and Employment Authorization: If the employee presented an acceptable document(s) from List A or an
acceptable receipt for a List A document, enter the document(s) information in this column. If the employee presented a List A
document that consists of a combination of documents, enter information from each document in that combination in a separate
area under List A as described below. All documents must be unexpired. If you enter document information in the List A
column, you should not enter document information in the List B or List C columns. If you complete Section 2 using a
computer, a selection in List A will fill all the fields in the Lists B and C columns with N/A.
Document Title:
Full name of List A Document
Abbreviations
U.S. Passport
U.S. Passport
U.S. Passport Card
U.S. Passport Card
Permanent Resident Card (Form I-551)
Perm. Resident Card (Form I-551)
Alien Registration Receipt Card (Form I-551)
Foreign passport containing a temporary I-551 stamp
1. Foreign Passport
2. Temporary I-551 Stamp
Foreign passport containing a temporary I-551 printed
notation on a machine-readable immigrant visa (MRIV)
Employment Authorization Document (Form I-766)
Employment Auth. Document (Form I-766)
For a nonimmigrant alien authorized to work for a specific
employer because of his or her status, a foreign passport
with Form I/94/I-94A that contains an endorsement of the
alien's nonimmigrant status
1. Foreign Passport, work-authorized nonimmigrant
2. Form I-94/I94A
3. "Form I-20" or "Form DS-2019"
Note: In limited circumstances, certain J-1
students may be required to present a letter
from their Responsible Officer in order to work.
Enter the document title, issuing authority,
document number and expiration date from this
document in the Additional Information field.
Passport from the Federated States of Micronesia (FSM)
with Form I-94/I-94A
Passport from the Republic of the Marshall Islands (RMI)
with Form I-94/I94A
Receipt: The arrival portion of Form I-94/I-94A containing a
temporary I-551 stamp and photograph
Receipt: The departure portion of Form I-94/I-94A
with an unexpired refugee admission stamp
Receipt for an application to replace a lost, stolen or
damaged Permanent Resident Card (Form I-551)
Receipt for an application to replace a lost, stolen or
damaged Employment Authorization Document (Form I-766)
1. FSM Passport with Form I-94
2. Form I-94/I94A
1. RMI Passport with Form I-94
2. Form I-94/I94A
Receipt for an application to replace a lost, stolen or
damaged foreign passport with Form I-94/I-94A that contains
an endorsement of the alien's nonimmigrant status
1. Receipt:
work-authorized nonimmigrant
2. Receipt: Replacement Form I-94/I-94A
Receipt for an application to replace a lost, stolen or
damaged passport from the Federated States of Micronesia
with Form I-94/I-94A
Receipt for an application to replace a lost, stolen or
damaged passport from the Republic of the Marshall Islands
with Form I-94/I-94A
1. Receipt: Replacement FSM Passport with
Form I-94
2. Receipt: Replacement Form I-94/I-94A
1. Receipt: Replacement RMI Passport
with Form I-94
2. Receipt: Replacement Form I-94/I-94A
Receipt: Form I-94/I-94A w/I-551 stamp, photo
Receipt: Form I-94/I-94A w/refugee stamp
Receipt replacement Perm. Res. Card
(Form I-551)
Receipt replacement EAD (Form I-766)
Issuing Authority: Enter the issuing authority of the List A document or receipt. The issuing authority is the specific
entity that issued the document. If the employee presented a combination of documents, use the second and third Issuing
Authority fields as necessary.
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Appendix
Document Number: Enter the document number, if any, of the List A document or receipt presented. If the document
does not contain a number, enter N/A in this field. If the employee presented a combination of documents, use the second
and third Document Number fields as necessary. If the document presented was a Form I-20 or DS-2019, enter the
Student and Exchange Visitor Information System (SEVIS) number in the third Document Number field exactly as it
appears on the Form I-20 or the DS-2019.
Expiration Date (if any) (mm/dd/yyyy): Enter the expiration date, if any, of the List A document. The document is not
acceptable if it has already expired. If the document does not contain an expiration date, enter N/A in this field. If the
document uses text rather than a date to indicate when it expires, enter the text as shown on the document, such as “D/
S”(which means, “duration of status”). For a receipt, enter the expiration date of the receipt validity period as described
above. If the employee presented a combination of documents, use the second and third Expiration Date fields as
necessary. If the document presented was a Form I-20 or DS-2019, enter the program end date here.
List B - Identity: If the employee presented an acceptable document from List B or an acceptable receipt for the application to
replace a lost, stolen, or destroyed List B document, enter the document information in this column. If a parent or legal guardian
attested to the identity of an employee who is an individual under age 18 or certain employees with disabilities in Section 1,
enter either "Individual under age 18" or "Special Placement" in this field. Refer to the Handbook for Employers: Guidance for
Completing Form I-9 (M-274) for more guidance on individuals under age 18 and certain person with disabilities.
If you enter document information in the List B column, you must also enter document information in the List C column. If an
employee presents acceptable List B and List C documents, do not ask the employees to present a List A document. No entries
should be made in the List A column. If you complete Section 2 using a computer, a selection in List B will fill all the fields in
the List A column with N/A.
Document Title:
the document title or
issuing authority.
Full name of List B Document
Driver's license issued by a State or outlying possession of
the United States
ID card issued by a State or outlying possession of the
United States
ID card issued by federal, state, or local government
agencies or entities
Abbreviations
Driver's license issued by state/territory
ID card issued by state/territory
Government ID
School ID card with photograph
School ID
Voter's registration card
Voter registration card
U.S. Military card
U.S. Military card
U.S. Military draft record
U.S. Military draft record
Military dependent's ID card
Military dependent's ID card
U.S. Coast Guard Merchant Mariner Card
USCG Merchant Mariner card
Native American tribal document
Native American tribal document
Driver's license issued by a Canadian government authority
Canadian driver's license
School record (for persons under age 18 who are unable to
present a document listed above)
Report card (for persons under age 18 who are unable to
present a document listed above)
Clinic record (for persons under age 18 who are unable to
present a document listed above)
Doctor record (for persons under age 18 who are unable to
present a document listed above)
Hospital record (for persons under age 18 who are unable to
present a document listed above)
Day-care record (for persons under age 18 who are unable to
present a document listed above)
Nursery school record (for persons under age 18 who are
unable to present a document listed above)
School record (under age 18)
Report card (under age 18)
Clinic record (under age 18)
Doctor record (under age 18)
Hospital record (under age 18)
Day-care record (under age 18)
Nursery school record (under age 18)
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Full name of List B Document
Abbreviations
Individual under age 18 endorsement by parent or guardian
Individual under Age 18
Special placement endorsement for persons with disabilities
Special Placement
Receipt for the application to replace a lost, stolen or
damaged Driver's License issued by a State or outlying
possession of the United States
Receipt for the application to replace a lost, stolen or
damaged ID card issued by a State or outlying possession of
the United States
Receipt for the application to replace a lost, stolen or
damaged ID card issued by federal, state, or local
government agencies or entities
Receipt for the application to replace a lost, stolen or
damaged School ID card with photograph
Receipt for the application to replace a lost, stolen or
damaged Voter's registration card
Receipt for the application to replace a lost, stolen or
damaged U.S. Military card
Receipt for the application to replace a lost, stolen or
damaged Military dependent's ID card
Receipt for the application to replace a lost, stolen or
damaged U.S. Military draft record
Receipt for the application to replace a lost, stolen or
damaged U.S. Coast Guard Merchant Mariner Card
Receipt for the application to replace a lost, stolen or
damaged Driver's license issued by a Canadian government
authority
Receipt for the application to replace a lost, stolen or
damaged Native American tribal document
Receipt for the application to replace a lost, stolen or
damaged School record (for persons under age 18 who are
unable to present a document listed above)
Receipt for the application to replace a lost, stolen or
damaged Report card (for persons under age 18 who are
unable to present a document listed above)
Receipt for the application to replace a lost, stolen or
damaged Clinic record (for persons under age 18 who are
unable to present a document listed above)
Receipt for the application to replace a lost, stolen or
damaged Doctor record (for persons under age 18 who are
unable to present a document listed above)
Receipt for the application to replace a lost, stolen or
damaged Hospital record (for persons under age 18 who are
unable to present a document listed above)
Receipt for the application to replace a lost, stolen or
damaged Day-care record (for persons under age 18 who
are unable to present a document listed above)
Receipt for the application to replace a lost, stolen or
damaged Nursery school record (for persons under age 18
who are unable to present a document listed above)
Receipt: Replacement driver's license
Receipt: Replacement ID card
Receipt: Replacement Gov't ID
Receipt: Replacement School ID
Receipt: Replacement Voter reg. card
Receipt: Replacement U.S. Military card
Receipt: Replacement U.S. Military dep. card
Receipt: Replacement Military draft
record
Receipt: Replacement Merchant Mariner card
Receipt: Replacement Canadian DL
Receipt: Replacement Native American
tribal doc
Receipt: Replacement School record
(under age 18)
Receipt: Replacement Report card
(under age 18)
Receipt: Replacement Clinic record
(under age 18)
Receipt: Replacement Doctor record
(under age 18)
Receipt: Replacement Hospital record
(under age 18)
Receipt: Replacement Day-care record
(under age 18)
Receipt: Replacement Nursery school record
(under age 18)
Issuing Authority: Enter the issuing authority of the List B document or receipt. The issuing authority is the entity that
issued the document. If the employee presented a document that is issued by a state agency, include the state as part of
the issuing authority.
Document Number: Enter the document number, if any, of the List B document or receipt exactly as it appears on the
document. If the document does not contain a number, enter N/A in this field.
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List C - Employment Authorization: If the employee presented an acceptable document from List C, or an acceptable
receipt for the application to replace a lost, stolen, or destroyed List C document, enter the document information in this
column. If you enter document information in the List C column, you must also enter document information in the List B
column. If an employee presents acceptable List B and List C documents, do not ask the employee to present a list A document.
No entries should be made in the List A column.
Document Title: If the employee presented a document from List C, enter the title of the List C document or receipt in
this field. The abbreviations provided are available in the dropdown when the form is completed on a computer. When
completing the form on paper, you may choose to use these abbreviations or any other common abbreviations to document
the document title or issuing authority. If you are completing the form on a computer, and you select an Employment
authorization document issued by DHS, the field will populate with List C #7 and provide a space for you to enter a
description of the documentation the employee presented. Refer to the M-274 for guidance on entering List C #7
documentation.
Full name of List C Document
Abbreviations
Social Security Account Number card without restrictions
(Unrestricted) Social Security Card
Certification of Birth Abroad (Form FS-545)
Form FS-545
Certification of Report of Birth (Form DS-1350)
Form DS-1350
Consular Report of Birth Abroad (Form FS-240)
Form FS-240
Original or certified copy of a U.S. birth certificate bearing an
official seal
Birth Certificate
Native American tribal document
Native American tribal document
U.S. Citizen ID Card (Form I-197)
Form I-197
Identification Card for use of Resident Citizen in the United
States (Form I-179)
Form I-179
Employment Auth. document (DHS) List C #7
Receipt for the application to replace a lost, stolen or damaged
Social Security Account Number Card without restrictions
Receipt for the application to replace a lost, stolen or
damaged Original or certified copy of a U.S. birth certificate
bearing an official seal
Receipt for the application to replace a lost, stolen or
damaged Native American Tribal Document
Receipt: Replacement Unrestricted SS
Card
Receipt: Replacement Birth Certificate
Receipt: Replacement Native American Tribal
Doc.
Receipt: Replacement Employment Auth. Doc.
(DHS)
Additional Information: Use this space to notate any additional information required for Form I-9 such as:
›Employment authorization extensions for Temporary Protected Status beneficiaries, F-1 OPT STEM students, CAPGAP, H-1B and H-2A employees continuing employment with the same employer or changing employers, and other
nonimmigrant categories that may receive extensions of stay
›Additional document(s) that certain nonimmigrant employees may present
›Discrepancies that E-Verify employers must notate when participating in the IMAGE program
›Employee termination dates and form retention dates
›E-Verify case number, which may also be entered in the margin or attached as a separate sheet per E-Verify
requirements and your chosen business process.
›Any other comments or notations necessary for the employer's business process
You may leave this field blank if the employee's circumstances do not require additional notations.
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Entering Information in the Employer Certification
Employee's First Day of Employment: Enter the employee's first day of employment as a 2-digit month, 2-digit day and
4-digit year (mm/dd/yyyy).
Signature of Employer or Authorized Representative: Review the form for accuracy and completeness. The person who
physically examines the employee's original document(s) and completes Section 2 must sign his or her name in this field. If you
used a form obtained from the USCIS website, you must print the form to sign your name in this field. By signing Section 2,
you attest under penalty of perjury (28 U.S.C. § 1746) that you have physically examined the documents presented by the
employee, the document(s) reasonably appear to be genuine and to relate to the employee named, that to the best of your
knowledge the employee is authorized to work in the United States, that the information you entered in Section 2 is complete,
true and correct to the best of your knowledge, and that you are aware that you may face severe penalties provided by law and
may be subject to criminal prosecution for knowingly and willfully making false statements or knowingly accepting false
documentation when completing this form.
Today's Date: The person who signs Section 2 must enter the date he or she signed Section 2 in this field. Do not backdate this
field. If you used a form obtained from the USCIS website, you must print the form to write the date in this field. Enter the date
as a 2-digit month, 2-digit day and 4-digit year (mm/dd/yyyy). For example, enter January 8, 2014 as 01/08/2014.
Title of Employer or Authorized Representative: Enter the title, position or role of the person who physically examines the
employee's original document(s), completes and signs Section 2.
Last Name of the Employer or Authorized Representative: Enter the full legal last name of the person who physically
examines the employee’s original documents, completes and signs Section 2. Last name refers to family name or surname. If
the person has two last names or a hyphenated last name, include both names in this field.
First Name of the Employer or Authorized Representative: Enter the full legal first name of the person who physically
examines the employee’s original documents, completes, and signs Section 2. First name refers to the given name.
.
Employer’s Business or Organization Address (Street Name and Number): Enter an actual, physical address of the
employer. If your company has multiple locations, use the most appropriate address that identifies the location of the employer.
Do not provide a P.O. Box address.
City or Town: Enter the city or town for the employer’s business or organization address. If the location is not a city or town,
you may enter the name of the village, county, township, reservation, etc. that applies.
State: Enter the two-character abbreviation of the state for the employer’s business or organization address.
ZIP Code: Enter the 5-digit ZIP code for the employer’s business or organization address.
Completing Section 3: Reverification and Rehires
Section 3 applies to both reverification and rehires. When completing this section, you must also complete the Last Name, First
Name and Middle Initial fields in the Employee Info from Section 1 area at the top of Section 2, leaving the Citizenship/
Immigration Status field blank. When completing Section 3 in either a reverification or rehire situation, if the employee’s name
has changed, record the new name in Block A.
Reverification
Reverification in Section 3 must be completed prior to the earlier of:
›The expiration date, if any, of the employment authorization stated in Section 1, or
›The expiration date, if any, of the List A or List C employment authorization document recorded in Section 2
(with some exceptions listed below).
Some employees may have entered “N/A” in the expiration date field in Section 1 if they are aliens whose employment
authorization does not expire, e.g. asylees, refugees, certain citizens of the Federated States of Micronesia, the Republic of the
Marshall Islands, or Palau. Reverification does not apply for such employees unless they choose to present evidence of
employment authorization in Section 2 that contains an expiration date and requires reverification, such as Form I-766,
Employment Authorization Document.
You should not reverify U.S. citizens and noncitizen nationals, or lawful permanent residents (including conditional residents)
who presented a Permanent Resident Card (Form I-551). Reverification does not apply to List B documents.
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For reverification, an employee must present an unexpired document(s) (or a receipt) from either List A or List C showing he or
she is still authorized to work. You CANNOT require the employee to present a particular document from List A or List C. The
employee is also not required to show the same type of document that he or she presented previously. See specific instructions
on how to complete Section 3 below.
Rehires
If you rehire an employee within three years from the date that the Form I-9 was previously executed, you may either rely on
the employee’s previously executed Form I-9 or complete a new Form I-9.
If you choose to rely on a previously completed Form I-9, follow these guidelines.
›If the employee remains employment authorized as indicated on the previously executed Form I-9, the employee does
not need to provide any additional documentation. Provide in Section 3 the employee’s rehire date, any name changes if
applicable, and sign and date the form.
›If the previously executed Form I-9 indicates that the employee’s employment authorization from Section 1 or
employment authorization documentation from Section 2 that is subject to reverification has expired, then
reverification of employment authorization is required in Section 3 in addition to providing the rehire date. If the
previously executed Form I-9 is not the current version of the form, you must complete Section 3 on the current
version of the form.
›If you already used Section 3 of the employee’s previously executed Form I-9, but are rehiring the employee within
three years of the original execution of Form I-9, you may complete Section 3 on a new Form I-9 and attach it to the
previously executed form.
Employees rehired after three years of original execution of the Form I-9 must complete a new Form I-9.
Complete each block in Section 3 as follows:
Block A - New Name: If an employee who is being reverified or rehired has also changed his or her name since originally
completing Section 1 of this form, complete this block with the employee’s new name. Enter only the part of the name that has
changed, for example: if the employee changed only his or her last name, enter the last name in the Last Name field in this
Block, then enter N/A in the First Name and Middle Initial fields. If the employee has not changed his or her name, enter N/A in
each field of Block A.
Block B - Date of Rehire: Complete this block if you are rehiring an employee within three years of the date Form I-9 was
originally executed. Enter the date of rehire in this field. Enter N/A in this field if the employee is not being rehired.
Block C - Complete this block if you are reverifying expiring or expired employment authorization or employment
authorization documentation of a current or rehired employee. Enter the information from the List A or List C document(s) (or
receipt) that the employee presented to reverify his or her employment authorization. All documents must be unexpired.
Document Title: Enter the title of the List A or C document (or receipt) the employee has presented to show continuing
employment authorization in this field.
Document Number: Enter the document number, if any, of the document you entered in the Document Title field
exactly as it appears on the document. Enter N/A if the document does not have a number.
Expiration Date (if any) (mm/dd/yyyy): Enter the expiration date, if any, of the document you entered in the
Document Title field as a 2-digit month, 2-digit day, and 4-digit year (mm/dd/yyyy). If the document does not contain an
expiration date, enter N/A in this field.
Signature of Employer or Authorized Representative: The person who completes Section 3 must sign in this field. If you
used a form obtained from the USCIS website, you must print Section 3 of the form to sign your name in this field. By signing
Section 3, you attest under penalty of perjury (28 U.S.C. §1746) that you have examined the documents presented by the
employee, that the document(s) reasonably appear to be genuine and to relate to the employee named, that to the best of your
knowledge the employee is authorized to work in the United States, that the information you entered in Section 3 is complete,
true and correct to the best of your knowledge, and that you are aware that you may face severe penalties provided by law and
may be subject to criminal prosecution for knowingly and willfully making false statements or knowingly accepting false
documentation when completing this form.
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Today's Date: The person who completes Section 3 must enter the date Section 3 was completed and signed in this field. Do
not backdate this field. If you used a form obtained from the USCIS website, you must print Section 3 of the form to enter the
date in this field. Enter the date as a 2-digit month, 2-digit day, and 4-digit year (mm/dd/yyyy). For example, enter January 8,
2014 as 01/08/2014.
Name of Employer or Authorized Representative: The person who completed, signed and dated Section 3 must enter his
or her name in this field.
What is the Filing Fee?
There is no fee for completing Form I-9. This form is not filed with USCIS or any government agency. Form I-9 must be
retained by the employer and made available for inspection by U.S. Government officials as specified in the “USCIS Privacy
Act Statement” below.
USCIS Forms and Information
For additional guidance about Form I-9, employers and employees should refer to the Handbook for Employers: Guidance for
Completing Form I-9 (M-274) or USCIS’ Form I-9 website at https://www.uscis.gov/i-9-central.
You can also obtain information about Form I-9 by e-mailing USCIS at [email protected], or by calling 1-888-464-4218 or
1-877-875-6028 (TTY).
You may download and obtain the English and Spanish versions of Form I-9, the Handbook for Employers, or the instructions
to Form I-9 from the USCIS website at https://www.uscis.gov/i-9. To complete Form I-9 on a computer, you will need the latest
version of Adobe Reader, which can be downloaded for free at http://get.adobe.com/reader/. You may order USCIS forms by
calling our toll-free number at 1-800-870-3676. You may also obtain forms and information by contacting the USCIS National
Customer Service Center at 1-800-375-5283 or 1-800-767-1833 (TTY).
Employees with questions about Form I-9 and/or E-Verify can reach the USCIS employee hotline by calling 1-888-897-7781 or
1-877-875-6028 (TTY).
Photocopying Blank and Completed Forms I-9 and Retaining Completed Forms I-9
Employers may photocopy or print blank Forms I-9 for future use. All pages of the instructions and Lists of Acceptable
Documents must be available, either in print or electronically, to all employees completing this form. Employers must retain
each employee's completed Form I-9 for as long as the individual works for the employer and for a specified period after
employment has ended. Employers are required to retain the pages of the form on which the employee and employer entered
data. If copies of documentation presented by the employee are made, those copies must also be retained. Once the individual's
employment ends, the employer must retain this form and attachments for either 3 years after the date of hire (i.e., first day of
work for pay) or 1 year after the date employment ended, whichever is later. In the case of recruiters or referrers for a fee (only
applicable to those that are agricultural associations, agricultural employers, or farm labor contractors), the retention period is 3
years after the date of hire (i.e., first day of work for pay).
Forms I-9 obtained from the USCIS website that are not printed and signed manually (by hand) are not considered complete. In
the event of an inspection, retaining incomplete forms may make you subject to fines and penalties associated with incomplete
forms.
Employers should ensure that information employees provide on Form I-9 is used only for Form I-9 purposes. Completed
Forms I-9 and all accompanying documents should be stored in a safe, secure location.
Form I-9 may be generated, signed, and retained electronically, in compliance with Department of Homeland Security
regulations at 8 CFR 274a.2.
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USCIS Privacy Act Statement
AUTHORITIES: The authority for collecting this information is the Immigration Reform and Control Act of 1986, Public
Law 99-603 (8 USC § 1324a).
PURPOSE: This information is collected by employers to comply with the requirements of the Immigration Reform and
Control Act of 1986. This law requires that employers verify the identity and employment authorization of individuals they hire
for employment to preclude the unlawful hiring, or recruiting or referring for a fee, of aliens who are not authorized to work in
the United States.
DISCLOSURE: Providing the information collected by this form is voluntary. However an employer should not continue to
employ an individual without a completed form. Failure of the employer to prepare and/or ensure proper completion of this
form for each employee hired in the United States after November 6, 1986 or in the Commonwealth of the Mariana Islands after
November 27, 2011, may subject the employer to civil and/or criminal penalties. In addition, employing individuals knowing
that they are unauthorized to work in the United States may subject the employer to civil and/or criminal penalties.
ROUTINE USES: This information will be used by employers as a record of their basis for determining eligibility of an
employee to work in the United States. The employer must retain this form for the required period and make it available for
inspection by authorized officials of the Department of Homeland Security, Department of Labor and the Department of Justice,
Civil Rights Division, Immigrant and Employee Rights Section.
Paperwork Reduction Act
An agency may not conduct or sponsor an information collection and a person is not required to respond to a collection of
information unless it displays a currently valid OMB control number. The public reporting burden for this collection of
information is estimated at 35 minutes per response, when completing the form manually, and 26 minutes per response when
using a computer to aid in completion of the form, including the time for reviewing instructions and completing and retaining
the form. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to: U.S. Citizenship and Immigration Services, Regulatory Coordination Division, Office
of Policy and Strategy, 20 Massachusetts Avenue NW, Washington, DC 20529-2140; OMB No. 1615-0047. Do not mail your
completed Form I-9 to this address.
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SS-4
Application for Employer Identification Number
OMB No. 1545-0003
(For use by employers, corporations, partnerships, trusts, estates, churches,
government agencies, Indian tribal entities, certain individuals, and others.)
▶ Go to www.irs.gov/FormSS4 for instructions and the latest information.
Department of the Treasury
▶ See separate instructions for each line. ▶ Keep a copy for your records.
Internal Revenue Service
1
Legal name of entity (or individual) for whom the EIN is being requested
Type or print clearly.
Form
(Rev. December 2017)
8a
3
EIN
2
Trade name of business (if different from name on line 1)
4a
Mailing address (room, apt., suite no. and street, or P.O. box) 5a
Street address (if different) (Do not enter a P.O. box.)
4b
City, state, and ZIP code (if foreign, see instructions)
5b
City, state, and ZIP code (if foreign, see instructions)
6
County and state where principal business is located
7a
Name of responsible party
Executor, administrator, trustee, “care of” name
7b
Is this application for a limited liability company (LLC)
(or a foreign equivalent)? . . . . . . . .
8b If 8a is “Yes,” enter the number of
LLC members . . . . . . ▶
8c
Yes
If 8a is “Yes,” was the LLC organized in the United States? . .
9a
Type of entity (check only one box). Caution. If 8a is “Yes,” see the instructions for the correct box to check.
Sole proprietor (SSN)
Partnership
Corporation (enter form number to be filed)
No
. . .
SSN, ITIN, or EIN
.
▶
10
11
13
Other (specify) ▶
If a corporation, name the state or foreign country (if
applicable) where incorporated
Reason for applying (check only one box)
Started new business (specify type) ▶
.
.
.
.
.
.
.
.
.
.
.
Yes
No
Estate (SSN of decedent)
Plan administrator (TIN)
Trust (TIN of grantor)
Personal service corporation
Church or church-controlled organization
Other nonprofit organization (specify) ▶
9b
.
Military/National Guard
Farmers’ cooperative
REMIC
State
State/local government
Federal government
Indian tribal governments/enterprises
Group Exemption Number (GEN) if any
Foreign country
▶
Banking purpose (specify purpose) ▶
Changed type of organization (specify new type) ▶
Purchased going business
Hired employees (Check the box and see line 13.)
Created a trust (specify type) ▶
Compliance with IRS withholding regulations
Created a pension plan (specify type) ▶
Other (specify) ▶
12
Closing month of accounting year
Date business started or acquired (month, day, year). See instructions.
14
If you expect your employment tax liability to be $1,000 or
less in a full calendar year and want to file Form 944
Highest number of employees expected in the next 12 months (enter -0- if none).
annually instead of Forms 941 quarterly, check here.
If no employees expected, skip line 14.
(Your employment tax liability generally will be $1,000
or less if you expect to pay $4,000 or less in total wages.)
Household
Other
Agricultural
If you do not check this box, you must file Form 941 for
every quarter.
15
First date wages or annuities were paid (month, day, year). Note: If applicant is a withholding agent, enter date income will first be paid to
nonresident alien (month, day, year) . . . . . . . . . . . . . . . . . ▶
16
Check one box that best describes the principal activity of your business.
Health care & social assistance
Wholesale-agent/broker
Construction
Rental & leasing
Transportation & warehousing
Accommodation & food service
Wholesale-other
Retail
Real estate
Manufacturing
Other (specify) ▶
Finance & insurance
Indicate principal line of merchandise sold, specific construction work done, products produced, or services provided.
17
18
Has the applicant entity shown on line 1 ever applied for and received an EIN?
Yes
No
If “Yes,” write previous EIN here ▶
Complete this section only if you want to authorize the named individual to receive the entity’s EIN and answer questions about the completion of this form.
Third
Party
Designee
Designee’s name
Designee’s telephone number (include area code)
Address and ZIP code
Designee’s fax number (include area code)
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete.
Applicant’s telephone number (include area code)
Name and title (type or print clearly) ▶
Applicant’s fax number (include area code)
Signature
▶
Date ▶
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
A-44
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Cat. No. 16055N
Form
SS-4 (Rev. 12-2017)
Appendix
Page 2
Form SS-4 (Rev. 12-2017)
Do I Need an EIN?
File Form SS-4 if the applicant entity does not already have an EIN but is required to show an EIN on any return, statement,
or other document.1 See also the separate instructions for each line on Form SS-4.
IF the applicant...
Started a new business
AND...
Does not currently have (nor expect to have)
employees
THEN...
Complete lines 1, 2, 4a–8a, 8b–c (if applicable), 9a,
9b (if applicable), and 10–14 and 16–18.
Hired (or will hire) employees,
including household employees
Does not already have an EIN
Complete lines 1, 2, 4a–6, 7a–b (if applicable), 8a,
8b–c (if applicable), 9a, 9b (if applicable), 10–18.
Opened a bank account
Needs an EIN for banking purposes only
Complete lines 1–5b, 7a–b (if applicable), 8a, 8b–c
(if applicable), 9a, 9b (if applicable), 10, and 18.
Changed type of organization
Either the legal character of the organization or its
ownership changed (for example, you incorporate a
sole proprietorship or form a partnership)2
Complete lines 1–18 (as applicable).
Purchased a going business3
Created a trust
Does not already have an EIN
The trust is other than a grantor trust or an IRA
trust4
Complete lines 1–18 (as applicable).
Complete lines 1–18 (as applicable).
Created a pension plan as a
plan administrator5
Needs an EIN for reporting purposes
Complete lines 1, 3, 4a–5b, 9a, 10, and 18.
Is a foreign person needing an
EIN to comply with IRS
withholding regulations
Needs an EIN to complete a Form W-8 (other than
Form W-8ECI), avoid withholding on portfolio assets,
or claim tax treaty benefits6
Complete lines 1–5b, 7a–b (SSN or ITIN optional),
8a, 8b–c (if applicable), 9a, 9b (if applicable), 10,
and 18.
Is administering an estate
Needs an EIN to report estate income on Form 1041
Complete lines 1–6, 9a, 10–12, 13–17 (if applicable),
and 18.
Is a withholding agent for
taxes on non-wage income
paid to an alien (i.e.,
individual, corporation, or
partnership, etc.)
Is a state or local agency
Is an agent, broker, fiduciary, manager, tenant, or
spouse who is required to file Form 1042, Annual
Withholding Tax Return for U.S. Source Income of
Foreign Persons
Complete lines 1, 2, 3 (if applicable), 4a–5b, 7a–b (if
applicable), 8a, 8b–c (if applicable), 9a, 9b (if
applicable), 10, and 18.
Serves as a tax reporting agent for public assistance
recipients under Rev. Proc. 80-4, 1980-1 C.B. 5817
Complete lines 1, 2, 4a–5b, 9a, 10, and 18.
Is a single-member LLC (or
similar single-member entity)
Needs an EIN to file Form 8832, Classification
Election, for filing employment tax returns and
excise tax returns, or for state reporting purposes8, or
is a foreign-owned U.S. disregarded entity and needs
an EIN to file Form 5472, Information Return of a 25%
Foreign-Owned U.S. Corporation or a Foreign
Corporation Engaged in a U.S. Trade or Business
(Under Sections 6038A and 6038C of the Internal
Revenue Code)
Complete lines 1–18 (as applicable).
Is an S corporation
Needs an EIN to file Form 2553, Election by a Small
Business Corporation9
Complete lines 1–18 (as applicable).
1
For example, a sole proprietorship or self-employed farmer who establishes a qualified retirement plan, or is required to file excise, employment, alcohol, tobacco, or
firearms returns, must have an EIN. A partnership, corporation, REMIC (real estate mortgage investment conduit), nonprofit organization (church, club, etc.), or farmers’
cooperative must use an EIN for any tax-related purpose even if the entity does not have employees.
2
However, do not apply for a new EIN if the existing entity only (a) changed its business name, (b) elected on Form 8832 to change the way it is taxed (or is covered by the
default rules), or (c) terminated its partnership status because at least 50% of the total interests in partnership capital and profits were sold or exchanged within a 12month period. The EIN of the terminated partnership should continue to be used. See Regulations section 301.6109-1(d)(2)(iii).
3
Do not use the EIN of the prior business unless you became the “owner” of a corporation by acquiring its stock.
4
However, grantor trusts that do not file using Optional Method 1 and IRA trusts that are required to file Form 990-T, Exempt Organization Business Income Tax Return,
must have an EIN. For more information on grantor trusts, see the Instructions for Form 1041.
5
A plan administrator is the person or group of persons specified as the administrator by the instrument under which the plan is operated.
6
Entities applying to be a Qualified Intermediary (QI) need a QI-EIN even if they already have an EIN. See Rev. Proc. 2000-12.
7
See also Household employer on page 4 of the instructions. Note: State or local agencies may need an EIN for other reasons, for example, hired employees.
8
See Disregarded entities on page 4 of the instructions for details on completing Form SS-4 for an LLC.
9
An existing corporation that is electing or revoking S corporation status should use its previously-assigned EIN.
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A-45
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The Payroll Source
Instructions for Form SS-4
(Rev. December 2017)
Department of the Treasury
Internal Revenue Service
Application for Employer Identification Number (EIN)
How To Apply for an EIN
Section references are to the Internal Revenue Code unless
otherwise noted.
General Instructions
Use these instructions to complete Form SS-4, Application for
Employer Identification Number (EIN). Also see Do I Need an EIN?
on page 2 of Form SS-4.
Future Developments
For the latest information related to Form SS-4 and its instructions,
such as legislation enacted after they were published, go to IRS.gov/
FormSS4.
Purpose of Form
Use Form SS-4 to apply for an EIN. An EIN is a nine-digit number
(for example, 12-3456789) assigned to sole proprietors,
corporations, partnerships, estates, trusts, and other entities for tax
filing and reporting purposes. The information you provide on this
form will establish your business tax account.
See Form SS-4PR (for Puerto Rico) for the
TIP Spanish-language version of Form SS-4.
!
CAUTION
(ITIN).
An EIN is for use in connection with your business activities
only. Don't use your EIN in place of your social security
number (SSN) or individual taxpayer identification number
Reminders
Apply for an EIN online. For applicants in the U.S. or U.S.
possessions, you can apply for and receive an EIN free of charge on
IRS.gov. See How To Apply for an EIN, later.
File only one Form SS-4. Generally, a sole proprietor should file
only one Form SS-4 and needs only one EIN, regardless of the
number of businesses operated as a sole proprietorship or trade
names under which a business operates. However, if a sole
proprietorship incorporates or enters into a partnership, a new EIN is
required. Also, each corporation in an affiliated group must have its
own EIN.
EIN applied for, but not received. If you don’t have an EIN by the
time a return is due, write “Applied For” and the date you applied in
the space shown for the number. Don’t show your SSN as an EIN on
returns. If you don’t have an EIN by the time a tax deposit is due,
send your payment to the Internal Revenue Service Center for your
filing area as shown in the instructions for the form that you are filing.
Make your check or money order payable to the “United States
Treasury” and show your name (as shown on Form SS-4), address,
type of tax, period covered, and date you applied for an EIN.
For information about EINs and federal tax deposits, see
TIP Pub. 15, Pub. 51, and Pub. 80.
To ensure fair and equitable treatment for all taxpayers, EIN
issuances are limited to one per responsible party, per day.
CAUTION For trusts, the limitation is applied to the grantor, owner, or
trustor. For estates, the limitation is applied to the decedent
(decedent estate) or the debtor (bankruptcy estate). This limitation is
applicable to all requests for EINs whether online, telephone, fax, or
mail.
!
Dec 11, 2017
A-46
You can apply for an EIN online (only for applicants in the U.S. or
U.S. possessions), by telephone (only for applicants outside of the
U.S. or U.S. possessions), by fax, or by mail, depending on how
soon you need to use the EIN. Use only one method for each entity
so you don’t receive more than one EIN for an entity.
Apply for an EIN online. If you have a legal residence, principal
place of business, or principal office or agency in the U.S. or U.S.
possessions, you can receive an EIN online and use it immediately
to file a return or make a payment. Go to the IRS website at IRS.gov/
Businesses and click on Employer ID Numbers.
The principal officer, general partner, grantor, owner, trustor, etc.,
must have a valid Taxpayer Identification Number (SSN, EIN, or
ITIN) in order to use the online application. Taxpayers who apply
online have an option to view, print, and save their EIN assignment
notice at the end of the session. (Authorized third party designees
see Line 18 instructions.)
If you have NO legal residence, principal place of business,
or principal office or agency in the U.S. or U.S. possessions,
CAUTION you can't use the online application to obtain an EIN. Please
use one of the other methods to apply.
!
Apply by telephone—option available to international applicants only. If you have NO legal residence, principal place of
business, or principal office or agency in the U.S. or U.S.
possessions, you may call 267-941-1099 (not a toll-free number),
6:00 a.m. to 11:00 p.m. (Eastern time), Monday through Friday, to
obtain an EIN.
The person making the call must be authorized to receive the EIN
and answer questions concerning Form SS-4. Complete the Third
Party Designee section only if you want to authorize the named
individual to receive the entity’s EIN and answer questions about the
completion of Form SS-4. The designee’s authority terminates at the
time the EIN is assigned and released to the designee. You must
complete the signature area for the authorization to be valid.
Note. It will be helpful to complete Form SS-4 before contacting the
IRS. An IRS representative will use the information from Form SS-4
to establish your account and assign you an EIN. Write the number
you're given on the upper right corner of the form and sign and date
it. Keep this copy for your records.
If requested by an IRS representative, mail or fax the signed
Form SS-4 (including any third party designee authorization) within
24 hours to the IRS address provided by the IRS representative.
!
CAUTION
The IRS no longer issues EINs by telephone for domestic
taxpayers. Only international applicants can receive an EIN
by telephone.
Apply by fax. Under the Fax-TIN program, you can receive your
EIN by fax generally within 4 business days. Complete and fax Form
SS-4 to the IRS using the appropriate fax number listed in Where To
File or Fax, later. A long-distance charge to callers outside of the
local calling area will apply. Fax-TIN numbers can only be used to
apply for an EIN. The numbers may change without notice. Fax-TIN
is available 24 hours a day, 7 days a week.
Be sure to provide your fax number so the IRS can fax the EIN
back to you.
Apply by mail. Complete Form SS-4 at least 4 to 5 weeks before
you will need an EIN. Sign and date the application and mail it to the
appropriate address listed in Where To File or Fax, later. You will
Cat. No. 62736F
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Appendix
receive your EIN in the mail in approximately 4 weeks. Also see
Third Party Designee, later.
Call 1-800-829-4933 to verify a number or to ask about the status
of an application by mail.
Form 8821, Tax Information Authorization.
Form 8822-B, Change of Address or Responsible Party —
Business.
Form 8832, Entity Classification Election.
Form 8849, Claim for Refund of Excise Taxes.
Form SS-4 downloaded from IRS.gov is a fillable form and,
For more information about filing Form SS-4 and related issues,
see:
Pub. 15, Employer's Tax Guide.
Pub. 51, Agricultural Employer's Tax Guide.
Pub. 80, Federal Tax Guide for Employers in the U.S. Virgin
Islands, Guam, American Samoa, and the Commonwealth of the
Northern Mariana Islands.
Pub. 538, Accounting Periods and Methods.
Pub. 542, Corporations.
Pub. 557, Tax-Exempt Status for Your Organization.
Pub. 583, Starting a Business and Keeping Records.
Pub. 966, Electronic Choices to Pay All Your Federal Taxes.
Pub. 1635, Understanding Your EIN.
TIP when completed, is suitable for faxing or mailing to the IRS.
Where To File or Fax
If you have a principal place of
business, office or agency, or
legal residence in the case of an
individual, located in:
File or fax to:
One of the 50 states or the District
of Columbia
Internal Revenue Service
Attn: EIN Operation
Cincinnati, OH 45999
Fax: (855) 641-6935
If you have no legal residence,
principal office or principal agency
in any state or the District of
Columbia (international/U.S.
possessions)
Specific Instructions
Internal Revenue Service
Attn: EIN International Operation
Cincinnati, OH 45999
Follow the instructions for each line to expedite processing and to
avoid unnecessary IRS requests for additional information. Enter
“N/A” on the lines that don't apply.
Fax: (855) 215-1627 (within the U.S.)
Fax: (304) 707-9471 (outside the U.S.)
Line 1. Legal name of entity (or individual) for whom the EIN is
being requested. Enter the legal name of the entity (or individual)
applying for the EIN exactly as it appears on the social security card,
charter, or other applicable legal document. An entry is required.
Individuals. Enter your first name, middle initial, and last name. If
you're a sole proprietor, enter your individual name, not your
business name. Enter your business name on line 2. Don't use
abbreviations or nicknames on line 1.
Trusts. Enter the name of the trust as it appears on the trust
instrument.
Estate of a decedent. Enter the name of the estate. For an
estate that has no legal name, enter the name of the decedent
followed by “Estate.”
Partnerships. Enter the legal name of the partnership as it
appears in the partnership agreement.
Corporations. Enter the corporate name as it appears in the
corporate charter or other legal document creating it.
Plan administrators. Enter the name of the plan administrator. A
plan administrator who already has an EIN should use that number.
How To Get Tax Help, Forms, and
Publications
Tax help for your business is available at IRS.gov/
TIP Businesses.
You can download or print all of the forms and publications you
may need on IRS.gov/FormsPubs. Otherwise, you can go to
IRS.gov/OrderForms to place an order and have forms mailed to
you. You should receive your order within 10 business days.
Related Forms and Publications
The following forms and instructions may be useful to filers of Form
SS-4.
Form 11-C, Occupational Tax and Registration Return for
Wagering.
Form 637, Application for Registration (For Certain Excise Tax
Activities).
Form 720, Quarterly Federal Excise Tax Return.
Form 730, Monthly Tax Return for Wagers.
Form 941, Employer's QUARTERLY Federal Tax Return.
Form 944, Employer's ANNUAL Federal Tax Return.
Form 990-T, Exempt Organization Business Income Tax Return.
Instructions for Form 990-T.
Form 1023, Application for Recognition of Exemption Under
Section 501(c)(3) of the Internal Revenue Code.
Form 1024, Application for Recognition of Exemption Under
Section 501(a).
Schedule C (Form 1040), Profit or Loss From Business (Sole
Proprietorship).
Schedule F (Form 1040), Profit or Loss From Farming.
Instructions for Form 1041 and Schedules A, B, G, J, and K-1,
U.S. Income Tax Return for Estates and Trusts.
Form 1042, Annual Withholding Tax Return for U.S. Source
Income of Foreign Persons.
Form 1042-S, Foreign Person's U.S. Source Income Subject to
Withholding.
Instructions for Form 1065, U.S. Return of Partnership Income.
Instructions for Form 1066, U.S. Real Estate Mortgage
Investment Conduit (REMIC) Income Tax Return.
Instructions for Form 1120, U.S. Corporation Income Tax Return.
Form 1120S, U.S. Income Tax Return for an S Corporation.
Form 2290, Heavy Highway Vehicle Use Tax Return.
Form 2553, Election by a Small Business Corporation.
Form 2848, Power of Attorney and Declaration of Representative.
Line 2. Trade name of business. Enter the trade name of the
business if different from the legal name. The trade name is the
“doing business as” (DBA) name.
Use the full legal name shown on line 1 on all tax returns
filed for the entity. (However, if you enter a trade name on
CAUTION line 2 and choose to use the trade name instead of the legal
name, enter the trade name on all returns you file.) To prevent
processing delays and errors, use only the legal name (or the trade
name) on all tax returns.
!
Line 3. Executor, administrator, trustee, “care of” name. For
trusts, enter the name of the trustee. For estates, enter the name of
the executor, administrator, or other fiduciary. If the entity applying
has a designated person to receive tax information, enter that
person's name as the “care of” person. Enter the individual's first
name, middle initial, and last name.
Lines 4a–b. Mailing address. Enter the mailing address for the
entity's correspondence. If the entity's address is outside the United
States or its possessions, you must enter the city, province or state,
postal code, and the name of the country. Don't abbreviate the
country name. If line 3 is completed, enter the address for the
executor, trustee, or “care of” person. Generally, this address will be
used on all tax returns.
If the entity is filing the Form SS-4 only to obtain an EIN for the
Form 8832, use the same address where you would like to have the
acceptance or nonacceptance letter sent.
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Instr. for Form SS-4 (Rev. 12-2017)
A-47
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The Payroll Source
File Form 8822-B to report any subsequent changes to the
Don't file Form 8832 if the LLC accepts the default
classifications above. If the LLC timely files Form 2553, it will
CAUTION be treated as a corporation as of the effective date of the S
corporation election as long as it meets all other requirements to
qualify as an S corporation. The LLC doesn't need to file Form 8832
in addition to Form 2553. See the Instructions for Form 2553.
!
TIP entity's mailing address.
Lines 5a–b. Street address. Provide the entity's physical address
only if different from its mailing address shown in lines 4a–b. Don't
enter a P.O. box number here. If the entity's address is outside the
United States or its possessions, you must enter the city, province or
state, postal code, and the name of the country. Don't abbreviate the
country name.
Line 9a. Type of entity. Check the box that best describes the
type of entity applying for the EIN. If you're an alien individual with an
ITIN previously assigned to you, enter the ITIN in place of a
requested SSN.
Line 6. County and state where principal business is located.
Enter the entity's primary physical location.
!
Lines 7a–b. Name of responsible party. Enter the full name (first
name, middle initial, last name, if applicable) and SSN, ITIN, or EIN
of the entity's responsible party.
Responsible party defined. The “responsible party” is the
person who ultimately owns or controls the entity or who exercises
ultimate effective control over the entity. The person identified as the
responsible party should have a level of control over, or entitlement
to, the funds or assets in the entity that, as a practical matter,
enables the person, directly or indirectly, to control, manage, or
direct the entity and the disposition of its funds and assets. Unless
the applicant is a government entity, the responsible party
must be an individual (i.e., a natural person), not an entity.
For entities with shares or interests traded on a public exchange,
or which are registered with the Securities and Exchange
Commission, “responsible party” is (a) the principal officer, if the
entity is a corporation; or (b) a general partner, if a partnership. The
general requirement that the responsible party be an individual
applies to these entities. For example, if a corporation is the general
partner of a publicly traded partnership for which Form SS-4 is filed,
then the responsible party of the partnership is the principal officer of
the corporation.
For tax-exempt organizations, the responsible party is generally
the same as the “principal officer” as defined in the Form 990
instructions.
For government entities, the responsible party is generally the
agency or agency representative in a position to legally bind the
particular government entity.
For trusts, the responsible party is a grantor, owner, or trustor.
CAUTION
Sole proprietor. Check this box if you file Schedule C, or
Schedule F (Form 1040) and have a qualified plan, or are required to
file excise, employment, alcohol, tobacco, or firearms returns, or are
a payer of gambling winnings. Enter your SSN or ITIN in the space
provided. If you're a nonresident alien with no effectively connected
income from sources within the United States, you don't need to
enter an SSN or ITIN.
Corporation. This box is for any corporation other than a
personal service corporation. If you check this box, enter the income
tax form number to be filed by the entity in the space provided.
If you entered “1120S” after the Corporation checkbox, the
corporation must file Form 2553 no later than the 15th day of
CAUTION the 3rd month of the tax year the election is to take effect.
Until Form 2553 has been received and approved, you will be
considered a Form 1120 filer. See the Instructions for Form 2553.
!
Personal service corporation. Check this box if the entity is a
personal service corporation. An entity is a personal service
corporation for a tax year only if:
The principal activity of the entity during the testing period
(generally the prior tax year) for the tax year is the performance of
personal services substantially by employee-owners, and
The employee-owners own at least 10% of the fair market value
of the outstanding stock in the entity on the last day of the testing
period.
Personal services include performance of services in such fields
as accounting, actuarial science, architecture, consulting,
engineering, health (including veterinary services), law, and the
performing arts. For more information about personal service
corporations, see the Instructions for Form 1120 and Pub. 542.
File Form 8822-B to report any subsequent changes to
TIP responsible party information.
If you’re applying for an EIN for a government entity, you may
enter an EIN for the responsible party on line 7b. Otherwise, you
must enter an SSN or ITIN on line 7b. But leave line 7b blank if the
responsible party does not have and is ineligible to obtain an SSN or
ITIN.
If the corporation is recently formed, the testing period
begins on the first day of its tax year and ends on the earlier
CAUTION of the last day of its tax year, or the last day of the calendar
year in which its tax year begins.
!
Other nonprofit organization. Check the Other nonprofit
organization box if the nonprofit organization is other than a church
or church-controlled organization and specify the type of nonprofit
organization (for example, an educational organization).
Lines 8a–c. Limited liability company (LLC) information. An
LLC is an entity organized under the laws of a state or foreign
country as a limited liability company. For federal tax purposes, an
LLC may be treated as a partnership or corporation or be
disregarded as an entity separate from its owner.
By default, a domestic LLC with only one member is disregarded
as an entity separate from its owner and must include all of its
income and expenses on the owner's tax return (for example,
Schedule C (Form 1040)). For more information on single-member
LLCs, see Disregarded entities, later.
Also by default, a domestic LLC with two or more members is
treated as a partnership. A domestic LLC may file Form 8832 to
avoid either default classification and elect to be classified as an
association taxable as a corporation. For more information on entity
classifications (including the rules for foreign entities), see Form
8832 and its instructions.
If the answer to line 8a is “Yes,” enter the number of LLC
members. If the LLC is owned solely by an individual and his or her
spouse in a community property state and they choose to treat the
entity as a disregarded entity, enter “1” on line 8b.
Instr. for Form SS-4 (Rev. 12-2017)
A-48
This isn't an election for a tax classification of an entity. See
Disregarded entities, later.
!
CAUTION
If the organization also seeks tax-exempt status, you must
file either Form 1023 (or Form 1023-EZ) or Form 1024. See
Pub. 557 for more information.
If the organization is covered by a group exemption letter, enter
the four-digit group exemption number (GEN) in the last entry. (Don't
confuse the GEN with the nine-digit EIN.) If you don't know the GEN,
contact the parent organization. See Pub. 557 for more information
about group exemption letters.
If the organization is a section 527 political organization, check
the box for Other nonprofit organization and specify “Section 527
organization” in the space to the right. To be recognized as exempt
from tax, a section 527 political organization must electronically file
Form 8871, Political Organization Notice of Section 527 Status,
within 24 hours of the date on which the organization was
established. The organization may also have to file Form 8872,
Political Organization Report of Contributions and Expenditures. Go
to IRS.gov/PolOrgs for more information.
-3-
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Appendix
Plan administrator. If the plan administrator is an individual,
enter the plan administrator's taxpayer identification number (TIN) in
the space provided.
REMIC. Check this box if the entity has elected to be treated as a
real estate mortgage investment conduit (REMIC). See the
Instructions for Form 1066 for more information.
State/local government. State and local governments generally
have the characteristics of a government, such as powers of
taxation, law enforcement, and civil authority. If you're unsure
whether or not your organization is a government, search “Is My
Entity a Government Entity?” at IRS.gov for clarification.
Federal government. The federal government is made up of the
Executive, Legislative, and Judicial branches, as well as
independent federal agencies. Unions, VFW organizations, and
political organizations aren't federal agencies.
Other. If not specifically listed, check the box for Other, and enter
the type of entity and the type of return, if any, that will be filed (for
example, “Common trust fund, Form 1065” or “Created a pension
plan”). Don't enter “N/A.” If you're an alien individual applying for an
EIN, see the instructions for Lines 7a–b.
Household employer. If you're an individual that will employ
someone to provide services in your household, check the box
Other and enter “Household employer” and your SSN. If you're a
trust that qualifies as a household employer, you don't need a
separate EIN for reporting tax information relating to household
employees; use the EIN of the trust.
Household employer agent. If you're an agent of a household
employer that is a disabled individual or other welfare recipient
receiving home care services through a state or local program,
check the box Other and enter “Household employer agent.” For
more information, see Rev. Proc. 84-33 and Rev. Proc. 2013-39. If
you're a state or local government, also check the box for state/local
government.
QSub. For a qualified subchapter S subsidiary (QSub) check the
box Other and specify “QSub.” See Rev. Rul. 2008-18, 2008-13
I.R.B. 674, if the QSub election is made pursuant to a reorganization
under section 368(a)(1)(F), and Disregarded entities below.
Withholding agent. If you're a withholding agent required to file
Form 1042, check the box Other and enter “Withholding agent.”
Disregarded entities. A disregarded entity is an eligible entity
that is disregarded as separate from its owner for federal income tax
purposes. Disregarded entities include single-member limited
liability companies (LLCs), and certain qualified foreign entities. See
the instructions for Forms 8832 and 8869, and Regulations section
301.7701-3 for more information on domestic and foreign
disregarded entities.
The disregarded entity is required to use its name and EIN for
reporting and payment of employment taxes: to register for excise
tax activities on Form 637; to pay and report excise taxes reported
on Forms 720, 730, 2290, and 11-C; to claim any refunds, credits,
and payments on Form 8849; and where a U.S. disregarded entity is
wholly owned by a foreign person, to file information returns on Form
5472. See the instructions for the employment and excise tax
returns, and Form 5472 for more information.
Complete Form SS-4 for disregarded entities as follows.
If a disregarded entity is filing Form SS-4 to obtain an EIN
because it is required to report and pay employment and excise
taxes, or for non-federal purposes such as a state requirement,
check the box Other for line 9a and write “Disregarded entity” (or
“Disregarded entity-sole proprietorship” if the owner of the
disregarded entity is an individual).
If the disregarded entity is requesting an EIN for purposes of filing
Form 5472, as required under section 6038A for a U.S. disregarded
entity that is wholly owned by a foreign person, check the box Other
for line 9a and write “Foreign-owned U.S. disregarded entity-Form
5472.”
If the disregarded entity is requesting an EIN for purposes of filing
Form 8832 to elect classification as an association taxable as a
corporation, or Form 2553 to elect S corporation status, check the
box Corporation for line 9a and write “Single-member” and the form
number of the return that will be filed (Form 1120 or 1120S).
If the disregarded entity is requesting an EIN because it has
acquired one or more additional owners and its classification has
changed to partnership under the default rules of Regulations
section 301.7701-3(f), check the box Partnership for line 9a.
If a foreign eligible entity is requesting an EIN for purposes of
filing Form 8832 to elect classification as a disregarded entity, check
the box Other for line 9a and write "foreign disregarded entity."
Line 10. Reason for applying. Check only one box. Don't enter
“N/A.” A selection is required.
Started new business. Check this box if you're starting a new
business that requires an EIN. If you check this box, enter the type of
business being started. Don't apply if you already have an EIN and
are only adding another place of business.
Hired employees. Check this box if the existing business is
requesting an EIN because it has hired or is hiring employees and is
therefore required to file employment tax returns. Don't apply if you
already have an EIN and are only hiring employees. For information
on employment taxes (for example, for family members), see Pub.
15, Pub. 51, or Pub. 80.
!
CAUTION
966.
You must make electronic deposits of all depository taxes
(such as employment tax, excise tax, and corporate income
tax) using EFTPS. See Pub. 15, Pub. 51, Pub. 80, and Pub.
Banking purpose. Check this box if you're requesting an EIN for
banking purposes only, and enter the banking purpose (for example,
a bowling league for depositing dues or an investment club for
dividend and interest reporting).
Changed type of organization. Check this box if the business
is changing its type of organization. For example, the business was
a sole proprietorship and has been incorporated or has become a
partnership. If you check this box, specify in the space provided
(including available space immediately below) the type of change
made. For example, “From sole proprietorship to partnership.”
Purchased going business. Check this box if you purchased an
existing business. Don't use the former owner's EIN unless you
became the “owner” of a corporation by acquiring its stock.
Created a trust. Check this box if you created a trust, and enter
the type of trust created. For example, indicate if the trust is a
nonexempt charitable trust or a split-interest trust.
Exception. Don't file this form for certain grantor-type trusts. The
trustee doesn't need an EIN for the trust if the trustee furnishes the
name and TIN of the grantor/owner and the address of the trust to all
payers. However, grantor trusts that don't file using Optional Method
1 and IRA trusts that are required to file Form 990-T must have an
EIN. For more information on grantor trusts, see the Instructions for
Form 1041.
Don't check this box if you're applying for a trust EIN when a
TIP new pension plan is established. Check the Created a
pension plan box.
Created a pension plan. Check this box if you have created a
pension plan and need an EIN for reporting purposes. Also, enter
the type of plan in the space provided. For more information about
pension plans, visit IRS.gov and enter “Types of retirement plans” in
the search box.
Check this box if you're applying for a trust EIN when a new
TIP pension plan is established. In addition, check the Other box
on line 9a and write “Created a pension plan” in the space
provided.
Other. Check this box if you're requesting an EIN for any other
reason, and enter the reason. For example, a newly-formed state
government entity should enter “Newly-formed state government
entity” in the space provided. A foreign-owned U.S. disregarded
entity required to file Form 5472 should enter “Foreign-owned U.S.
disregarded entity filing Form 5472” in the space provided.
Line 11. Date business started or acquired. If you're starting a
new business, enter the starting date of the business. If the business
you acquired is already operating, enter the date you acquired the
business. For foreign applicants, this is the date you began or
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The Payroll Source
acquired a business in the United States. If you're changing the form
of ownership of your business, enter the date the new ownership
entity began. Trusts should enter the date the trust was funded or
the date that the trust was required to obtain an EIN under
Regulations section 301.6109-1(a)(2). Estates should enter the date
of death of the decedent whose name appears on line 1 or the date
when the estate was legally funded.
date you began or will begin to pay income (including annuities) to a
nonresident alien in the United States.
Line 16. Check the one box on line 16 that best describes the
principal activity of the applicant's business. Check the box Other
(and specify the applicant's principal activity) if none of the listed
boxes applies. You must check a box.
Construction. Check this box if the applicant is engaged in
erecting buildings or engineering projects (for example, streets,
highways, bridges, and tunnels). The term “construction” also
includes special trade contractors (for example, plumbing, HVAC,
electrical, carpentry, concrete, excavation, etc., contractors).
Real estate. Check this box if the applicant is engaged in renting
or leasing real estate to others; managing, selling, buying, or renting
real estate for others; or providing related real estate services (for
example, appraisal services). Also check this box for mortgage real
estate investment trusts (REITs). Mortgage REITs are engaged in
issuing shares of funds consisting primarily of portfolios of real
estate mortgage assets with gross income of the trust solely derived
from interest earned.
Rental & leasing. Check this box if the applicant is engaged in
providing tangible goods such as autos, computers, consumer
goods, or industrial machinery and equipment to customers in return
for a periodic rental or lease payment. Also check this box for equity
real estate investment trusts (REITs). Equity REITs are engaged in
issuing shares of funds consisting primarily of portfolios of real
estate assets with gross income of the trust derived from renting real
property.
Manufacturing. Check this box if the applicant is engaged in the
mechanical, physical, or chemical transformation of materials,
substances, or components into new products. The assembling of
component parts of manufactured products is also considered to be
manufacturing.
Transportation & warehousing. Check this box if the applicant
provides transportation of passengers or cargo; warehousing or
storage of goods; scenic or sight-seeing transportation; or support
activities related to transportation.
Finance & insurance. Check this box if the applicant is engaged
in transactions involving the creation, liquidation, or change of
ownership of financial assets and/or facilitating such financial
transactions; underwriting annuities/insurance policies; facilitating
such underwriting by selling insurance policies; or by providing other
insurance or employee-benefit related services.
Health care & social assistance. Check this box if the applicant
is engaged in providing physical, medical, or psychiatric care; or
providing social assistance activities such as youth centers,
adoption agencies, individual/family services, temporary shelters,
daycare, etc.
Accommodation & food services. Check this box if the
applicant is engaged in providing customers with lodging, meal
preparation, snacks, or beverages for immediate consumption.
Wholesale-agent/broker. Check this box if the applicant is
engaged in arranging for the purchase or sale of goods owned by
others or purchasing goods on a commission basis for goods traded
in the wholesale market, usually between businesses.
Wholesale-other. Check this box if the applicant is engaged in
selling goods in the wholesale market generally to other businesses
for resale on their own account, goods used in production, or capital
or durable nonconsumer goods.
Retail. Check this box if the applicant is engaged in selling
merchandise to the general public from a fixed store; by direct,
mail-order, or electronic sales; or by using vending machines.
Other. Check this box if the applicant is engaged in an activity
not described above. Describe the applicant's principal business
activity in the space provided.
Line 12. Closing month of accounting year. Enter the last month
of your accounting year or tax year. An accounting or tax year is
usually 12 consecutive months, either a calendar year or a fiscal
year (including a period of 52 or 53 weeks). A calendar year is 12
consecutive months ending on December 31. A fiscal year is either
12 consecutive months ending on the last day of any month other
than December or a 52-53 week year. For more information on
accounting periods, see Pub. 538.
Individuals. Your tax year generally will be a calendar year.
Partnerships. Partnerships must adopt one of the following tax
years.
The tax year of the majority of its partners.
The tax year common to all of its principal partners.
The tax year that results in the least aggregate deferral of income.
In certain cases, some other tax year.
See the Instructions for Form 1065 for more information.
REMICs. REMICs must have a calendar year as their tax year.
Personal service corporations. A personal service corporation
generally must adopt a calendar year unless it meets one of the
following requirements.
It can establish a business purpose for having a different tax year.
It elects under section 444 to have a tax year other than a
calendar year.
Trusts. Generally, a trust must adopt a calendar year except for
the following trusts.
Tax-exempt trusts.
Charitable trusts.
Grantor-owned trusts.
Line 13. Highest number of employees expected in the next 12
months. Complete each box by entering the number (including
zero (-0-)) of Agricultural, Household, or Other employees expected
by the applicant in the next 12 months.
If no employees are expected, skip line 14.
Line 14. Do you want to file Form 944? If you expect your
employment tax liability to be $1,000 or less in a full calendar year,
you're eligible to file Form 944 annually (once each year) instead of
filing Form 941 quarterly (every 3 months). Your employment tax
liability generally will be $1,000 or less if you expect to pay $4,000 or
less in total wages subject to social security and Medicare taxes and
federal income tax withholding. If you qualify and want to file Form
944 instead of Forms 941, check the box on line 14. If you don't
check the box, then you must file Form 941 for every quarter.
!
CAUTION
Once you check the box you must continue to file Form 944,
regardless of the amount of tax shown on your return, until
the IRS instructs you to file Form 941.
For employers in the U.S. possessions, generally, if you pay
TIP $6,536 or less in wages subject to social security and
Medicare taxes, you're likely to pay $1,000 or less in
employment taxes.
For more information on employment taxes, see Pub. 15, Pub.
51, or Pub. 80.
Line 15. First date wages or annuities were paid. If the business
has employees, enter the date on which the business began to pay
wages or annuities. For foreign applicants, this is the date you
began to pay wages in the United States. If the business doesn't
plan to have employees, enter “N/A.”
Withholding agent. Enter the date you began or will begin to
pay income (including annuities) to a nonresident alien. This also
applies to individuals who are required to file Form 1042 to report
alimony paid to a nonresident alien. For foreign applicants, this is the
Instr. for Form SS-4 (Rev. 12-2017)
A-50
Line 17. Use line 17 to describe the applicant's principal line of
business in more detail. For example, if you checked the
Construction box on line 16, enter additional detail such as “General
contractor for residential buildings” on line 17. An entry is required.
For mortgage REITs, indicate mortgage REIT; and for equity REITs,
indicate what type of real property is the principal type (residential
REIT, nonresidential REIT, miniwarehouse REIT, etc.).
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Appendix
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, and to federal law enforcement
and intelligence agencies to combat terrorism.
Line 18. Check the applicable box to indicate whether or not the
applicant entity applying for an EIN was issued one previously.
Third Party Designee. Complete this section only if you want to
authorize the named individual to answer questions about the
completion of Form SS-4 and receive the entity’s newly assigned
EIN. You must complete the signature area for the authorization to
be valid. The designee’s authority terminates at the time the EIN is
assigned and released to the designee. EINs are released to
authorized third party designees by the method they used to obtain
the EIN (online, telephone, or fax); however, the EIN notice will be
mailed to the taxpayer.
!
CAUTION
We will be unable to issue an EIN to you unless you provide all of
the requested information that applies to your entity. Providing false
information could subject you to penalties.
You're 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.
If the third party designee’s address or telephone number
matches the address or telephone number of the taxpayer,
the application must be mailed or faxed.
Signature. When required, the application must be signed by (a)
the individual, if the applicant is an individual; (b) the president, vice
president, or other principal officer, if the applicant is a corporation;
(c) a responsible and duly authorized member or officer having
knowledge of its affairs, if the applicant is a partnership, government
entity, or other unincorporated organization; or (d) the fiduciary, if the
applicant is a trust or an estate. Foreign applicants may have any
duly-authorized person (for example, division manager) sign Form
SS-4.
The time needed to complete and file this form will vary
depending on individual circumstances. The estimated average time
is:
Recordkeeping
. . . . . . . . . . . . . . . . . . . . .
Learning about the law or the form
Privacy Act and Paperwork Reduction Act Notice. We ask for
the information on this form to carry out the Internal Revenue laws of
the United States. We need it to comply with section 6109 and the
regulations thereunder, which generally require the inclusion of an
employer identification number (EIN) on certain returns, statements,
or other documents filed with the Internal Revenue Service. If your
entity is required to obtain an EIN, you're required to provide all of
the information requested on this form. Information on this form may
be used to determine which federal tax returns you're required to file
and to provide you with related forms and publications.
. . . . . . . . .
Preparing, copying, assembling, and sending the
form to the IRS . . . . . . . . . . . . . . . . . . . .
.
8 hr., 36 min.
42 min.
52 min.
If you have comments concerning the accuracy of these time
estimates or suggestions for making this form simpler, we would be
happy to hear from you. You can send your comments from IRS.gov/
FormsPubs. Click on More Information and then click on Give us
feedback. Or you can write to the Internal Revenue Service, Tax
Forms and Publications Division, 1111 Constitution Ave. NW,
IR-6526, Washington, DC 20224. Don't send Form SS-4 to this
address. Instead, see Where To File or Fax, earlier.
We disclose this form to the Social Security Administration (SSA)
for their use in determining compliance with applicable laws. We
may give this information to the Department of Justice for use in civil
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Instr. for Form SS-4 (Rev. 12-2017)
A-51
The Payroll Source
SOCIAL SECURITY ADMINISTRATION
Application for a Social Security Card
Applying for a Social Security Card is free!
USE THIS APPLICATION TO:
Apply for an original Social Security card
Apply for a replacement Social Security card
Change or correct information on your Social Security number record
IMPORTANT: You MUST provide a properly completed application and the required evidence before we
can process your application. We can only accept original documents or documents certified by the
custodian of the original record. Notarized copies or photocopies which have not been certified by the
custodian of the record are not acceptable. We will return any documents submitted with your application.
For assistance call us at 1-800-772-1213 or visit our website at www.socialsecurity.gov.
Original Social Security Card
To apply for an original card, you must provide at least two documents to prove age, identity, and U.S.
citizenship or current lawful, work-authorized immigration status. If you are not a U.S. citizen and do not
have DHS work authorization, you must prove that you have a valid non-work reason for requesting a
card. See page 2 for an explanation of acceptable documents.
NOTE: If you are age 12 or older and have never received a Social Security number, you must apply in
person.
Replacement Social Security Card
To apply for a replacement card, you must provide one document to prove your identity. If you were born
outside the U.S., you must also provide documents to prove your U.S. citizenship or current, lawful, workauthorized status. See page 2 for an explanation of acceptable documents.
Changing Information on Your Social Security Record
To change the information on your Social Security number record (i.e., a name or citizenship change, or
corrected date of birth) you must provide documents to prove your identity, support the requested change,
and establish the reason for the change. For example, you may provide a birth certificate to show your
correct date of birth. A document supporting a name change must be recent and identify you by both your
old and new names. If the name change event occurred over two years ago or if the name change
document does not have enough information to prove your identity, you must also provide documents to
prove your identity in your prior name and/or in some cases your new legal name. If you were born outside
the U.S. you must provide a document to prove your U.S. citizenship or current lawful, work-authorized
status. See page 2 for an explanation of acceptable documents.
LIMITS ON REPLACEMENT SOCIAL SECURITY CARDS
Public Law 108-458 limits the number of replacement Social Security cards you may receive to 3 per
calendar year and 10 in a lifetime. Cards issued to reflect changes to your legal name or changes to a work
authorization legend do not count toward these limits. We may also grant exceptions to these limits if you
provide evidence from an official source to establish that a Social Security card is required.
IF YOU HAVE ANY QUESTIONS
If you have any questions about this form or about the evidence documents you must provide, please visit
our website at www.socialsecurity.gov for additional information as well as locations of our offices and
Social Security Card Centers. You may also call Social Security at 1-800-772-1213. You can also find
your nearest office or Card Center in your local phone book.
Form SS-5 (08-2011) ef (08-2011) Destroy Prior Editions
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Appendix
EVIDENCE DOCUMENTS
The following lists are examples of the types of documents you must provide with your application and are not all
inclusive. Call us at 1-800-772-1213 if you cannot provide these documents.
IMPORTANT : If you are completing this application on behalf of someone else, you must provide evidence that
shows your authority to sign the application as well as documents to prove your identity and the identity of the
person for whom you are filing the application. We can only accept original documents or documents certified by
the custodian of the original record. Notarized copies or photocopies which have not been certified by the
custodian of the record are not acceptable.
Evidence of Age
In general, you must provide your birth certificate. In some situations, we may accept another document that
shows your age. Some of the other documents we may accept are:
U.S. hospital record of your birth (created at the time of birth)
Religious record established before age five showing your age or date of birth
Passport
Final Adoption Decree (the adoption decree must show that the birth information was taken from the original
birth certificate)
Evidence of Identity
You must provide current, unexpired evidence of identity in your legal name. Your legal name will be shown on
the Social Security card. Generally, we prefer to see documents issued in the U.S. Documents you submit to
establish identity must show your legal name AND provide biographical information (your date of birth, age, or
parents' names) and/or physical information (photograph, or physical description - height, eye and hair color,
etc.). If you send a photo identity document but do not appear in person, the document must show your
biographical information (e.g., your date of birth, age, or parents' names). Generally, documents without an
expiration date should have been issued within the past two years for adults and within the past four years for
children.
As proof of your identity, you must provide a:
U.S. driver's license; or
U.S. State-issued non-driver identity card; or
U.S. passport
If you do not have one of the documents above or cannot get a replacement within 10 work days, we may accept
other documents that show your legal name and biographical information, such as a U.S. military identity card,
Certificate of Naturalization, employee identity card, certified copy of medical record (clinic, doctor or hospital),
health insurance card, Medicaid card, or school identity card/record. For young children, we may accept medical
records (clinic, doctor, or hospital) maintained by the medical provider. We may also accept a final adoption
decree, or a school identity card, or other school record maintained by the school.
If you are not a U.S. citizen, we must see your current U.S. immigration document(s) and your foreign passport
with biographical information or photograph.
WE CANNOT ACCEPT A BIRTH CERTIFICATE, HOSPITAL SOUVENIR BIRTH CERTIFICATE, SOCIAL
SECURITY CARD STUB OR A SOCIAL SECURITY RECORD as evidence of identity.
Evidence of U.S. Citizenship
In general, you must provide your U.S. birth certificate or U.S. Passport. Other documents you may provide are a
Consular Report of Birth, Certificate of Citizenship, or Certificate of Naturalization.
Evidence of Immigration Status
You must provide a current unexpired document issued to you by the Department of Homeland Security (DHS)
showing your immigration status, such as Form I-551, I-94, or I-766. If you are an international student or
exchange visitor, you may need to provide additional documents, such as Form I-20, DS-2019, or a letter
authorizing employment from your school and employer (F-1) or sponsor (J-1). We CANNOT accept a receipt
showing you applied for the document. If you are not authorized to work in the U.S., we can issue you a Social
Security card only if you need the number for a valid non-work reason. Your card will be marked to show you
cannot work and if you do work, we will notify DHS. See page 3, item 5 for more information.
Form SS-5 (08-2011) ef (08-2011)
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The Payroll Source
HOW TO COMPLETE THIS APPLICATION
Complete and sign this application LEGIBLY using ONLY black or blue ink on the attached or
downloaded form using only 8 ½” x 11” (or A4 8.25” x 11.7”) paper.
GENERAL: Items on the form are self-explanatory or are discussed below. The numbers match the
numbered items on the form. If you are completing this form for someone else, please complete the
items as they apply to that person.
4. Show the month, day, and full (4 digit) year of birth; for example, “1998” for year of birth.
5. If you check “Legal Alien Not Allowed to Work” or “Other,” you must provide a document from a
U.S. Federal, State, or local government agency that explains why you need a Social Security number
and that you meet all the requirements for the government benefit. NOTE: Most agencies do not require
that you have a Social Security number. Contact us to see if your reason qualifies for a Social Security
number.
6., 7. Providing race and ethnicity information is voluntary and is requested for informational and
statistical purposes only. Your choice whether to answer or not does not affect decisions we make on
your application. If you do provide this information, we will treat it very carefully.
9.B., 10.B. If you are applying for an original Social Security card for a child under age 18, you MUST
show the parents' Social Security numbers unless the parent was never assigned a Social Security
number. If the number is not known and you cannot obtain it, check the “unknown” box.
13. If the date of birth you show in item 4 is different from the date of birth currently shown on your
Social Security record, show the date of birth currently shown on your record in item 13 and provide
evidence to support the date of birth shown in item 4.
16. Show an address where you can receive your card 7 to 14 days from now.
17. WHO CAN SIGN THE APPLICATION? If you are age 18 or older and are physically and mentally
capable of reading and completing the application, you must sign in item 17. If you are under age 18,
you may either sign yourself, or a parent or legal guardian may sign for you. If you are over age 18 and
cannot sign on your own behalf, a legal guardian, parent, or close relative may generally sign for you. If
you cannot sign your name, you should sign with an "X” mark and have two people sign as witnesses in
the space beside the mark. Please do not alter your signature by including additional information on the
signature line as this may invalidate your application. Call us if you have questions about who may sign
your application.
HOW TO SUBMIT THIS APPLICATION
In most cases, you can take or mail this signed application with your documents to any Social Security
office. Any documents you mail to us will be returned to you. Go to
https://secure.ssa.gov/apps6z/FOLO/fo001.jsp to find the Social Security office or Social Security Card
Center that serves your area.
Form SS-5 (08-2011) ef (08-2011)
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Appendix
PROTECT YOUR SOCIAL SECURITY NUMBER AND CARD
Protect your SSN card and number from loss and identity theft. DO NOT carry your SSN card with you.
Keep it in a secure location and only take it with you when you must show the card; e.g., to obtain a new
job, open a new bank account, or to obtain benefits from certain U.S. agencies. Use caution in giving
out your Social Security number to others, particularly during phone, mail, email and Internet requests
you did not initiate.
PRIVACY ACT STATEMENT
Collection and Use of Personal Information
Sections 205(c) and 702 of the Social Security Act, as amended, authorize us to collect this
information. The information you provide will be used to assign you a Social Security number and
issue a Social Security card.
The information you furnish on this form is voluntary. However, failure to provide the requested
information may prevent us from issuing you a Social Security number and card.
We rarely use the information you supply for any purpose other than for issuing a Social Security
number and card. However, we may use it for the administration and integrity of Social Security
programs. We may also disclose information to another person or to another agency in accordance
with approved routine uses, which include but are not limited to the following:
1. To enable a third party or an agency to assist Social Security in establishing rights to
Social Security benefits and/or coverage;
2. To comply with Federal laws requiring the release of information from Social Security
records (e.g., to the Government Accountability Office and Department of Veterans'
Affairs);
3. To make determinations for eligibility in similar health and income maintenance
programs at the Federal, State, and local level; and
4. To facilitate statistical research, audit or investigative activities necessary to assure the
integrity of Social Security programs.
We may also use the information you provide in computer matching programs. Matching programs
compare our records with records kept by other Federal, State, or local government agencies.
Information from these matching programs can be used to establish or verify a person's eligibility
for Federally-funded or administered benefit programs and for repayment of payments or
delinquent debts under these programs.
Complete lists of routine uses for this information are available in System of Records Notice
60-0058 (Master Files of Social Security Number (SSN) Holders and SSN Applications). The
Notice, additional information regarding this form, and information regarding our systems and
programs, are available on-line at www.socialsecurity.gov or at any local Social Security office.
This information collection meets the requirements of 44 U.S.C. §3507, as amended by Section 2 of the
Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid
Office of Management and Budget control number. We estimate that it will take about 8.5 to 9.5 minutes
to read the instructions, gather the facts, and answer the questions. You may send comments on our
time estimate to: SSA, 6401 Security Blvd., Baltimore, MD 21235-6401. Send only comments relating
to our time estimate to this address, not the completed form.
Form SS-5 (08-2011) ef (08-2011)
Page 4
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
A-55
The Payroll Source
SOCIAL SECURITY ADMINISTRATION
Application for a Social Security Card
1
Form Approved
OMB No. 0960-0066
NAME
First
Full Middle Name
Last
FULL NAME AT BIRTH
IF OTHER THAN ABOVE
First
Full Middle Name
Last
TO BE SHOWN ON CARD
OTHER NAMES USED
2
Social Security number previously assigned to the person
listed in item 1
3
PLACE
OF BIRTH
5
6
8
9
10
11
Office
Use
Only
(Do Not Abbreviate)
City
State or Foreign Country
CITIZENSHIP
ETHNICITY
7
Are You Hispanic or Latino?
(Your Response is Voluntary)
No
DATE
OF
BIRTH
4
MM/DD/YYYY
Other (See
Instructions On
Page 3)
Legal Alien Not Allowed
To Work(See
Instructions On Page 3)
Native Hawaiian
American Indian
Select One or More
(Your Response is Voluntary)
Alaska Native
Other Pacific
Islander
Black/African
American
White
SEX
Male
Asian
Female
First
A. PARENT/ MOTHER'S
NAME AT HER BIRTH
B. PARENT/ MOTHER'S SOCIAL
SECURITY NUMBER (See instructions for 9 B on Page 3)
First
A. PARENT/ FATHER'S
NAME
B. PARENT/ FATHER'S SOCIAL
SECURITY NUMBER (See instructions for 10B on Page 3)
Full Middle Name
Last
Full Middle Name
Unknown
Last
Unknown
Has the person listed in item 1 or anyone acting on his/her behalf ever filed for or received a Social Security number
card before?
Yes (If "yes" answer questions 12-13)
Don't Know (If "don't know," skip to question 14.)
No
13
14
TODAY'S
DATE
16
MAILING ADDRESS
17
RACE
Name shown on the most recent Social
Security card issued for the person
listed in item 1
Enter any different date of birth if used on an
earlier application for a card
12
FCI
Legal Alien
Allowed To
Work
U.S. Citizen
(Check One)
Yes
15
First
Full Middle Name
Last
MM/DD/YYYY
DAYTIME PHONE
NUMBER
MM/DD/YYYY
Street Address, Apt. No., PO Box, Rural Route No.
Area Code
Number
City
State/Foreign Country
ZIP Code
(Do Not Abbreviate)
I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying statements or forms,
and it is true and correct to the best to my knowledge.
YOUR SIGNATURE
18
YOUR RELATIONSHIP TO THE PERSON IN ITEM 1 IS:
Natural Or
Adoptive Parent
Self
Legal Guardian
Other
Specify
DO NOT WRITE BELOW THIS LINE (FOR SSA USE ONLY)
NPN
PBC
DOC
EVI
EVA
EVC
NTI
PRA
CAN
NWR
ITV
DNR
UNIT
SIGNATURE AND TITLE OF EMPLOYEE(S) REVIEWING
EVIDENCE AND/OR CONDUCTING INTERVIEW
EVIDENCE SUBMITTED
DATE
DCL
Form SS-5 (08-2011) ef (08-2011)
A-56
Destroy Prior Editions
Page 5
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
DATE
Appendix
Form
SS-8
(Rev. May 2014)
Department of the Treasury
Internal Revenue Service
OMB. No. 1545-0004
Determination of Worker Status for Purposes
of Federal Employment Taxes and
Income Tax Withholding
For IRS Use Only:
Case Number:
Earliest Receipt Date:
▶ Information about Form SS-8 and its separate instructions is at www.irs.gov/formss8.
Name of firm (or person) for whom the worker performed services
Worker’s name
Firm’s mailing address (include street address, apt. or suite no., city, state, and ZIP code)
Worker’s mailing address (include street address, apt. or suite no., city, state, and ZIP code)
Trade name
Firm's email address
Worker's daytime telephone number
Worker's email address
Firm's fax number
Firm's website
Worker's alternate telephone number
Worker's fax number
Firm's telephone number (include area code)
Firm’s employer identification number
Worker’s social security number
Worker’s employer identification number (if any)
Note. If the worker is paid for these services by a firm other than the one listed on this form, enter the name, address, and employer identification
number of the payer. ▶
Disclosure of Information
The information provided on Form SS-8 may be disclosed to the firm, worker, or payer named above to assist the IRS in the determination process.
For example, if you are a worker, we may disclose the information you provide on Form SS-8 to the firm or payer named above. The information can
only be disclosed to assist with the determination process. If you provide incomplete information, we may not be able to process your request. See
Privacy Act and Paperwork Reduction Act Notice in the separate instructions for more information. If you do not want this information disclosed to
other parties, do not file Form SS-8.
Parts I–V. All filers of Form SS-8 must complete all questions in Parts I–IV. Part V must be completed if the worker provides a service directly to
customers or is a salesperson. If you cannot answer a question, enter “Unknown” or “Does not apply.” If you need more space for a question, attach
another sheet with the part and question number clearly identified. Write your firm's name (or worker's name) and employer identification number (or
social security number) at the top of each additional sheet attached to this form.
Part I
1
General Information
This form is being completed by:
Firm
Worker; for services performed
to
(beginning date)
.
(ending date)
2
Explain your reason(s) for filing this form (for example, you received a bill from the IRS, you believe you erroneously received a Form 1099 or
Form W-2, you are unable to get workers' compensation benefits, or you were audited or are being audited by the IRS).
3
4
Total number of workers who performed or are performing the same or similar services:
Application
Bid
Employment Agency
How did the worker obtain the job?
5
Attach copies of all supporting documentation (for example, contracts, invoices, memos, Forms W-2 or Forms 1099-MISC issued or received, IRS
closing agreements or IRS rulings). In addition, please inform us of any current or past litigation concerning the worker’s status. If no income reporting forms
.
(Form 1099-MISC or W-2) were furnished to the worker, enter the amount of income earned for the year(s) at issue $
.
Other (specify)
If both Form W-2 and Form 1099-MISC were issued or received, explain why.
6
Describe the firm’s business.
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Cat. No. 16106T
Form SS-8 (Rev. 5-2014)
A-57
The Payroll Source
Page 2
Form SS-8 (Rev. 5-2014)
Part I
7
General Information (continued)
If the worker received pay from more than one entity because of an event such as the sale, merger, acquisition, or reorganization of the firm for
whom the services are performed, provide the following: Name of the firm's previous owner:
Previous owner's taxpayer identification number:
Other (specify)
Description of above change:
Change was a:
8
Date of change (MM/DD/YY):
Describe the work done by the worker and provide the worker’s job title.
9
Explain why you believe the worker is an employee or an independent contractor.
10
Sale
Merger
Acquisition
Reorganization
Did the worker perform services for the firm in any capacity before providing the services that are the subject of this determination request?
Yes
No
N/A
If “Yes,” what were the dates of the prior service?
If “Yes,” explain the differences, if any, between the current and prior service.
11
If the work is done under a written agreement between the firm and the worker, attach a copy (preferably signed by both parties). Describe the
terms and conditions of the work arrangement.
Part II
Behavioral Control (Provide names and titles of specific individuals, if applicable.)
1
What specific training and/or instruction is the worker given by the firm?
2
How does the worker receive work assignments?
3
Who determines the methods by which the assignments are performed?
4
Who is the worker required to contact if problems or complaints arise and who is responsible for their resolution?
5
What types of reports are required from the worker? Attach examples.
6
Describe the worker’s daily routine such as his or her schedule or hours.
7
At what location(s) does the worker perform services (for example, firm’s premises, own shop or office, home, customer’s location)? Indicate
the appropriate percentage of time the worker spends in each location, if more than one.
8
Describe any meetings the worker is required to attend and any penalties for not attending (for example, sales meetings, monthly meetings,
staff meetings).
9
10
11
Is the worker required to provide the services personally? . . .
If substitutes or helpers are needed, who hires them?
If the worker hires the substitutes or helpers, is approval required?
If “Yes,” by whom?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Yes
No
.
.
.
.
.
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.
.
.
.
.
.
.
.
.
.
Yes
No
12
13
Who pays the substitutes or helpers?
Is the worker reimbursed if the worker pays the substitutes or helpers? .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Yes
No
If “Yes,” by whom?
Form SS-8 (Rev. 5-2014)
A-58
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Appendix
Page 3
Form SS-8 (Rev. 5-2014)
Part III
1
Financial Control (Provide names and titles of specific individuals, if applicable.)
List the supplies, equipment, materials, and property provided by each party:
The firm:
The worker:
2
Other party:
Does the worker lease equipment, space, or a facility? . . . . . . . . .
If “Yes,” what are the terms of the lease? (Attach a copy or explanatory statement.)
3
What expenses are incurred by the worker in the performance of services for the firm?
4
Specify which, if any, expenses are reimbursed by:
The firm:
Other party:
5
Type of pay the worker receives:
Salary
Commission
Hourly Wage
Lump Sum
Other (specify)
If type of pay is commission, and the firm guarantees a minimum amount of pay, specify amount. $
6
Is the worker allowed a drawing account for advances?
If “Yes,” how often?
Specify any restrictions.
.
.
.
.
.
.
.
.
7
Whom does the customer pay? . . . . . . . . .
If worker, does the worker pay the total amount to the firm?
.
.
. .
Yes
.
.
Firm
. . .
No If “No,” explain.
8
9
Does the firm carry workers' compensation insurance on the worker?
. . . . . . . . . . . . . . .
Yes
No
What economic loss or financial risk, if any, can the worker incur beyond the normal loss of salary (for example, loss or damage of equipment,
material)?
10
.
.
.
.
.
.
.
Does the worker establish the level of payment for the services provided or the products sold? .
If “No,” who does?
Part IV
1
.
.
.
.
.
.
.
.
.
.
.
.
.
Yes
.
No
Piece Work
.
.
Yes
.
No
Worker
.
.
.
.
Yes
.
No
Relationship of the Worker and Firm
Please check the benefits available to the worker:
Paid vacations
Pensions
Personal days
Other (specify)
Sick pay
Paid holidays
Bonuses
Insurance benefits
2
Can the relationship be terminated by either party without incurring liability or penalty?
If “No,” explain your answer.
3
Did the worker perform similar services for others during the time period entered in Part I, line 1? . . . . . . .
Yes
No
Yes
No
If “Yes,” is the worker required to get approval from the firm? . . . . . . . . . . . . . . . . . .
Describe any agreements prohibiting competition between the worker and the firm while the worker is performing services or during any later
period. Attach any available documentation.
4
.
.
.
.
.
.
.
.
.
.
Yes
5
6
Is the worker a member of a union?
. . . . . . . . . . . . . . . . . . . . . . . . .
Yes
What type of advertising, if any, does the worker do (for example, a business listing in a directory or business cards)? Provide copies, if
applicable.
7
If the worker assembles or processes a product at home, who provides the materials and instructions or pattern?
8
What does the worker do with the finished product (for example, return it to the firm, provide it to another party, or sell it)?
9
How does the firm represent the worker to its customers (for example, employee, partner, representative, or contractor), and under whose
business name does the worker perform these services?
10
No
No
If the worker no longer performs services for the firm, how did the relationship end (for example, worker quit or was fired, job completed,
contract ended, firm or worker went out of business)?
Form SS-8 (Rev. 5-2014)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
A-59
The Payroll Source
Page 4
Form SS-8 (Rev. 5-2014)
Part V
For Service Providers or Salespersons. Complete this part if the worker provided a service directly to
customers or is a salesperson.
1
What are the worker’s responsibilities in soliciting new customers?
2
3
Who provides the worker with leads to prospective customers?
Describe any reporting requirements pertaining to the leads.
4
5
6
What terms and conditions of sale, if any, are required by the firm?
Are orders submitted to and subject to approval by the firm? . .
Who determines the worker’s territory?
.
.
.
.
.
.
.
.
.
.
Yes
No
7
Did the worker pay for the privilege of serving customers on the route or in the territory? .
If “Yes,” whom did the worker pay?
If “Yes,” how much did the worker pay? . . . . . . . . . . . . . . .
.
.
.
.
.
.
.
.
.
Yes
No
.
.
.
.
.
. $
8
Where does the worker sell the product (for example, in a home, retail establishment)?
9
List the product and/or services distributed by the worker (for example, meat, vegetables, fruit, bakery products, beverages, or laundry or dry
cleaning services). If more than one type of product and/or service is distributed, specify the principal one.
.
.
.
.
.
.
10
11
Does the worker sell life insurance full time? . . . . .
Does the worker sell other types of insurance for the firm? .
12
If “Yes,” enter the percentage of the worker’s total working time spent in selling other types of insurance . . . . .
If the worker solicits orders from wholesalers, retailers, contractors, or operators of hotels, restaurants, or other similar
establishments, enter the percentage of the worker’s time spent in the solicitation . . . . . . . . . . . .
13
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Is the merchandise purchased by the customers for resale or use in their business operations? . .
Describe the merchandise and state whether it is equipment installed on the customers’ premises.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Yes
No
Yes
No
%
Yes
No
%
Under penalties of perjury, I declare that I have examined this request, including accompanying documents, and to the best of my knowledge and belief, the
facts presented are true, correct, and complete.
▲
Sign
Here
.
.
Title
▶
Date
▶
Type or print name below signature.
Form SS-8 (Rev. 5-2014)
A-60
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
Instructions for Form SS-8
(Rev. May 2014)
Department of the Treasury
Internal Revenue Service
Determination of Worker Status for Purposes of Federal Employment Taxes and
Income Tax Withholding
Section references are to the Internal Revenue Code unless
otherwise noted.
Future Developments
Information about any future developments affecting Form SS-8
(such as legislation enacted after we release it) will be posted at
www.irs.gov/formss8.
General Instructions
Purpose of Form
Firms and workers file Form SS-8 to request a determination of
the status of a worker under the common law rules for purposes
of federal employment taxes and income tax withholding.
Generally, under the common law rules a worker is an employee
if the firm has the right to control what will be done and how it will
be done. See Publication 15–A, Employer's Supplemental Tax
Guide, for more information on how to determine whether a
worker providing services is an employee or independent
contractor.
A Form SS-8 determination may be requested only in order to
resolve federal tax matters. If Form SS-8 is submitted for a tax
year for which the statute of limitations on the tax return has
expired, a determination letter will not be issued.
The IRS does not issue a determination letter for proposed
transactions or on hypothetical situations or for other reasons
not in the best interests of tax administration. We may, however,
issue an information letter when it is considered appropriate.
Definition
Firm. For the purposes of this form, the term “firm” means any
individual, business enterprise, organization, state, or other
entity for which a worker has performed services. The firm may
or may not have paid the worker directly for these services.
If the firm was not responsible for payment for services,
be sure to enter the name, address, and employer
CAUTION
identification number of the payer on the first page of
Form SS-8, below the identifying information for the firm and the
worker.
!
Note. Workers for state and local governments and/or interstate
instrumentalities may be covered by a Section 218 Agreement.
A Section 218 Agreement is a written, voluntary agreement
between the State Social Security Administrator and the Social
Security Administration. All 50 states, Puerto Rico, the Virgin
Islands and approximately 60 interstate instrumentalities have
Section 218 Agreements extending social security coverage to
specified employees. Workers covered under a Section 218
Agreement are subject to social security and Medicare tax
regardless of any determinations made under the common law
rules.
Whether a state or local government worker is subject to
social security and Medicare tax depends on which of the
following three categories the worker falls into:
1. Subject to social security under a Section 218
Agreement, or
May 16, 2014
2. Subject to social security under mandatory coverage
provisions, or
3. Excluded from social security because there is no Section
218 Agreement and the employee is covered by a qualified
retirement plan.
If the worker is uncertain whether a Section 218 Agreement
covers the state or local government entity, he or she should
contact the entity before submitting Form SS-8. If the entity is
uncertain about whether a Section 218 Agreement covers the
position in question, the entity should contact the State Social
Security Administrator for the state in which it operates.
The Form SS-8 Determination
Process
The IRS will acknowledge the receipt of your Form SS-8.
Because there are usually two (or more) parties who could be
affected by a determination of employment status, the IRS
attempts to get information from all parties involved by sending
those parties blank Forms SS-8 for completion. Some or all of
the information provided on this Form SS-8 may be shared with
the other parties listed on page 1. The case will be assigned to a
technician who will review the facts, apply the law, and render a
decision. The technician may ask for additional information from
the requestor, from other involved parties, or from third parties
that could help clarify the work relationship before rendering a
decision. The IRS will generally issue a formal determination to
the firm or payer (if that is a different entity), and will send a copy
to the worker. A determination letter applies only to a worker (or
a class of workers) requesting it, and the decision is binding on
the IRS if there is no change in the facts or law that form the
basis for the ruling. In certain cases, a formal determination will
not be issued. Instead, an information letter may be issued.
Although an information letter is advisory only and is not binding
on the IRS, it may be used to assist the worker to fulfill his or her
federal tax obligations. In other very limited circumstances the
IRS may issue a courtesy letter that the worker may rely on to
fulfill his or her federal tax obligations.
Neither the Form SS-8 determination process nor the review
of any records in connection with the determination constitutes
an examination (audit) of any federal tax return. If the periods
under consideration have previously been examined, the Form
SS-8 determination process will not constitute a reexamination
under IRS reopening procedures. Because this is not an
examination of any federal tax return, the appeal rights available
in connection with an examination do not apply to a Form SS-8
determination. If you disagree with a determination, you can
identify facts that were part of the original submission that you
think were not fully considered. If you have additional information
concerning the relationship that was not part of the original
submission, you can submit the additional information and
request that the office reconsider the determination.
Completing Form SS-8
Answer all questions as completely as possible. Attach
additional sheets if you need more space. Provide information
for all years the worker provided services for the firm.
Determinations are based on the entire relationship between the
firm and the worker. Also indicate if there were any significant
changes in the work relationship over the service term.
Cat. No. 66200M
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
A-61
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
The Payroll Source
!
CAUTION
Form SS-8 will be returned to the requestor if all
required information is not provided.
file a claim for any refund that may be due after a determination
of my employment tax status has been completed.”
Filing Form SS-8 does not alter the requirement to
timely file an income tax return. Do not delay filing your tax
return in anticipation of an answer to your Form SS-8 request. In
addition, if applicable, do not delay in responding to a request for
payment while waiting for a determination of your worker status.
Additional copies of this form may be obtained on IRS.gov or
by calling 1-800-TAX-FORM (1-800-829-3676).
Fee
There is no fee for requesting a Form SS-8 determination letter.
Instructions for Firms
Signature
If a worker has requested a determination of his or her status
while working for you, you will receive a request from the IRS to
complete a Form SS-8. In cases of this type, the IRS usually
gives each party an opportunity to present a statement of the
facts because any decision will affect the employment tax status
of the parties. Failure to respond to this request will not prevent
the IRS from issuing a determination letter based on the
information available to it so that the worker may fulfill his or her
federal tax obligations. However, the information that you
provide is extremely valuable in determining the status of the
worker.
Form SS-8 must be signed and dated by the taxpayer. A
stamped signature will not be accepted.
The person who signs for a corporation must be an officer of
the corporation who has personal knowledge of the facts. If the
corporation is a member of an affiliated group filing a
consolidated return, it must be signed by an officer of the
common parent of the group.
The person signing for a trust, partnership, or limited liability
company must be, respectively, a trustee, general partner, or
member-manager who has personal knowledge of the facts.
If you are requesting a determination for a particular class of
worker, complete the form for one individual who is
representative of the class of workers whose status is in
question. If you want a written determination for more than one
class of workers, complete a separate Form SS-8 for one worker
from each class whose status is typical of that class. A written
determination for any worker will apply to other workers of the
same class if the facts are not materially different for these
workers. Please provide a list of names and addresses of all
workers potentially affected by this determination so that the IRS
can contact them for information.
A Form SS-8 that is not properly signed and dated by the
taxpayer cannot be processed and will be returned.
Where To File
Send the completed and signed Form SS-8 to:
Internal Revenue Service
Form SS-8 Determinations
P.O. Box 630
Stop 631
Holtsville, NY 11742-0630
If you have a reasonable basis for not treating a worker as an
employee, you may be relieved from having to pay employment
taxes for that worker under section 530 of the Revenue Act of
1978. However, this relief provision cannot be considered in
conjunction with a Form SS-8 determination because the
determination does not constitute an examination of any tax
return. For more information regarding section 530 of the
Revenue Act of 1978 and to determine if you qualify for relief
under this section, visit IRS.gov.
Faxed, photocopied, or electronic versions of Form SS-8 are not
acceptable for the initial request for the Form SS-8
determination. Do not submit Form SS-8 with your tax return
as that will delay processing time.
Instructions for Workers
If you are requesting a determination for more than one firm,
complete a separate Form SS-8 for each firm.
!
CAUTION
How To Get Help
Form SS-8 is not a claim for refund of social security
and Medicare taxes or federal income tax withholding.
To get IRS forms and publications, go to IRS.gov or call
1-800-TAX-FORM (1-800-829-3676).
The Taxpayer Advocate Service Is
Here To Help You
If the IRS determines that you are an employee, you are
responsible for filing an amended return for any corrections
related to this decision. A determination that a worker is an
employee does not necessarily reduce any current or prior tax
liability. For more information, call 1-800-829-1040.
The Taxpayer Advocate Service (TAS) is your voice at the
IRS. Our job is to ensure that every taxpayer is treated fairly and
that you know and understand your rights.
Time for filing a claim for refund. Generally, you must file
your claim for a credit or refund within 3 years from the date your
original return was filed or within 2 years from the date the tax
was paid, whichever is later.
What can TAS do for you? We can offer you free help with IRS
problems that you can't resolve on your own. We know this
process can be confusing, but the worst thing you can do is
nothing at all! TAS can help if you can't resolve your problems
with the IRS and:
Your problem is causing financial difficulties for you, your
family, or your business.
You face (or your business is facing) an immediate threat of
adverse action.
You have tried repeatedly to contact the IRS but no one has
responded, or the IRS has not responded to you by the date
promised.
Filing Form SS-8 does not prevent the expiration of the
time in which a claim for a refund must be filed. If you are
concerned about a refund, and the statute of limitations for filing
a claim for refund for the year(s) at issue has not yet expired, you
should file Form 1040X, Amended U.S. Individual Income Tax
Return, to protect your statute of limitations. File a separate
Form 1040X for each year.
On the Form 1040X you file, do not complete lines 1 through
23 on the form. Write “Protective Claim” at the top of the form,
sign and date it. In addition, enter the following statement in Part
III: “Filed Form SS-8 with the Internal Revenue Service Office in
Holtsville, NY. By filing this protective claim, I reserve the right to
-2-
A-62
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Instructions for Form SS-8 (Rev. 05-2014)
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
If you qualify for our help, you'll be assigned to one advocate
who'll be with you at every turn and will do everything possible to
resolve your problem. Here's why we can help:
TAS is an independent organization within the IRS.
Our advocates know how to work with the IRS.
Our services are free and tailored to meet your needs.
We have offices in every state, the District of Columbia, and
Puerto Rico.
employer for purposes of employment taxes imposed under
Subtitle C. Section 6001 authorizes the IRS to request
information needed to determine if a worker(s) or firm is subject
to these taxes. Section 6109 requires you to provide your
identification number. Neither workers nor firms are required to
request a status determination, but if you choose to do so, you
must provide the information requested on this form. Failure to
provide the requested information may prevent us from making a
status determination. If any worker or the firm has requested a
status determination and you are being asked to provide
information for use in that determination, you are not required to
provide the requested information. However, failure to provide
such information will prevent the IRS from considering it in
making the status determination. Providing false or fraudulent
information may subject you to penalties. Generally, tax returns
and return information are confidential, as required by section
6103. However, section 6103 allows or requires the IRS to
disclose or give the information shown on this form to others as
described in the Code. Routine uses of this information include
providing it to the Department of Justice for use in civil and
criminal litigation, to the Social Security Administration for the
administration of social security programs, and to cities, states,
the District of Columbia, and U.S. commonwealths and
possessions for the administration of their tax laws. We also may
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. We may provide this information to the
affected worker(s), the firm, or payer as part of the status
determination process.
How can you reach us? If you think TAS can help you, call your
local advocate, whose number is in your local directory and at
www.irs.gov/advocate, or call us toll-free at 1-877-777-4778.
How else does TAS help taxpayers?
TAS also handles large-scale, systemic problems that affect
many taxpayers. If you know of one of these broad issues,
please report it through the Systemic Advocacy Management
System at www.irs.gov/sams.
For additional information about TAS, visit
www.taxpayeradvocate.irs.gov or see Pub. 1546, The Taxpayer
Advocate Service of the IRS – How to Get Help With Unresolved
Tax Problems.
Low Income Taxpayer Clinics
Low Income Taxpayer Clinics (LITCs) serve individuals whose
income is below a certain level and need to resolve tax problems
such as audits, appeals and tax collection disputes. Some
clinics can provide information about taxpayer rights and
responsibilities in different languages for individuals who speak
English as a second language. Visit www.irs.gov/litc or see IRS
Publication 4134, Low Income Taxpayer Clinic List.
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.
Representation
You may either represent yourself or, with proper written
authorization, have someone else represent you. Your
representative must be someone who is allowed to practice
before the IRS, such as an attorney, certified public accountant,
or enrolled agent (a person enrolled to practice before the IRS).
Use Form 2848, Power of Attorney and Declaration of
Representative, to authorize someone else to represent you
before the IRS.
The time needed to complete and file this Form SS-8 will vary
depending on individual circumstances. The estimated average
time is: Recordkeeping, 23 hrs., 55 min.; Learning about the
law or the form, 1 hr., 48 min.; Preparing the form, 5 hrs., 03
min.; and Sending the form to the IRS, 48 min. If you have
comments concerning the accuracy of these time estimates or
suggestions for making this form simpler, we would be happy to
hear from you. You can send your comments from www.irs.gov/
formspubs. Click on “More Information” and then on “Give us
feedback.” Or you can send your comments to the Internal
Revenue Service, Tax Forms and Publications, 1111
Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not
send the form to this address. Instead, see Where To File,
earlier.
Privacy Act and Paperwork Reduction Act Notice. We ask
for the information on Form SS-8 to carry out the Internal
Revenue laws of the United States. This information will be used
to determine the employment status of the worker(s) described
on the form. Subtitle C, Employment Taxes, of the Internal
Revenue Code imposes employment taxes on wages, including
income tax withholding. Sections 3121(d), 3306(a), and 3401(c)
and (d) and the related regulations define employee and
Instructions for Form SS-8 (Rev. 05-2014)
-3-
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A-63
The Payroll Source
Form Approved
OMB No. 0960-0565
Social Security Administration
EMPLOYER REPORT OF SPECIAL WAGE PAYMENTS
PART I - TO BE COMPLETED BY SSA/EMPLOYER:
Tax Year Employee Name
SSA Claim Number
(To be completed by SSA)
Employee's SSN
Employer
Address
PART 2 - TO BE COMPLETED BY EMPLOYER:
Employees are sometime paid wages in a year subsequent to the year that the wages were earned. The most common
types of payments are accumulated (for prior years) vacation pay or sick pay paid after retirement; deferred
compensation; severance pay (when paid on account of retirement) and bonuses--paid pursuant to a prior agreement or
contract.
Wages which are earned in a year prior to the year they are paid usually do not affect benefits payable under the Social
Security annual earnings test. However, for the Social Security Administration to pay benefits accurately, these prior
year amounts must be reported to us. The above named individual has filed for Social Security benefits. To ensure that
correct Social Security benefits are paid, please complete the information below and return this form to the Social
Security Administration. (Please see reverse side for instructions for the completion of this form.)
1. Employer Identification Number
(EIN)
2. Retirement date
(MM/DD/YYYY)
3. Date employee last performed services
(MM/DD/YYYY)
If the dates in items 2 and 3 are not the same, please explain the difference.
4. For wages paid to the employee in the "tax year" (see Part I above), enter the amount that was for
services performed prior to the tax year; or was not attributable to services rendered during the tax

year; or was paid on account of retirement:
$
Check the type(s) of wages paid in the tax year but for services performed in a prior year or were paid on account of retirement.
Vacation Pay
Sick Pay
Severance Pay
Bonus
Deferred Compensation
Other (Explain)
Yes
5. Will payments listed in item "4" be made for years after the tax year?
If answered Yes, please show the amounts and years in which these amounts will be paid, if known.
Amount
Year
Amount
6. Nonqualified deferred compensation and section 457 plans only. If payments and deferrals
occurred during the tax year, enter the amount of wages earned by the employee during
the tax year.
Signature

Title
Form SSA-131 (8-2001) EF (06-2002)
Destroy Prior Editions
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Date
Phone Number
(Over)
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From: APA Digital Publications (bookshelf.americanpayroll.org)
No
Year
$
Appendix
EMPLOYER INSTRUCTIONS FOR COMPLETING SPECIAL WAGE PAYMENT FORM
1. Provide the EIN that was used or will be used to report the employee's wages on the Form W-2.
2. Enter the date the employee retired. Enter "Not Retired" if the employee has not retired.
3. Enter the date that the employee last performed services; was not expected to return to work; and was not subject to
recall to render additional services. This date should be the same as or earlier than the date in item "2." Enter "Not
Retired" if the employee has not retired.
4. Enter the wages that were paid to the employee in the tax year that were for services that were performed in years
prior to the tax year or that were paid on account of retirement.
Examples (not all inclusive) of payments to be included:
• Payments in lieu of vacation that were earned in a year prior to the tax year.
• Accumulated sick payments which were paid in a lump sum based on "retirement" as the sole condition of
payment.
• Accumulated sick payments paid at or after the date in item 3, which were earned in a year prior to the tax
year.
• Payments "on account of retirement"--dismissal, severance or termination pay paid because of retirement.
• Bonuses which are paid pursuant to a prior contract, agreement or promise causing the employee to expect such
payments regularly; or announced to induce the employee to work more steadily, rapidly or efficiently or to
remain with the employer.
• Stock Options.
Do not include in item "4" payments:
• For annual, sick, holiday or vacation pay if used (absence from work) prior to the date of retirement
(earlier of items "2" or "3").
• That were reported or will be reported under "Nonqualified Plans" on the Form W-2.
• That were deducted from the employee's wages and paid to a deferred compensation plan (e.g., 401k).
• Employees health and dental plan benefits (non-covered/non-taxable for Social Security Wages).
• Bonuses earned and paid in the tax year.
5. Check whether payments listed in item 4 will be made for years after the tax year. If yes, please show the
amounts and years in which these will be paid, if known.
6. Nonqualified deferred compensation and section 457 plans only. If you were unable to report nonqualified
deferred compensation or section 457 plan payments and deferrals (contributions) on Form W-2 because
both payments and deferrals occurred during the year, show the amount of wages earned by the employee
during the tax year. Generally, the wages earned will be the compensation reported in block 1 of Form W-2
less payments from a nonqualified deferred compensation (or 457) plan, but including any amounts deferred
under the plan during the tax year (See IRS Publication 957).
Paperwork/Privacy Act Notice: This report is authorized by regulation 20 CFR 404.702. The information that
you provide will be used in making a determination regarding the amount of Social Security benefits payable to
the above named individual. While your response is voluntary, if you do not respond we may not be able to make
a correct determination regarding the amount of Social Security benefits payable to the above named individual
for the year in question.
We may also use the information you give us when we match records by computer. Matching programs compare
our records with those of other Federal, State, or local government agencies. Many agencies may use matching
programs to find or prove that a person qualifies for benefits paid by the Federal Government. The law allows us to
do this even if you do not agree to it.
Explanations about these and other reasons why information you provide us may be used or given out are available
in Social Security Offices. If you want to learn more about this, contact any Social Security Office.
PAPERWORK REDUCTION ACT: This information collection meets the clearance requirements of 44 U.S.C.
§3507, as amended by Section 2 of the Paperwork Reduction Act of 1995. You are not required to answer these
questions unless we display a valid Office of Management and Budget control number. We estimate that it will
take you about 20 minutes to read the instructions, gather the necessary facts, and answer the questions.
Form SSA-131 (8-2001) EF (06-2002)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
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A-65
The Payroll Source
Social Security Administration
Statement Concerning Your Employment in a Job
Not Covered by Social Security
Employee Name
Employee ID#
Employer Name
Employer ID#
Your earnings from this job are not covered under Social Security. When you retire, or if you become disabled,
you may receive a pension based on earnings from this job. If you do, and you are also entitled to a benefit
from Social Security based on either your own work or the work of your husband or wife, or former husband or
wife, your pension may affect the amount of the Social Security benefit you receive. Your Medicare benefits,
however, will not be affected. Under the Social Security law, there are two ways your Social Security benefit
amount may be affected.
Windfall Elimination Provision
Under the Windfall Elimination Provision, your Social Security retirement or disability benefit is figured using a
modified formula when you are also entitled to a pension from a job where you did not pay Social Security tax.
As a result, you will receive a lower Social Security benefit than if you were not entitled to a pension from this
job. For example, if you are age 62 in 2013, the maximum monthly reduction in your Social Security benefit as
a result of this provision is $395.50. This amount is updated annually. This provision reduces, but does not
totally eliminate, your Social Security benefit. For additional information, please refer to Social Security
Publication, “Windfall Elimination Provision.”
Government Pension Offset Provision
Under the Government Pension Offset Provision, any Social Security spouse or widow(er) benefit to which you
become entitled will be offset if you also receive a Federal, State or local government pension based on work
where you did not pay Social Security tax. The offset reduces the amount of your Social Security spouse or
widow(er) benefit by two-thirds of the amount of your pension.
For example, if you get a monthly pension of $600 based on earnings that are not covered under Social
Security, two-thirds of that amount, $400, is used to offset your Social Security spouse or widow(er) benefit. If
you are eligible for a $500 widow(er) benefit, you will receive $100 per month from Social Security ($500 $400=$100). Even if your pension is high enough to totally offset your spouse or widow(er) Social Security
benefit, you are still eligible for Medicare at age 65. For additional information, please refer to Social Security
Publication, “Government Pension Offset.”
For More Information
Social Security publications and additional information, including information about exceptions to each
provision, are available at www.socialsecurity.gov. You may also call toll free 1-800-772-1213, or for the deaf
or hard of hearing call the TTY number 1-800-325-0778, or contact your local Social Security office.
I certify that I have received Form SSA-1945 that contains information about the possible effects of the
Windfall Elimination Provision and the Government Pension Offset Provision on my potential future
Social Security Benefits.
Signature of Employee
Form SSA-1945 (01-2013)
Destroy Prior Editions
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Date
Appendix
Information about Social Security Form SSA-1945 Statement Concerning Your
Employment in a Job Not Covered by Social Security
New legislation [Section 419(c) of Public Law 108-203, the Social Security Protection Act of 2004] requires
State and local government employers to provide a statement to employees hired January 1, 2005 or later in a
job not covered under Social Security. The statement explains how a pension from that job could affect future
Social Security benefits to which they may become entitled.
Form SSA-1945, Statement Concerning Your Employment in a Job Not Covered by Social Security, is
the document that employers should use to meet the requirements of the law. The SSA-1945 explains the
potential effects of two provisions in the Social Security law for workers who also receive a pension based on
their work in a job not covered by Social Security. The Windfall Elimination Provision can affect the amount of a
worker’s Social Security retirement or disability benefit. The Government Pension Offset Provision can affect a
Social Security benefit received as a spouse, surviving spouse, or an ex-spouse.
Employers must:
•
•
Give the statement to the employee prior to the start of employment;
•
Submit a copy of the signed form to the pension paying agency.
Get the employee’s signature on the form; and
Social Security will not be setting any additional guidelines for the use of this form.
Copies of the SSA-1945 are available online at the Social Security website,
www.socialsecurity.gov/online/ssa-1945.pdf. Paper copies can be requested by email at
[email protected] or by fax at 410-965-2037. The request must include the name, complete
address and telephone number of the employer. Forms will not be sent to a post office box. Also, if
appropriate, include the name of the person to whom the forms are to be delivered. The forms are available in
packages of 25. Please refer to Inventory Control Number (ICN) 276950 when ordering.
Form SSA-1945 (01-2013)
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22222
Void
a Employee’s social security number
For Official Use Only
OMB No. 1545-0008
▶
b Employer identification number (EIN)
1 Wages, tips, other compensation
2 Federal income tax withheld
c Employer’s name, address, and ZIP code
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
d Control number
e Employee’s first name and initial
10 Dependent care benefits
Suff. 11 Nonqualified plans
Last name
13
Statutory
employee
Retirement
plan
12a See instructions for box 12
C
o
d
e
Third-party
sick pay
14 Other
12b
C
o
d
e
12c
C
o
d
e
12d
C
o
d
e
f Employee’s address and ZIP code
15 State
Form
16 State wages, tips, etc. 17 State income tax
Employer’s state ID number
W-2
18 Local wages, tips, etc. 19 Local income tax
2019
Wage and Tax Statement
20 Locality name
Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction
Act Notice, see the separate instructions.
Copy A For Social Security Administration — Send this entire page with
Form W-3 to the Social Security Administration; photocopies are not acceptable.
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)
1 Wages, tips, other compensation
2 Federal income tax withheld
c Employer’s name, address, and ZIP code
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
d Control number
e Employee’s first name and initial
Last name
10 Dependent care benefits
Suff. 11 Nonqualified plans
13
Statutory
employee
14 Other
Retirement
plan
12a
C
o
d
e
Third-party
sick pay
12b
C
o
d
e
12c
C
o
d
e
12d
C
o
d
e
f Employee’s address and ZIP code
15 State
Form
Employer’s state ID number
W-2
16 State wages, tips, etc. 17 State income tax
Wage and Tax
Statement
Copy 1—For State, City, or Local Tax Department
A-68
18 Local wages, tips, etc. 19 Local income tax
2019
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
20 Locality name
Department of the Treasury—Internal Revenue Service
Appendix
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)
1 Wages, tips, other compensation
2 Federal income tax withheld
c Employer’s name, address, and ZIP code
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
d Control number
e Employee’s first name and initial
10 Dependent care benefits
Suff. 11 Nonqualified plans
Last name
13
Statutory
employee
14 Other
Retirement
plan
12a See instructions for box 12
C
o
d
e
Third-party
sick pay
12b
C
o
d
e
12c
C
o
d
e
12d
C
o
d
e
f Employee’s address and ZIP code
15 State
Form
Employer’s state ID number
W-2
Wage and Tax
Statement
16 State wages, tips, etc. 17 State income tax
18 Local wages, tips, etc. 19 Local income tax
2019
20 Locality name
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 2019 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 2019 or if income is earned
for services provided while you were an inmate at a penal
institution. For 2019 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 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. 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
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 800-772-1213. You also may visit
the SSA website 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 2019 and more than $8,239.80 in social
security and/or Tier 1 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 $4,836.30 in
Tier 2 RRTA tax was withheld, you also may be able to
claim a credit. See your Form 1040 instructions and Pub.
505, Tax Withholding and Estimated Tax.
(Also see Instructions for Employee on the back of Copy C.)
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A-69
The Payroll Source
b Employer identification number (EIN)
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.
1 Wages, tips, other compensation
2 Federal income tax withheld
c Employer’s name, address, and ZIP code
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
a Employee’s social security number
OMB No. 1545-0008
9
d Control number
e Employee’s first name and initial
10 Dependent care benefits
Suff. 11 Nonqualified plans
Last name
13
Statutory
employee
14 Other
Retirement
plan
12a See instructions for box 12
C
o
d
e
Third-party
sick pay
12b
C
o
d
e
12c
C
o
d
e
12d
C
o
d
e
f Employee’s address and ZIP code
15 State
Form
Employer’s state ID number
W-2
16 State wages, tips, etc. 17 State income tax
Wage and Tax
Statement
Copy C—For EMPLOYEE’S RECORDS (See Notice to
Employee on the back of Copy B.)
2019
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 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 box 1, 3, 5, or 7. For information
on how to report tips on your tax return, see your Form 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 10. This amount includes 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 also is
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. This box shouldn’t be used if you had a deferral and a
A-70
18 Local wages, tips, etc. 19 Local income tax
20 Locality name
Department of the Treasury—Internal Revenue Service
Safe, accurate,
FAST! Use
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 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 $19,000
($13,000 if you only have SIMPLE plans; $22,000 for section 403(b)
plans if you qualify for the 15-year rule explained in Pub. 571). Deferrals
under code G are limited to $19,000. Deferrals under code H are limited
to $7,000.
However, if you were at least age 50 in 2019, 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 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 the Form 1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040.
See 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)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Appendix
a Employee’s social security number
OMB No. 1545-0008
b Employer identification number (EIN)
1 Wages, tips, other compensation
2 Federal income tax withheld
c Employer’s name, address, and ZIP code
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
d Control number
e Employee’s first name and initial
10 Dependent care benefits
Suff. 11 Nonqualified plans
Last name
13
Statutory
employee
14 Other
Retirement
plan
12a
C
o
d
e
Third-party
sick pay
12b
C
o
d
e
12c
C
o
d
e
12d
C
o
d
e
f Employee’s address and ZIP code
15 State
Form
Employer’s state ID number
W-2
16 State wages, tips, etc. 17 State income tax
Wage and Tax
Statement
Copy 2—To Be Filed With Employee’s State, City, or Local
Income Tax Return
18 Local wages, tips, etc. 19 Local income tax
2019
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 the Form 1040 instructions for how to deduct.
J—Nontaxable sick pay (information only, not included in box 1, 3, or 5)
K—20% excise tax on excess golden parachute payments. See the
Form 1040 instructions.
L—Substantiated employee business expense reimbursements (nontaxable)
M—Uncollected social security or RRTA tax on taxable cost of groupterm life insurance over $50,000 (former employees only). See the Form
1040 instructions.
N—Uncollected Medicare tax on taxable cost of group-term life
insurance over $50,000 (former employees only). See the Form 1040
instructions.
P—Excludable moving expense reimbursements paid directly to a
member of the U.S. Armed Forces (not included in box 1, 3, or 5)
Q—Nontaxable combat pay. See the instructions for Form 1040 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 plan (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,
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).
20 Locality name
Department of the Treasury—Internal Revenue Service
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 also is included in box 1. It is
subject to an additional 20% tax plus interest. See 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 taxexempt organization section 457(b) plan.
FF—Permitted benefits under a qualified small employer health
reimbursement arrangement
GG—Income from qualified equity grants under section 83(i)
HH—Aggregate deferrals under section 83(i) elections as of the close of
the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply
to the amount of traditional IRA contributions 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 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.
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
A-71
The Payroll Source
Void
a Employee’s social security number
OMB No. 1545-0008
b Employer identification number (EIN)
1 Wages, tips, other compensation
2 Federal income tax withheld
c Employer’s name, address, and ZIP code
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
d Control number
e Employee’s first name and initial
10 Dependent care benefits
Suff. 11 Nonqualified plans
Last name
13
Statutory
employee
14 Other
Retirement
plan
12a See instructions for box 12
C
o
d
e
Third-party
sick pay
12b
C
o
d
e
12c
C
o
d
e
12d
C
o
d
e
f Employee’s address and ZIP code
15 State
Form
Employer’s state ID number
W-2
16 State wages, tips, etc. 17 State income tax
Wage and Tax
Statement
Copy D — For Employer
18 Local wages, tips, etc. 19 Local income tax
2019
20 Locality name
Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction
Act Notice, see separate instructions.
Employers, Please Note—
Specific information needed to complete Form W-2 is available
in a separate booklet titled the 2019 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, 2020, furnish Copies B, C, and 2 to
each person who was your employee during 2019. Mail or
electronically file Copy A of Form(s) W-2 and W-3 with the SSA
by January 31, 2020. 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
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).
A-72
E-filing. If you file 250 or more Forms 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/FormW2.
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Appendix
DO NOT STAPLE
33333
(Check one)
941
Military
CT-1
Hshld.
emp.
943
944
Medicare
govt. emp.
Kind
of
Employer
(Check one)
d Establishment number
▲
Kind
of
Payer
For Official Use Only ▶
OMB No. 1545-0008
▲
b
a Control number
None apply
501c non-govt.
State/local
non-501c
State/local 501c
Third-party
sick pay
Federal govt.
1 Wages, tips, other compensation
2 Federal income tax withheld
e Employer identification number (EIN)
3 Social security wages
4 Social security tax withheld
f Employer’s name
5 Medicare wages and tips
6 Medicare tax withheld
7 Social security tips
8 Allocated tips
c Total number of Forms W-2
(Check if
applicable)
10 Dependent care benefits
9
11 Nonqualified plans
12a Deferred compensation
h Other EIN used this year
13 For third-party sick pay use only
12b
15 State
14 Income tax withheld by payer of third-party sick pay
g Employer’s address and ZIP code
Employer’s state ID number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
Employer's contact person
Employer's telephone number
Employer's fax number
Employer's email address
For Official Use Only
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 ▶
Form
W-3
Date ▶
Title ▶
Transmittal of Wage and Tax Statements
2019
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 2019 General Instructions for Forms
W-2 and W-3 for information on completing this form. Do not file Form
W-3 for Form(s) W-2 that were submitted electronically to the SSA.
Purpose of Form
Complete a Form W-3 Transmittal only when filing paper Copy A of
Form(s) W-2, Wage and Tax Statement. Don't file Form W-3 alone. 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.
When To File Paper Forms
E-Filing
Mail Form W-3 with Copy A of Form(s) W-2 by January 31, 2020.
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
January 31, 2020. For more information, go to www.SSA.gov/bso. First
time filers, select “Register”; returning filers select “Log In.”
Where To File Paper Forms
Send this entire page with the entire Copy A page of Form(s) W-2 to:
Social Security Administration
Direct 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 Pub. 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
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
A-73
The Payroll Source
DO NOT CUT, FOLD, OR STAPLE THIS FORM
For Official Use Only
44444
▶
OMB No. 1545-0008
a Employer’s name, address, and ZIP code
c Tax year/Form corrected
d Employee’s correct SSN
/ W-2
e Corrected SSN and/or name (Check this box and complete boxes f and/or
g if incorrect on form previously filed.)
Complete boxes f and/or g only if incorrect on form previously filed
▶
f Employee’s previously reported SSN
b Employer's Federal EIN
g Employee’s previously reported name
h Employee’s first name and initial
Note. Only complete money fields that are being corrected (exception: for
corrections involving MQGE, see the General Instructions for Forms W-2
and W-3, under Specific Instructions for Form W-2c, boxes 5 and 6).
Last name
Suff.
i Employee’s address and ZIP code
Previously reported
Correct information
1 Wages, tips, other compensation
1 Wages, tips, other compensation
2 Federal income tax withheld
2 Federal income tax withheld
3 Social security wages
3 Social security wages
4 Social security tax withheld
4 Social security tax withheld
5 Medicare wages and tips
5 Medicare wages and tips
6 Medicare tax withheld
6 Medicare tax withheld
7 Social security tips
7 Social security tips
8 Allocated tips
8 Allocated tips
9
9
11 Nonqualified plans
13
Statutory
employee
Retirement
plan
11 Nonqualified plans
Third-party
sick pay
14 Other (see instructions)
13
Statutory
employee
Retirement
plan
Previously reported
10 Dependent care benefits
10 Dependent care benefits
12a See instructions for box 12
12a See instructions for box 12
12b
12b
12c
12c
12d
12d
C
o
d
e
Third-party
sick pay
14 Other (see instructions)
Correct information
C
o
d
e
C
o
d
e
C
o
d
e
C
o
d
e
C
o
d
e
C
o
d
e
C
o
d
e
State Correction Information
Previously reported
15 State
Correct information
15 State
Employer’s state ID number
Previously reported
15 State
Employer’s state ID number
Correct information
15 State
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.
17 State income tax
17 State income tax
17 State income tax
17 State income tax
Locality Correction Information
Previously reported
Correct information
Previously reported
18 Local wages, tips, etc.
18 Local wages, tips, etc.
18 Local wages, tips, etc.
19 Local income tax
19 Local income tax
19 Local income tax
19 Local income tax
20 Locality name
20 Locality name
20 Locality name
20 Locality name
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
Form
A-74
Correct information
18 Local wages, tips, etc.
W-2c
(Rev. 8-2014)
Corrected Wage and Tax Statement
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Copy A—For Social Security Administration
Cat. No. 61437D
Department of the Treasury
Internal Revenue Service
Appendix
Notice to Employee
This is a corrected Form W-2, Wage and Tax Statement,
(or Form W-2AS, W-2CM, W-2GU, W-2VI or W-2c) for the
tax year shown in box c. If you have filed an income tax
return for the year shown, you may have to file an
amended return. Compare amounts on this form with
those reported on your income tax return. If the corrected
amounts change your U.S. income tax, file Form 1040X,
Amended U.S. Individual Income Tax Return, with Copy B
of this Form W-2c to amend the return you already filed.
If there is a correction in box 5, Medicare wages and
tips, use the corrected amount to determine if you need
to file or amend Form 8959, Additional Medicare Tax. If
you need to file Form 8959 or an amended Form 8959,
attach it to Form 1040 or Form 1040X, as applicable.
Employers, Please Note:
Specific information needed to complete Form W-2c is
given in the separate General Instructions for Forms W-2
and W-3, under Specific Instructions for Form W-2c. You
can order those instructions and additional forms by
calling 1-800-TAX-FORM (1-800-829-3676). You can
also get forms and instructions from the IRS website at
www.irs.gov.
If you have not filed your return for the year shown in
box c, attach Copy B of the original Form W-2 you
received from your employer and Copy B of this Form
W-2c to your return when you file it.
For more information, contact your nearest Internal
Revenue Service office. Employees in American Samoa,
Commonwealth of the Northern Mariana Islands, Guam,
or the U.S. Virgin Islands should contact their local taxing
authority for more information.
E-filing. If you file 250 or more Form(s) W-2c, you must
file electronically. Even if you are not 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-2c at a
time over the Internet. When you e-file with the SSA, no
separate Form W-3c filing is required. An electronic Form
W-3c 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.socialsecurity.gov/employer.
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
A-75
The Payroll Source
DO NOT CUT, FOLD, OR STAPLE
55555
a Tax year/Form corrected
For Official Use Only
/ W-
▶
OMB No. 1545-0008
c Kind of Payer (Check one)
943
944
b Employer’s name, address, and ZIP code
Kind of Employer (Check one) Third-party
sick pay
941/941-SS Military
Hshld.
emp.
CT-1
None apply 501c non-govt.
Medicare
govt. emp.
State/local State/local
non-501c
501c
Federal
govt.
(Check if
applicable)
d Number of Forms W-2c
e Employer’s Federal EIN
f Establishment number
g Employer’s state ID number
Complete boxes h, i, or j only if
incorrect on last form filed.
h Employer’s originally reported Federal EIN
i Incorrect establishment number
j
Total of amounts previously reported
as shown on enclosed Forms W-2c.
Employer's incorrect state ID number
Total of amounts previously reported
as shown on enclosed Forms W-2c.
Total of corrected amounts as
shown on enclosed Forms W-2c.
Total of corrected amounts as
shown on enclosed Forms W-2c.
1 Wages, tips, other compensation
1 Wages, tips, other compensation
2 Federal income tax withheld
2 Federal income tax withheld
3 Social security wages
3 Social security wages
4 Social security tax withheld
4 Social security tax withheld
5 Medicare wages and tips
5 Medicare wages and tips
6 Medicare tax withheld
6 Medicare tax withheld
7 Social security tips
7 Social security tips
8 Allocated tips
8 Allocated tips
9
9
10 Dependent care benefits
10 Dependent care benefits
11 Nonqualified plans
11 Nonqualified plans
12a Deferred compensation
12a Deferred compensation
14 Inc. tax w/h by third-party sick pay payer
14 Inc. tax w/h by third-party sick pay payer
12b
12b
16 State wages, tips, etc.
16 State wages, tips, etc.
17 State income tax
17 State income tax
18 Local wages, tips, etc.
18 Local wages, tips, etc.
19 Local income tax
19 Local income tax
Explain decreases here:
Has an adjustment been made on an employment tax return filed with the Internal Revenue Service?
If “Yes,” give date the return was filed ▶
Yes
No
Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it is true,
correct, and complete.
Signature
Title
▶
Date
▶
Employer's contact person
Employer's telephone number
Employer's fax number
Employer's email address
Form
W-3c
(Rev. 11-2015)
▶
For Official Use Only
Transmittal of Corrected Wage and Tax Statements
Department of the Treasury
Internal Revenue Service
Purpose of Form
When To File
Use this form to transmit Copy A of the most recent version of Form(s) W-2c,
Corrected Wage and Tax Statement. 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 filed or if those Forms W-2c are being filed only to
correct an employee’s name and social security number (SSN) or the employer
identification number (EIN). See the General Instructions for Forms W-2 and W-3
for information on completing this form.
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.
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-filing options on its
Business Services Online (BSO) website:
• W-2c Online. Use fill-in forms to create, save, print, and submit up to 25 Forms
W-2c 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-2c Electronically (EFW2C).
For more information, go to www.socialsecurity.gov/employer. First time filers,
select "Go to Register"; returning filers select "Go To Log In."
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.
A-76
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Cat. No. 10164R
Page 1 of 34
11:56 - 28-Jan-2019
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
2019
Department of the Treasury
Internal Revenue Service
General Instructions for
Forms W-2 and W-3
(Including Forms W-2AS, W-2CM, W-2GU, W-2VI, W-3SS, W-2c, and W-3c)
Section references are to the Internal Revenue Code
unless otherwise noted.
Contents
Future Developments . . . . . . . . . . . . . . . . . . .
What's New . . . . . . . . . . . . . . . . . . . . . . . . . .
Reminders . . . . . . . . . . . . . . . . . . . . . . . . . . .
Need Help? . . . . . . . . . . . . . . . . . . . . . . . . . .
How To Get Forms and Publications . . . . . . . .
Common Errors on Forms W-2 . . . . . . . . . . . .
General Instructions for Forms W-2 and W-3 . .
Special Reporting Situations for Form W-2 . . . .
Penalties . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Specific Instructions for Form W-2 . . . . . . . . . .
Specific Instructions for Form W-3 . . . . . . . . . .
General Instructions for Forms W-2c and W-3c .
Special Situations for Forms W-2c and W-3c . .
Specific Instructions for Form W-2c . . . . . . . . .
Specific Instructions for Form W-3c . . . . . . . . .
Form W-2 Reference Guide for Box 12 Codes .
Form W-2 Box 13 Retirement Plan Checkbox
Decision Chart . . . . . . . . . . . . . . . . . . . . .
Nonqualified Deferred Compensation Reporting
Example Chart . . . . . . . . . . . . . . . . . . . . .
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Future Developments
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Page
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.. 4
.. 4
.. 4
.. 5
.. 7
. 13
. 14
. 22
. 24
. 25
. 26
. 27
. 29
. . . . 30
. . . . 31
. . . . 33
For the latest information about developments related to
Forms W-2 and W-3 and their instructions, such as
legislation enacted after they were published, go to
IRS.gov/FormW2.
What's New
Employee stock options are not subject to Railroad
Retirement Tax. In Wisconsin Central Ltd. v. U.S., 138
S. Ct. 2067, the U. S. Supreme Court ruled that employee
stock options are not “money remuneration” subject to the
Railroad Retirement Tax Act (RRTA). If you are a railroad
employer, do not withhold Tier 1 and Tier 2 taxes when
employees covered by the RRTA exercise stock options.
You still must withhold federal income tax on taxable
compensation from railroad employees exercising their
options. See For employees covered by RRTA tax.
Box 9 Verification code. The Verification code pilot
program has ended. Box 9 is no longer in use.
Disaster tax relief. Disaster tax relief is available for
those affected by recent disasters. For more information
about disaster relief, go to IRS.gov/DisasterTaxRelief.
Jan 28, 2019
Penalties increased. Failure to file and failure to furnish
penalties and penalties for intentional disregard of filing
and payee statement requirements have increased due to
adjustments for inflation. The higher penalty amounts
apply to returns required to be filed after December 31,
2019. See Penalties for more information.
Reminders
Due date for filing with SSA. The due date for filing
2019 Forms W-2, W-2AS, W-2CM, W-2GU, W-2VI, W-3,
and W-3SS with the SSA is January 31, 2020, whether
you file using paper forms or electronically.
Extensions of time to file. Extensions of time to file
Form W-2 with the SSA are not automatic. You may
request one 30-day extension to file Form W-2 by
submitting a complete application on Form 8809,
Application for Extension of Time To File Information
Returns, indicating that at least one of the criteria on the
form and instructions for granting an extension applies
and signing under penalties of perjury. The IRS will only
grant the extension in extraordinary circumstances or
catastrophe. See Extension of time to file Forms W-2 with
the SSA for more information. This does not affect
extensions of time to furnish Forms W-2 to employees.
See Extension of time to furnish Forms W-2 to employees
for more information.
Get it done faster...
TIP E-file your Forms W-2 and W-2c with the SSA.
See E-filing.
Rejected wage reports from the Social Security Administration (SSA). The SSA will reject Form W-2
electronic and paper wage reports under the following
conditions:
• Medicare wages and tips are less than the sum of
social security wages and social security tips,
• Social security tax is greater than zero; social security
wages and social security tips are equal to zero, and
• Medicare tax is greater than zero; Medicare wages and
tips are equal to zero.
Additionally, Forms W-2 and W-2c electronic and
paper wage reports for household employers will be
rejected under the following conditions:
• The sum of social security wages and social security
tips is less than the minimum yearly earnings subject to
social security and Medicare tax withholding for a
household employee, and
• The Medicare wages and tips are less than the
minimum yearly earnings subject to social security and
Medicare tax withholding for a household employee.
Cat. No. 25979S
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The Payroll Source
employees, and keep for your records. BSO generates
Form W-3 automatically based on your Forms W-2. You
also can use BSO to upload wage files to the SSA, check
on the status of previously submitted wage reports, and
take advantage of other convenient services for
employers and businesses. Visit the SSA’s Employer W-2
Filing Instructions & Information website at SSA.gov/
employer for more information about using BSO to save
time for your organization. Here you also will find forms
and publications used for wage reporting, information
about verifying employee social security numbers online,
how to reach an SSA employer services representative for
your region, and more.
If the above conditions occur in an electronic wage
report, the SSA will notify the submitter by email or postal
mail to correct the report and resubmit it to the SSA. If the
above conditions occur in a paper wage report, the SSA
will notify the employer by email or postal mail to correct
the report and resubmit it to the SSA.
Note. Do not write “corrected” or “amended” on any
resubmitted reports.
Household employers, see Pub. 926, Household
Employer's Tax Guide.
Social security numbers. Do not truncate social
security numbers shown on Forms W-2, W-2AS, W-2GU,
and W-2VI. Social security numbers are required on
Forms W-2. See Taxpayer identification numbers (TINs),
later. Also see Regulations section 301.6109-4(b)(2).
Filers of other forms, such as certain Forms 1099/1098,
may truncate the taxpayer identification number
(XX-XXX1234) of the payee on the payee statement to
combat identity theft.
Preview BSO by viewing a brief online tutorial. Go
TIP to SSA.gov/employer/bsotut.htm.
Correcting wage reports. You can use BSO to
create, save, print, and submit Forms W-2c, Corrected
Wage and Tax Statement, online for the current year as
well as for prior years. After logging into BSO, navigate to
the Electronic Wage Reporting home page and click on
the “Forms W-2c/W-3c Online” tab. Also, see E-filing and
E-filing Forms W-2c and W-3c.
Limit on health flexible spending arrangement (FSA).
For 2019, a cafeteria plan may not allow an employee to
request salary reduction contributions for a health FSA in
excess of $2,700. The salary reduction contribution
limitation of $2,700 does not include any amount (up to
$500) carried over from a previous year. For more
information, see Health flexible spending arrangement
(FSA).
Tax relief for victims of terrorist attacks. Disability
payments for injuries incurred as a direct result of a
terrorist attack directed against the United States (or its
allies) are not included in income. Because federal
income tax withholding is required only when a payment is
includable in income, no federal income tax should be
withheld from these payments.
Additional Medicare Tax. In addition to withholding
Medicare tax at 1.45%, an employer is required to
withhold a 0.9% Additional Medicare Tax on any Federal
Insurance Contributions Act (FICA) wages or Railroad
Retirement Tax Act (RRTA) compensation it pays to an
employee in excess of $200,000 in a calendar year. An
employer is required to begin withholding Additional
Medicare Tax in the pay period in which it pays wages or
compensation in excess of $200,000 to an employee and
continue to withhold it until the end of the calendar year.
Additional Medicare Tax is imposed only on the
employee. There is no employer share of Additional
Medicare Tax. All wages and compensation that are
subject to Medicare tax are subject to Additional Medicare
Tax withholding if paid in excess of the $200,000
withholding threshold.
For more information on Additional Medicare Tax, go to
IRS.gov/ADMT.
Unless otherwise noted, references to Medicare tax
include Additional Medicare Tax.
Distributions from governmental section 457(b)
plans of state and local agencies. Generally, report
distributions from section 457(b) plans of state and local
agencies on Form 1099-R, Distributions From Pensions,
Annuities, Retirement or Profit-Sharing Plans, IRAs,
Insurance Contracts, etc. See Notice 2003-20 on
page 894 of Internal Revenue Bulletin 2003-19 at
IRS.gov/pub/irs-irbs/irb03-19.pdf.
Earned income credit (EIC) notice (not applicable to
Forms W-2AS, W-2CM, W-2GU, and W-2VI). You must
notify employees who have no income tax withheld that
they may be able to claim an income tax refund because
of the EIC. You can do this by using the official Internal
Revenue Service (IRS) Form W-2 with the EIC notice on
the back of Copy B or a substitute Form W-2 with the
same statement. You must give your employee Notice
797, Possible Federal Tax Refund Due to the Earned
Income Credit (EIC), or your own statement that contains
the same wording if (a) you use a substitute Form W-2
that does not contain the EIC notice, (b) you are not
required to furnish Form W-2, or (c) you do not furnish a
timely Form W-2 to your employee. For more information,
see section 10 in Pub. 15 (Circular E), Employer's Tax
Guide.
Medicaid waiver payments. Notice 2014-7 provides
that certain Medicaid waiver payments are excludable
from income for federal income tax purposes. See Notice
2014-7, 2014-4 I.R.B. 445, available at IRS.gov/irb/
2014-4_IRB#NOT-2014-7. Also, see IRS.gov/
MedicaidWaiverPayments for questions and answers on
the notice.
Electronic statements for employees. Furnishing
Copies B, C, and 2 of Forms W-2 to your employees
electronically may save you time and effort. See Pub.
15-A, Employer's Supplemental Tax Guide, Furnishing
Form W-2 to employees electronically, for additional
information.
Business Services Online (BSO). The SSA has
enhanced its secure BSO website to make it easier to
register and navigate. Use BSO’s online fill-in forms to
create, save, and submit Forms W-2 and W-2c to the SSA
electronically. BSO lets you print copies of these forms to
file with state or local governments, distribute to your
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Appendix
report Guam wages paid by Guam employers, and Form
W-2VI is used to report U.S. Virgin Islands (USVI) wages
paid by USVI employers. Do not use these forms to report
wages subject to U.S. income tax withholding. Instead,
use Form W-2 to show U.S. income tax withheld.
E-filing. The SSA encourages all employers to e-file.
E-filing can save you time and effort and helps ensure
accuracy. You must e-file if you are required to file 250 or
more Forms W-2 or W-2c. If you are required to e-file but
fail to do so, you may incur a penalty.
The SSA’s BSO website makes e-filing easy by
providing two ways to submit your Forms W-2 or W-2c
Copy A and Forms W-3 or W-3c information.
• If you need to file 50 or fewer Forms W-2 or 25 or fewer
Forms W-2c at a time, you can use BSO to create them
online. BSO guides you through the process of creating
Forms W-2 or W-2c, saving and printing them, and
submitting them to the SSA when you are ready. You do
not have to wait until you have submitted Forms W-2 or
W-2c to the SSA before printing copies for your
employees. BSO generates Form W-3 or W-3c
automatically based on your Forms W-2 or W-2c.
• If you need to file more than 50 Forms W-2 or more
than 25 Forms W-2c, BSO’s “file upload” feature might be
the best e-filing method for your business or organization.
To obtain file format specifications, visit the SSA’s website
at SSA.gov/employer/EFW2 &EFW2C.htm, and select the
appropriate document. This information also is available
by calling the SSA’s Employer Reporting Service Center
at 800-772-6270 (toll free).
!
CAUTION
Military Spouses Residency Relief Act (MSRRA). You
may be required to report wages and taxes on a form
different from the form you generally use if an employee
claims residence or domicile under MSRRA in a different
jurisdiction in one of the 50 states, the District of
Columbia, American Samoa, the Commonwealth of the
Northern Mariana Islands, Guam, Puerto Rico, or the U.S.
Virgin Islands.
Under MSRRA, the spouse of an active duty
servicemember (civilian spouse) may keep his or her prior
residence or domicile for tax purposes (tax residence)
when accompanying the servicemember spouse, who is
relocating under military orders, to a new military duty
station in one of the 50 states, the District of Columbia, or
a U.S. possession. Before relocating, both spouses must
have had the same tax residence.
For example, if a civilian spouse is working in Guam but
properly claims tax residence in one of the 50 states
under MSRRA, his or her income from services would not
be taxable income for Guam tax purposes. Federal
income taxes should be withheld and remitted to the IRS.
State and local income taxes may need to be withheld
and remitted to state and local tax authorities. You should
consult with state, local, or U.S. possession tax authorities
regarding your withholding obligations under MSRRA.
If you e-file, do not file the same returns using
paper forms.
For more information about e-filing Forms W-2 or W-2c
and a link to the BSO website, visit the SSA’s Employer
W-2 Filing Instructions & Information website at SSA.gov/
employer.
Nonqualified deferred compensation plans. You are
not required to complete box 12 with code Y (Deferrals
under a section 409A nonqualified deferred compensation
plan). Section 409A provides that all amounts deferred
under a nonqualified deferred compensation (NQDC) plan
for all tax years are includible in gross income unless
certain requirements are satisfied. See Nonqualified
deferred compensation plans under Special Reporting
Situations for Form W-2 and the Nonqualified Deferred
Compensation Reporting Example Chart.
In a few situations, reporting instructions vary
depending on the filing method you choose. For example,
you can include every type of box 12 amount in one
employee wage record if you upload an electronic file. If
you file on paper or create Forms W-2 online, you can
include only four box 12 amounts per Form W-2. See the
TIP for Box 12—Codes under Specific Instructions for
Form W-2.
Waiver from e-filing. You can request a waiver from
this requirement by filing Form 8508, Request for Waiver
From Filing Information Returns Electronically. Submit
Form 8508 to the IRS at least 45 days before the due date
of Form W-2, or 45 days before you file your first Form
W-2c. See Form 8508 for information about filing this
form.
Reporting the cost of group health insurance coverage. You must report the cost of employer-sponsored
health coverage in box 12 using code DD. However,
transitional relief applies to certain employers and certain
types of plans. For more information, see Box 12—Codes
for Code DD—Cost of employer-sponsored health
coverage.
Form 944. Use the “944” checkbox in box b of Form W-3
or Form W-3SS if you filed Form 944, Employer's
ANNUAL Federal Tax Return. Also use the “944”
checkbox if you filed Formulario 944(SP), the
Spanish-language version of Form 944.
Severance payments. Severance payments are wages
subject to social security and Medicare taxes. As noted in
section 15 of Pub. 15 (Circular E), severance payments
also are subject to income tax withholding and FUTA tax.
Substitute forms. You may use an acceptable substitute
form instead of an official IRS form.
Form W-2. If you are not using the official IRS form to
furnish Form W-2 to employees or to file with the SSA,
you may use an acceptable substitute form that complies
with the rules in Pub. 1141, General Rules and
Specifications for Substitute Forms W-2 and W-3. Pub.
1141 is a revenue procedure that explains the
requirements for format and content of substitute Forms
Forms W-2 for U.S. possessions. In these instructions,
reference to Forms W-2 and W-3 includes Forms W-2AS,
W-2CM, W-2GU, W-2VI, and W-3SS, unless otherwise
noted. These instructions are not applicable to wage and
tax statements for Puerto Rico. Form W-2AS is used to
report American Samoa wages paid by American Samoa
employers, Form W-2CM is used to report the
Commonwealth of the Northern Mariana Islands (CNMI)
wages paid by CNMI employers, Form W-2GU is used to
General Instructions for Forms W-2 and W-3 (2019)
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The Payroll Source
You also can call the IRS with your employment tax
questions at 800-829-4933 or go to IRS.gov/Businesses/
Small-Businesses-Self-Employed/UnderstandingEmployment-Taxes.
W-2 and W-3. Your substitute forms must comply with the
requirements in Pub. 1141.
Pub. 1141 prohibits advertising on Form W-2. You must
not include advertising on any copy of Form W-2,
including coupons providing discounts on tax preparation
services attached to the employee copies. See Pub. 1141
for further information.
Form W-2c. If you are not using the official IRS form to
furnish Form W-2c to employees or to file with the SSA,
you may use an acceptable substitute form that complies
with the rules in Pub. 1223, General Rules and
Specifications for Substitute Forms W-2c and W-3c. Pub.
1223 is a revenue procedure that explains the
requirements for format and content of substitute Forms
W-2c and W-3c. Your substitute forms must comply with
the requirements in Pub. 1223.
Pub. 1223 prohibits advertising on Form W-2c. You
must not include advertising on any copy of Form W-2c,
including coupons providing discounts on tax preparation
services attached to the employee copies. See Pub. 1223
for further information.
How To Get Forms and Publications
Internet. You can access IRS.gov 24 hours a day, 7 days
a week to:
• Download, view, and order tax forms, instructions, and
publications.
• Access commercial tax preparation and e-file services.
• Research your tax questions online.
• See answers to frequently asked tax questions.
• Search publications online by topic or keyword.
• View Internal Revenue Bulletins published in the last
few years.
• Sign up to receive local and national tax news by email.
You can order forms, instructions, and publications at
IRS.gov/OrderForms. For any other tax information, go to
IRS.gov/Help/Tax-Law-Questions.
Do not print Copy A of Forms W-2, W-3, W-2c, or
W-3c from IRS.gov and then file them with the
CAUTION SSA. The SSA accepts only e-filed reports and
the official red-ink versions (or approved substitute
versions) of these forms. For more information about
acceptable substitute versions, see Substitute forms. For
information about e-filing, see E-filing.
!
Need Help?
Help with e-filing. If you have questions about how to
register or use BSO, call 800-772-6270 (toll free) to speak
with an employer reporting technician at the SSA. The
hours of operation are Monday through Friday from 7:00
a.m. to 7:00 p.m. Eastern time. If you experience
problems using any of the services within BSO, call
888-772-2970 (toll free) to speak with a systems operator
in technical support at the SSA. To speak with the SSA's
Employer Services Liaison Officer (ESLO) for the U.S.
Virgin Islands, call 212-264-1462 (not a toll-free number).
For Guam, the Commonwealth of the Northern Mariana
Islands, or American Samoa, call 510-970-8247 (not a
toll-free number). For all other employers, contact the
ESLO that services your region. For a complete telephone
listing, visit the SSA’s Employer W-2 Filing Instructions &
Information website at SSA.gov/employer/
wage_reporting_specialists.htm.
Mail. You can send your order for forms, instructions, and
publications to the following address. You should receive
a response within 10 days after your request is received.
Internal Revenue Service
1201 N. Mitsubishi Motorway
Bloomington, IL 61705-6613
Common Errors on Forms W-2
Forms W-2 provide information to your employees, the
SSA, the IRS, and state and local governments. Avoid
making the following errors, which cause processing
delays.
Information reporting customer service site. The IRS
operates a centralized customer service site to answer
questions about reporting on Forms W-2, W-3, 1099, and
other information returns. If you have questions about
reporting on these forms, call 866-455-7438 (toll free).
Do not:
• Download Copy A of Forms W-2, W-2AS, W-2GU,
W-2VI, W-3SS, or Form W-3 from IRS.gov and file with
SSA.
• Omit the decimal point and cents from entries.
• Make entries using ink that is too light. Use only black
ink.
• Make entries that are too small or too large. Use
12-point Courier font, if possible.
• Add dollar signs to the money-amount boxes. They
have been removed from Copy A and are not required.
• Inappropriately check the “Retirement plan” checkbox
in box 13. See Retirement plan.
• Misformat the employee's name in box e. Enter the
employee's first name and middle initial in the first box, his
or her surname in the second box, and his or her suffix
(such as “Jr.”) in the third box (optional).
• Enter the incorrect employer identification number (EIN)
or the employee’s SSN for the EIN.
• Cut, fold, or staple Copy A paper forms mailed to SSA.
TTY/TDD equipment. Telephone help is available using
TTY/TDD equipment for persons who are deaf, hard of
hearing, or have a speech disability. If you have questions
about reporting on information returns (Forms 1096, 1097,
1098, 1099, 3921, 3922, 5498, W-2, W-2G, and W-3), call
304-579-4827.
Employment tax information. Detailed employment tax
information is given in:
• Pub. 15 (Circular E), Employer's Tax Guide,
• Pub. 15-A, Employer's Supplemental Tax Guide,
• Pub. 15-B, Employer's Tax Guide to Fringe Benefits,
• Pub. 51 (Circular A), Agricultural Employer's Tax Guide,
and
• Pub. 80 (Circular SS), Federal Tax Guide for Employers
in the U.S. Virgin Islands, Guam, American Samoa, and
the Commonwealth of the Northern Mariana Islands.
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Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
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Appendix
• Mail any other copy other than Copy A of Form W-2 to
the SSA.
Use of a reporting agent or other third-party
payroll service provider does not relieve an
CAUTION employer of the responsibility to ensure that
Forms W-2 are furnished to employees and that Forms
W-2 and W-3 are filed with the SSA, correctly and on time.
See Penalties for more information.
!
General Instructions for Forms
W-2 and W-3
Who must file Form W-2. You must file Form(s) W-2 if
you have one or more employees to whom you made
payments (including noncash payments) for the
employees’ services in your trade or business during
2019.
Complete and file Form W-2 for each employee for
whom any of the following applies (even if the employee is
related to you).
• You withheld any income, social security, or Medicare
tax from wages regardless of the amount of wages; or
• You would have had to withhold income tax if the
employee had claimed no more than one withholding
allowance or had not claimed exemption from withholding
on Form W-4; or
• You paid $600 or more in wages even if you did not
withhold any income, social security, or Medicare tax.
Only in very limited situations will you not have to file
Form W-2. This may occur if you were not required to
withhold any income tax, social security tax, or Medicare
tax and you paid the employee less than $600, such as for
certain election workers and certain foreign agricultural
workers. See Election workers and Foreign agricultural
workers, later.
Unless otherwise noted, references to Medicare tax
include Additional Medicare Tax.
If you are required to file 250 or more Forms W-2 or
want to take advantage of the benefits of e-filing, see
E-filing.
Be sure that the payer's name and EIN on Forms W-2 and
W-3 are the same as those used on the Form 941,
Employer's QUARTERLY Federal Tax Return; Form 943,
Employer's Annual Federal Tax Return for Agricultural
Employees; Form 944; Form CT-1, Employer's Annual
Railroad Retirement Tax Return; or Schedule H (Form
1040) filed by or for the payer.
When to file. Mail or electronically file Copy A of Form(s)
W-2 and Form W-3 with the SSA by January 31, 2020.
You may owe a penalty for each Form W-2 that you file
late. See Penalties. If you terminate your business, see
Terminating a business.
Extension of time to file Forms W-2 with the SSA.
You may request only one extension of time to file Form
W-2 with the SSA by submitting a complete application on
Form 8809, Application for Extension of Time To File
Information Returns. When completing the Form 8809,
indicate that at least one of the criteria on the form and
instructions for granting an extension applies. You must
sign the application under penalties of perjury. Send the
application to the address shown on Form 8809. You must
request the extension before the due date of Forms W-2.
If the IRS grants your request for extension, you will have
an additional 30 days to file. The IRS will grant extensions
to file Forms W-2 only in limited cases for extraordinary
circumstances or catastrophe, such as a natural disaster
or fire destroying the books and records needed for filing
the forms. No additional extension of time to file will be
allowed. See Form 8809 for details.
Who must file Form W-3. Anyone required to file Form
W-2 must file Form W-3 to transmit Copy A of Forms W-2.
Make a copy of Form W-3, keep it and Copy D (For
Employer) of Forms W-2 with your records for 4 years. Be
sure to use Form W-3 for the correct year. If you are filing
Forms W-2 electronically, also see E-filing.
Household employers. Even employers with only one
household employee must file Form W-3 to transmit Copy
A of Form W-2. On Form W-3 check the “Hshld. emp.”
checkbox in box b. For more information, see Schedule H
(Form 1040), Household Employment Taxes, and its
separate instructions. You must have an employer
identification number (EIN). See Box b Employer
identification number (EIN).
Even if you request and are granted an extension
of time to file Forms W-2, you still must furnish
CAUTION Forms W-2 to your employees by January 31,
2020. But see Extension of time to furnish Forms W-2 to
employees.
!
Where to file paper Forms W-2 and W-3. File Copy A
of Form(s) W-2 with Form W-3 at the following address.
Social Security Administration
Direct Operations Center
Wilkes-Barre, PA 18769-0001
If you use “Certified Mail” to file, change the ZIP
Who may sign Form W-3. A transmitter or sender
(including a service bureau, reporting agent, paying agent,
or disbursing agent) may sign Form W-3 (or use its PIN to
e-file) for the employer or payer only if the sender satisfies
both of the following.
• It is authorized to sign by an agency agreement
(whether oral, written, or implied) that is valid under state
law; and
• It writes “For (name of payer)” next to the signature
(paper Form W-3 only).
General Instructions for Forms W-2 and W-3 (2019)
TIP 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.” Go to IRS.gov/PDS for a list of
IRS-approved private delivery services.
Do not send cash, checks, money orders, or
other forms of payment with the Forms W-2
CAUTION and W-3 that you submit to the SSA.
Employment tax forms (for example, Form 941 or Form
943), remittances, and Forms 1099 must be sent to the
IRS.
!
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The Payroll Source
If employment ends before December 31, 2019, you
may furnish copies to the employee at any time after
employment ends, but no later than January 31, 2020. If
an employee asks for Form W-2, give him or her the
completed copies within 30 days of the request or within
30 days of the final wage payment, whichever is later.
However, if you terminate your business, see Terminating
a business.
You may furnish Forms W-2 to employees on IRS
official forms or on acceptable substitute forms. See
Substitute forms. Be sure the Forms W-2 you provide to
employees are clear and legible and comply with the
requirements in Pub. 1141.
Forms W-2 that include logos, slogans, and
advertisements (including advertisements for tax
preparation software) may be considered as suspicious or
altered Forms W-2 (also known as “questionable Forms
W-2”). An employee may not recognize the importance of
the employee copy for tax reporting purposes due to the
use of logos, slogans, and advertisements. Therefore, the
IRS has determined that logos, slogans, and advertising
will not be allowed on Forms W-3, Copy A of Forms W-2,
or any employee copies reporting wages paid. Limited
exceptions on this prohibition exist with respect to
employee copies. See Pub. 1141 for more information.
Extension of time to furnish Forms W-2 to
employees. You may request an extension of time to
furnish Forms W-2 to employees by sending a letter to:
Copy 1. Send Copy 1 of Form W-2, if required, to your
state, city, or local tax department. For more information
concerning Copy 1 (including how to complete boxes 15
through 20), contact your state, city, or local tax
department.
American Samoa. File Copy 1 of Form W-3SS and
Forms W-2AS at the following address.
American Samoa Tax Office
Executive Office Building
First Floor
Pago Pago, AS 96799
Guam. File Copy 1 of Form W-3SS and Forms W-2GU
at the following address.
Guam Department of Revenue and Taxation
P.O. Box 23607
GMF, GU 96921
For additional information about Form W-2GU, see
GuamTax.com.
United States Virgin Islands. File Copy 1 of Form
W-3SS and Forms W-2VI at the following address.
Virgin Islands Bureau of Internal Revenue
6115 Estate Smith Bay
Suite 225
St. Thomas, VI 00802
Internal Revenue Service
Attn: Extension of Time Coordinator
240 Murall Drive, Mail Stop 4360
Kearneysville, WV 25430
For additional information about Form W-2VI, see
BIR.VI.gov.
Commonwealth of the Northern Mariana Islands.
File Form OS-3710 and Copy 1 of Forms W-2CM at the
following address.
Mail your letter on or before the due date for furnishing
Forms W-2 to employees. It must include:
• Your name and address,
• Your EIN,
• A statement that you are requesting an extension to
furnish “Forms W-2” to employees,
• The reason for delay, and
• Your signature or that of your authorized agent.
Division of Revenue and Taxation
Commonwealth of the Northern Mariana Islands
P.O. Box 5234 CHRB
Saipan, MP 96950
Forms OS-3710 and W-2CM are not IRS forms. For
additional information about Form W-2CM, see
CNMIDOF.net.
Requests for an extension of time to furnish
Forms W-2 to employees are not automatically
CAUTION granted. If approved, an extension generally will
be granted for no more than 15 days from the due date,
unless the need for up to a total of 30 days is clearly
shown. See the 2019 General Instructions for Certain
Information Returns.
!
Shipping and mailing. If you file more than one type of
employment tax form, group Forms W-2 of the same type
with a separate Form W-3 for each type, and send them in
separate groups. See the specific instructions for Box
b—Kind of Payer and Box b—Kind of Employer in Specific
Instructions for Form W-3.
Prepare and file Forms W-2 either alphabetically by
employees' last names or numerically by employees'
social security numbers. Do not staple or tape Form W-3
to the related Forms W-2 or Forms W-2 to each other.
These forms are machine read. Staple holes or tears
interfere with machine reading. Also, do not fold Forms
W-2 and W-3. Send the forms to the SSA in a flat mailing.
Undeliverable Forms W-2. Keep for 4 years any
employee copies of Forms W-2 that you tried to but could
not deliver. However, if the undelivered Form W-2 can be
produced electronically through April 15th of the fourth
year after the year at issue, you do not need to keep
undeliverable employee copies. Do not send
undeliverable employee copies of Forms W-2 to the
Social Security Administration (SSA).
Furnishing Copies B, C, and 2 to employees.
Generally, you must furnish Copies B, C, and 2 of Form
W-2 to your employees by January 31, 2020. You will
meet the “furnish” requirement if the form is properly
addressed and mailed on or before the due date.
Taxpayer identification numbers (TINs). Employers
use an employer identification number (EIN)
(XX-XXXXXXX). Employees use a social security number
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Appendix
(SSN) (XXX-XX-XXXX). When you list a number, separate
the nine digits properly to show the kind of number.
Do not accept an IRS individual taxpayer identification
number (ITIN) in place of an SSN for employee
identification or for Form W-2 reporting. An ITIN is
available only to resident and nonresident aliens who are
not eligible for U.S. employment and need identification
for other tax purposes. An ITIN will expire if it is not used
at least once on a federal tax return in the last three
consecutive tax years, either as the filer or a dependent.
ITINs issued before 2013 are scheduled to expire
according to an annual schedule. For more information,
see the Instructions for Form W-7 or visit IRS.gov/ITIN.
You can identify an ITIN because it is a 9-digit number
formatted like an SSN beginning with the number “9” and
with a number in one of the following ranges in the fourth
and fifth digit: 50–65, 70–88, 90–92, and 94–99 (for
example, 9NN-70-NNNN). Do not auto populate an ITIN
into box a, Employee's social security number, on Form
W-2. See section 4 of Pub. 15 (Circular E).
!
CAUTION
Agent for (name of employer)
Address of agent
Each Form W-2 should reflect the EIN of the agent in
box b. An agent files one Form W-3 for all of the Forms
W-2 and enters its own information in boxes e, f, and g of
Form W-3 as it appears on the agent's related
employment tax returns (for example, Form 941). Enter
the client-employer's EIN in box h of Form W-3 if the
Forms W-2 relate to only one employer (other than the
agent); if not, leave box h blank.
If the agent (a) is acting as an agent for two or more
employers or is an employer and is acting as an agent for
another employer, and (b) pays social security wages to
an individual on behalf of more than one employer, the
agent should file separate Forms W-2 for the affected
employee reflecting the wages paid by each employer.
See Rev. Proc. 2013-39, 2013-52 I.R.B. 830, available
at IRS.gov/irb/2013-52_IRB#RP-2013-39 and Form 2678
instructions for procedures to be followed in applying to
be an agent.
An individual with an ITIN who later becomes
eligible to work in the United States must obtain
an SSN from the Social Security Administration.
Generally, an agent is not responsible for
TIP refunding excess social security or railroad
retirement (RRTA) tax withheld from employees. If
an employee worked for more than one employer during
2019 and had more than $8,239.80 in social security and
Tier 1 RRTA tax withheld, he or she should claim the
excess on the appropriate line of Form 1040 or Form
1040NR. If an employee had more than $4,836.30 in Tier
2 RRTA tax withheld from more than one employer, the
employee should claim a refund on Form 843, Claim for
Refund and Request for Abatement.
The IRS uses SSNs to check the payments that you
report against the amounts shown on employees' tax
returns. The SSA uses SSNs to record employees'
earnings for future social security and Medicare benefits.
When you prepare Form W-2, be sure to show the correct
SSN for each employee. Do not truncate the employees'
SSNs on Form W-2. For information about verifying SSNs,
see section 4 of Pub. 15 (Circular E) or visit the SSA's
Employer W-2 Filing Instructions & Information website at
SSA.gov/employer.
!
CAUTION
Archer MSA. An employer's contribution to an
employee's Archer MSA is not subject to federal income
tax withholding or social security, Medicare, or railroad
retirement taxes if it is reasonable to believe at the time of
the payment that the contribution will be excludable from
the employee's income. However, if it is not reasonable to
believe at the time of payment that the contribution will be
excludable from the employee's income, employer
contributions are subject to income tax withholding and
social security and Medicare taxes (or railroad retirement
taxes, if applicable) and must be reported in boxes 1, 3,
and 5. (Use box 14 if railroad retirement taxes apply.)
You must report all employer contributions to an Archer
MSA in box 12 of Form W-2 with code R. Employer
contributions to an Archer MSA that are not excludable
from the income of the employee also must be reported in
boxes 1, 3, and 5 (box 14 if railroad retirement taxes
apply).
An employee's contributions to an Archer MSA are
includible in income as wages and are subject to federal
income tax withholding and social security and Medicare
taxes (or railroad retirement taxes, if applicable).
Employee contributions are deductible, within limits, on
the employee's Form 1040.
For more information, see Pub. 969, Health Savings
Accounts and Other Tax-Favored Health Plans, and
Notice 96-53, which is found on page 5 of Internal
Revenue Bulletin 1996-51 at IRS.gov/pub/irs-irbs/
irb96-51.pdf.
Form W-2 e-filed with the SSA must contain the
same TINs as shown on all copies of Form W-2
furnished to employees.
Special Reporting Situations for Form
W-2
Adoption benefits. Amounts paid or expenses incurred
by an employer for qualified adoption expenses under an
adoption assistance program are not subject to federal
income tax withholding and are not reportable in box 1.
However, these amounts (including adoption benefits paid
from a section 125 (cafeteria) plan, but not including
adoption benefits forfeited from a cafeteria plan) are
subject to social security, Medicare, and railroad
retirement taxes and must be reported in boxes 3 and 5.
(Use box 14 if railroad retirement taxes apply.) Also, the
total amount must be reported in box 12 with code T.
For more information on adoption benefits, see Notice
97-9, 1997-1 C.B. 365, which is on page 35 of Internal
Revenue Bulletin 1997-2 at IRS.gov/pub/irs-irbs/
irb97-02.pdf. Advise your employees to see the
Instructions for Form 8839, Qualified Adoption Expenses.
Agent reporting. An agent who has an approved Form
2678, Employer/Payer Appointment of Agent, should
enter the following in box c of Form W-2:
(Name of agent)
General Instructions for Forms W-2 and W-3 (2019)
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The Payroll Source
• Box 5— 13000.00 (includes the $3,000 accrued wages
and vacation pay)
• Box 6— 188.50 (1.45% of the amount in box 5)
Clergy and religious workers. For certain members of
the clergy and religious workers who are not subject to
social security and Medicare taxes as employees, boxes
3 and 5 of Form W-2 should be left blank. You may
include a minister's parsonage and/or utilities allowance in
box 14. For information on the rules that apply to ministers
and certain other religious workers, see Pub. 517, Social
Security and Other Information for Members of the Clergy
and Religious Workers, and section 4 in Pub. 15-A.
!
CAUTION
• Boxes for recipient’s name, address, and TIN—the
estate's name, address, and TIN.
• Box 3: 3000.00 (Even though amounts were withheld
for social security and Medicare taxes, the gross amount
is reported here.)
Deceased employee's wages. If an employee dies
during the year, you must report the accrued wages,
vacation pay, and other compensation paid after the date
of death. Also report wages that were available to the
employee while he or she was alive, regardless of
whether they actually were in the possession of the
employee, as well as any other regular wage payment,
even if you may have to reissue the payment in the name
of the estate or beneficiary.
If you made the payment after the employee's death
but in the same year the employee died, you must
withhold social security and Medicare taxes on the
payment and report the payment on the employee's Form
W-2 only as social security and Medicare wages to ensure
proper social security and Medicare credit is received. On
the employee's Form W-2, show the payment as social
security wages (box 3) and Medicare wages and tips
(box 5) and the social security and Medicare taxes
withheld in boxes 4 and 6. Do not show the payment in
box 1.
If you made the payment after the year of death, do not
report it on Form W-2, and do not withhold social security
and Medicare taxes.
Whether the payment is made in the year of death or
after the year of death, you also must report it in box 3 of
Form 1099-MISC, Miscellaneous Income, for the payment
to the estate or beneficiary. Use the name and taxpayer
identification number (TIN) of the payment recipient on
Form 1099-MISC. However, if the payment is a
reissuance of wages that were constructively received by
the deceased individual while he or she was still alive, do
not report it on Form 1099-MISC.
If Employer X made the payment after the year of
death, the $3,000 would not be subject to social security
and Medicare taxes and would not be shown on Form
W-2. However, the employer would still file Form
1099-MISC.
Designated Roth contributions. Under section 402A, a
participant in a section 401(k) plan, under a 403(b) salary
reduction agreement, or in a governmental 457(b) plan
that includes a qualified Roth contribution program, may
elect to make designated Roth contributions to the plan or
program in lieu of elective deferrals. Designated Roth
contributions are subject to federal income tax withholding
and social security and Medicare taxes (and railroad
retirement taxes, if applicable) and must be reported in
boxes 1, 3, and 5. (Use box 14 if railroad retirement taxes
apply.)
Section 402A requires separate reporting of the yearly
designated Roth contributions. Designated Roth
contributions to 401(k) plans will be reported using code
AA in box 12; designated Roth contributions under 403(b)
salary reduction agreements will be reported using code
BB in box 12; and designated Roth contributions under a
governmental section 457(b) plan will be reported using
code EE in box 12. For reporting instructions, see the
box 12 instructions for Code AA—Designated Roth
contributions under a section 401(k) plan, Code
BB—Designated Roth contributions under a section
403(b) plan, and Code EE—Designated Roth
contributions under a governmental section 457(b) plan.
Educational assistance programs. Employer-provided
educational assistance up to a maximum of $5,250 is
excludable from an employee's wages only if assistance
is provided under an educational assistance program
under section 127. See Pub. 970, Tax Benefits for
Education, and section 2 of Pub. 15-B for more
information. Also see Box 1—Wages, tips, other
compensation.
Example. Before Employee A's death on June 15,
2019, A was employed by Employer X and received
$10,000 in wages on which federal income tax of $1,500
was withheld. When A died, X owed A $2,000 in wages
and $1,000 in accrued vacation pay. The total of $3,000
(less the social security and Medicare taxes withheld) was
paid to A's estate on July 5, 2019. Because X made the
payment during the year of death, X must withhold social
security and Medicare taxes on the $3,000 payment and
must complete Form W-2 as follows.
• Box a— Employee A's SSN
• Box e— Employee A's name
• Box f— Employee A's address
• Box 1— 10000.00 (does not include the $3,000
accrued wages and vacation pay)
• Box 2— 1500.00
• Box 3— 13000.00 (includes the $3,000 accrued wages
and vacation pay)
• Box 4— 806.00 (6.2% of the amount in box 3)
Election workers. Report on Form W-2 payments of
$600 or more to election workers for services performed
in state, county, and municipal elections. File Form W-2
for payments of less than $600 paid to election workers if
social security and Medicare taxes were withheld under a
section 218 (Social Security Act) agreement. Do not
report election worker payments on Form 1099-MISC.
If the election worker is employed in another capacity
with the same government entity, see Rev. Rul. 2000-6,
which is on page 512 of Internal Revenue Bulletin 2000-6
at IRS.gov/pub/irs-irbs/irb00-06.pdf.
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Employer X also must complete Form 1099-MISC
as follows.
General Instructions for Forms W-2 and W-3 (2019)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
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Appendix
agreement, all federal employers (including the
Department of Defense) are required to withhold CNMI
income taxes, rather than federal income taxes, and
deposit the CNMI taxes with the CNMI Treasury for
employees who are subject to CNMI taxes and whose
regular place of federal employment is in the CNMI.
Federal employers also are required to file quarterly and
annual reports with the CNMI Division of Revenue and
Taxation. For questions, contact the CNMI Division of
Revenue and Taxation.
Federal employers may use Form W-2 (rather than
Forms W-2CM or OS-3710) to report income taxes
withheld and paid to CNMI, as well as to report social
security and Medicare taxes. Use the state boxes 15, 16,
and 17 for CNMI income tax reporting. See the
instructions for boxes 15, 16, and 17 under Boxes 15
through 20—State and local income tax information, later.
This rule applies only to income tax reporting. Federal
employers should withhold and report social security and
Medicare taxes for these employees in the same way as
for other federal employees. For more information, go to
IRS.gov/Individuals/International-Taxpayers/SpecialWithholding-Rules-for-US-Federal-Agency-EmployersWith-Employees-in-CNMI-or-Puerto-Rico.
Employee business expense reimbursements.
Reimbursements to employees for business expenses
must be reported as follows.
• Generally, payments made under an accountable plan
are excluded from the employee's gross income and are
not reported on Form W-2. However, if you pay a per diem
or mileage allowance and the amount paid for
substantiated miles or days traveled exceeds the amount
treated as substantiated under IRS rules, you must report
as wages on Form W-2 the amount in excess of the
amount treated as substantiated. The excess amount is
subject to income tax withholding and social security and
Medicare taxes (or railroad retirement taxes, if
applicable). Report the amount treated as substantiated
(that is, the nontaxable portion) in box 12 using code L.
See the box 12 instructions for Code L—Substantiated
employee business expense reimbursements. (Use
box 14 if railroad retirement taxes apply.)
• Payments made under a nonaccountable plan are
reported as wages on Form W-2 and are subject to
federal income tax withholding and social security and
Medicare taxes (or railroad retirement taxes, if
applicable). (Use box 14 if railroad retirement taxes
apply.)
For more information on accountable plans,
nonaccountable plans, amounts treated as substantiated
under a per diem or mileage allowance, the standard
mileage rate, the per diem substantiation method, and the
high-low substantiation method, see Pub. 463, Travel,
Gift, and Car Expenses; and section 5 of Pub. 15 (Circular
E).
Foreign agricultural workers. You must report
compensation of $600 or more paid in a calendar year to
an H-2A visa agricultural worker for agricultural labor. If
the H-2A visa agricultural worker furnishes a valid
taxpayer identification number, report these payments in
box 1 of Form W-2. If the worker does not furnish a valid
taxpayer identification number, report the payments on
Form 1099-MISC. See Form 1099-MISC below.
On Form W-2, no amount should be reported in box 3
or 5. In most cases, you do not need to withhold federal
income tax from compensation paid to H-2A visa
agricultural workers. Employers should withhold federal
income tax only if the H-2A visa agricultural worker and
the employer agree to withhold. The H-2A visa agricultural
worker must provide a completed Form W-4. If the
employer withholds income tax, the employer must report
the tax withheld in box 2 of Form W-2 and on line 8 of
Form 943. See Pub. 51 (Circular A).
Form 1099-MISC. If the H-2A visa agricultural worker
fails to furnish a taxpayer identification number to the
employer, and the total annual payments made to the
H-2A visa agricultural worker are $600 or more, the
employer must begin backup withholding on the payments
made until the H-2A visa agricultural worker furnishes a
valid taxpayer identification number. Employers must
report the compensation paid and any backup withholding
on Forms 1099-MISC and Form 945, Annual Return of
Withheld Federal Income Tax. See the 2019 Instructions
for Form 1099-MISC and the 2019 Instructions for Form
945.
For more information, go to IRS.gov/H2A.
Employee's social security and Medicare taxes (or
railroad retirement taxes, if applicable) paid by employer. If you paid your employee's share of social
security and Medicare taxes rather than deducting them
from the employee's wages, you must include these
payments as wages subject to federal (or American
Samoa, CNMI, Guam, or U.S. Virgin Islands) income tax
withholding and social security, Medicare, and federal
unemployment (FUTA) taxes. If you paid your employee's
share of railroad retirement taxes, you must include these
amounts as compensation subject to railroad retirement
taxes. The amount to include as wages and/or
compensation is determined by using the formula
contained in the discussion of Employee's Portion of
Taxes Paid by Employer in section 7 of Pub. 15-A and in
Rev. Proc. 83-43, 1983-24 I.R.B. 60.
This does not apply to household and agricultural
employers. If you pay a household or agricultural
CAUTION employee's social security and Medicare taxes,
you must include these payments in the employee's
wages for income tax withholding purposes. However, the
wage increase due to the tax payments is not subject to
social security, Medicare, or FUTA taxes. For information
on completing Forms W-2 and W-3 in this situation, see
the Instructions for Schedule H (Form 1040) and section 4
of Pub. 51 (Circular A).
!
Fringe benefits. Include all taxable fringe benefits in
box 1 of Form W-2 as wages, tips, and other
compensation and, if applicable, in boxes 3 and 5 as
social security and Medicare wages. Although not
required, you may include the total value of fringe benefits
in box 14 (or on a separate statement). However, if you
provided your employee a vehicle, you must include the
Federal employers in the CNMI. The U.S. Treasury
Department and the CNMI Division of Revenue and
Taxation entered into an agreement under 5 U.S.C. 5517
(“5517 agreement”) in December 2006. Under this
General Instructions for Forms W-2 and W-3 (2019)
-9-
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The Payroll Source
value of any personal use in boxes 1, 3, and 5 of Form
W-2. You must withhold social security and Medicare tax,
but you have the option not to withhold federal income tax
if you notify the employee and include the value of the
benefit in boxes 1, 3, 5, and 14. See Pub. 15-B for more
information.
Public Law 115-97, section 11045, does not
permit employees to deduct unreimbursed
CAUTION employee business expenses for tax years 2018
through 2025. If you included 100% of the vehicle’s
annual lease value in the employee’s income, the
employee will not be able to deduct expenses attributable
to the business use of an employer-provided vehicle. See
Pub. 15-B.
!
Golden parachute payments (not applicable to
Forms W-2AS, W-2CM, W-2GU, or W-2VI). Include any
golden parachute payments in boxes 1, 3, and 5 of Form
W-2. Withhold federal income, social security, and
Medicare taxes (or railroad retirement taxes, if applicable)
as usual and report them in boxes 2, 4, and 6,
respectively. (Use box 14 if railroad retirement taxes
apply.) Excess parachute payments also are subject to a
20% excise tax. If the excess payments are considered
wages, withhold the 20% excise tax and include it in box 2
as income tax withheld. Also report the excise tax in
box 12 with code K. For definitions and additional
information, see Regulations section 1.280G-1 and Rev.
Proc. 2003-68, 2003-34 I.R.B. 398, available at IRS.gov/
irb/2003-34_IRB#RP-2003-68.
Government employers. Federal, state, and local
governmental agencies have two options for reporting
their employees' wages that are subject to only Medicare
tax for part of the year and both social security and
Medicare taxes for part of the year.
The first option (which the SSA prefers) is to file a
single set of Forms W-2 per employee for the entire year,
even if only part of the year's wages are subject to both
social security and Medicare taxes. Check “941” (or “944”)
in box b of Form W-3 or check “941-SS” in box b of Form
W-3SS. The wages in box 5 of Form W-2 must be equal to
or greater than the wages in box 3 of Form W-2.
The second option is to file one set of Forms W-2 for
wages subject only to Medicare tax and another set for
wages subject to both social security and Medicare taxes.
Use a separate Form W-3 to transmit each set of Forms
W-2. For the Medicare-only Forms W-2, check “Medicare
govt. emp.” in box b of Form W-3. For the Forms W-2
showing wages subject to both social security and
Medicare taxes, check “941” (or “944”) in box b of Form
W-3 or check “941-SS” in box b of Form W-3SS. The
wages in box 5 of Form W-2 must be equal to or greater
than the wages in box 3 of Form W-2.
Group-term life insurance. You must include in boxes
1, 3, and 5 (or 14, if railroad retirement taxes apply) the
cost of group-term life insurance that is more than the cost
of $50,000 of coverage, reduced by the amount the
employee paid toward the insurance. Use Table 2-2 in
Pub. 15-B to determine the cost of the insurance. Also,
show the amount in box 12 with code C. For employees,
you must withhold social security and Medicare taxes, but
not federal income tax. For coverage provided to former
employees, the former employees must pay the employee
part of social security and Medicare taxes (or railroad
retirement taxes, if applicable) on the taxable cost of
group-term life insurance over $50,000 on Form 1040.
You are not required to collect those taxes. However, you
must report the uncollected social security tax (or railroad
retirement taxes, if applicable) with code M and the
uncollected Medicare tax (or RRTA Medicare tax, if
applicable) with code N in box 12 of Form W-2. However,
any uncollected Additional Medicare Tax (on the cost of
group-term life insurance, which, in combination with other
wages, is in excess of $200,000) is not reported with code
N in box 12.
Health flexible spending arrangement (FSA). For plan
year 2019, a cafeteria plan may not allow an employee to
request salary reduction contributions for a health FSA in
excess of $2,700 (as indexed for inflation).
If a cafeteria plan timely complies with the written plan
requirement limiting health FSA salary reduction
contributions, but one or more employees are erroneously
allowed to elect a salary reduction of more than $2,700 for
the plan year, the cafeteria plan will continue to be a
section 125 cafeteria plan for the plan year if:
• The terms of the plan apply uniformly to all participants,
• The error results from a reasonable mistake by the
employer (or the employer’s agent) and is not due to
willful neglect by the employer (or the employer’s agent),
and
• Salary reduction contributions in excess of $2,700 are
paid to the employee and reported as wages for income
tax withholding and employment tax purposes on the
employee’s Form W-2 (or Form W-2c) for the employee’s
taxable year in which, or with which, ends the cafeteria
plan year in which the correction is made.
!
CAUTION
For more information, see Notice 2013-71, 2013-47
I.R.B. 532, available at IRS.gov/irb/
2013-47_IRB#NOT-2013-71.
Health savings account (HSA). An employer's
contribution (including an employee's contributions
through a cafeteria plan) to an employee's HSA is not
subject to federal income tax withholding or social
security, Medicare, or railroad retirement taxes (or FUTA
tax) if it is reasonable to believe at the time of the payment
that the contribution will be excludable from the
employee's income. However, if it is not reasonable to
believe at the time of payment that the contribution will be
excludable from the employee's income, employer
contributions are subject to federal income tax
withholding, social security and Medicare taxes (or
railroad retirement taxes, if applicable), and FUTA tax,
and must be reported in boxes 1, 3, and 5 (use box 14 if
railroad retirement taxes apply), and on Form 940,
Employer's Annual Federal Unemployment (FUTA) Tax
Return.
You must report all employer contributions (including
an employee's contributions through a cafeteria plan) to
an HSA in box 12 of Form W-2 with code W. Employer
contributions to an HSA that are not excludable from the
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The salary reduction contribution limit of $2,700
does not include any amount (up to $500) carried
over from a previous year.
General Instructions for Forms W-2 and W-3 (2019)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
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Appendix
income of the employee also must be reported in boxes 1,
3, and 5. (Use box 14 if railroad retirement taxes apply.)
An employee's contributions to an HSA (unless made
through a cafeteria plan) are includible in income as
wages and are subject to federal income tax withholding
and social security and Medicare taxes (or railroad
retirement taxes, if applicable). Employee contributions
are deductible, within limits, on the employee's Form
1040. For more information about HSAs, see Notice
2004-2, Notice 2004-50, and Notice 2008-52. Notice
2004-2, 2004-2 I.R.B. 269, is available at IRS.gov/irb/
2004-02_IRB#NOT-2004-2. Notice 2004-50, 2004-33
I.R.B. 196, is available at IRS.gov/irb/
2004-33_IRB#NOT-2004-50. Notice 2008-52, 2008-25
I.R.B. 1166, is available at IRS.gov/irb/
2008-25_IRB#NOT-2008-52. Also see Form 8889, Health
Savings Accounts (HSAs), and Pub. 969.
Lost Form W-2—Reissued statement. If an employee
loses a Form W-2, write “REISSUED STATEMENT” on
the new copy and furnish it to the employee. You do not
have to add “REISSUED STATEMENT” on Forms W-2
provided to employees electronically. Do not send Copy A
of the reissued Form W-2 to the SSA. Employers are not
prohibited (by the Internal Revenue Code) from charging
a fee for the issuance of a duplicate Form W-2.
Military differential pay. Employers paying their
employees while they are on active duty in the United
States uniformed services should treat these payments as
wages. Differential wage payments made to an individual
while on active duty for periods scheduled to exceed 30
days are subject to income tax withholding, but are not
subject to social security, Medicare, and unemployment
taxes. Report differential wage payments in box 1 and any
federal income tax withholding in box 2. Differential wage
payments made to an individual while on active duty for
30 days or less are subject to income tax withholding,
social security, Medicare, and unemployment taxes, and
are reported in boxes 1, 3, and 5. See Rev. Rul. 2009-11,
2009-18 I.R.B. 896, available at IRS.gov/irb/
2009-18_IRB#RR-2009-11.
Moving expenses. Effective for tax years 2018 through
2025, the exclusion for qualified moving expense
reimbursements applies only to members of the U.S.
Armed Forces on active duty who move pursuant to a
military order and incident to a permanent change of
station. All other employees have only nonqualified
moving expenses and expense reimbursements subject
to tax and withholding.
Report qualified moving expenses for members of the
Armed Forces as follows.
• Qualified moving expenses that an employer paid to a
third party on behalf of the employee (for example, to a
moving company) and services that an employer
furnished in kind to an employee are not reported on Form
W-2.
• Qualified moving expense reimbursements paid directly
to an employee by an employer are reported only in
box 12 of Form W-2 with code P.
Nonqualified moving expenses and expense
reimbursements are reported in boxes 1, 3, and 5 (use
box 14 if railroad retirement taxes apply) of Form W-2.
General Instructions for Forms W-2 and W-3 (2019)
These amounts are subject to federal income tax
withholding and social security and Medicare taxes (or
railroad retirement taxes, if applicable).
Nonqualified deferred compensation plans. Section
409A provides that all amounts deferred under a
nonqualified deferred compensation (NQDC) plan for all
tax years are currently includible in gross income to the
extent not subject to a substantial risk of forfeiture and not
previously included in gross income, unless certain
requirements are met. Generally, section 409A is effective
with respect to amounts deferred in tax years beginning
after December 31, 2004, but deferrals made before that
year may be subject to section 409A under some
circumstances.
It is not necessary to show amounts deferred during the
year under an NQDC plan subject to section 409A. If you
report section 409A deferrals, show the amount in box 12
using code Y. For more information, see Notice 2008-115,
2008-52 I.R.B. 1367, available at IRS.gov/irb/
2008-52_IRB#NOT-2008-115.
Income included under section 409A from an NQDC
plan will be reported in box 1 and in box 12 using code Z.
This income also is subject to an additional tax of 20%
that is reported on Form 1040. For more information on
amounts includible in gross income and reporting
requirements, see Notice 2008-115 available at IRS.gov/
irb/2008-52_IRB#NOT-2008-115. For information on
correcting failures to comply with section 409A and
related reporting, see Notice 2008-113, 2008-51 I.R.B.
1305, available at IRS.gov/irb/
2008-51_IRB#NOT-2008-113; Notice 2010-6, 2010-3
I.R.B. 275, available at IRS.gov/irb/
2010-03_IRB#NOT-2010-6; and Notice 2010-80, 2010-51
I.R.B. 853, available at IRS.gov/irb/
2010-51_IRB#NOT-2010-80.
See the Nonqualified Deferred Compensation
Reporting Example Chart.
Qualified equity grants under section 83(i). Report
the amount includible in gross income from qualified
equity grants under section 83(i)(1)(A) for the calendar
year in box 12 using code GG. This amount is wages for
box 1 and you must withhold income tax under section
3401(i) at the rate and manner prescribed in section
3401(t). You must withhold at the maximum rate of tax
without regard to the employee’s Form W-4. Social
security and Medicare taxation of the deferral stock is not
affected by these rules. See Notice 2018-97, 2018-52
I.R.B. 1062, at IRS.gov/IRB/2018-52_IRB#NOT-2018-97.
Qualified small employer health reimbursement arrangement. Use box 12, code FF to report the total
amount of permitted benefits under a qualified small
employer health reimbursement arrangement (QSEHRA).
QSEHRAs allow eligible employers to pay or reimburse
medical care expenses of eligible employees after the
employees provide proof of coverage. The maximum
reimbursement for an eligible employee under a QSEHRA
for 2019 is $5,150 ($10,450 if it also provides
reimbursements for family members). For more
information about QSEHRAs, see Notice 2017-67,
2017-47 I.R.B. 517, at IRS.gov/irb/
2017-47_IRB#NOT-2017-67 and Pub. 15-B under
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The Payroll Source
Accident and Health Benefits. For information on
employer reporting requirements, see Code
FF—Permitted benefits under a qualified small employer
health reimbursement, later.
Railroad employers (not applicable to Forms W-2AS,
W-2CM, W-2GU, or W-2VI). Railroad employers must
file Form W-2 to report their employees' wages and
income tax withholding in boxes 1 and 2. You must file a
separate Form W-3 to transmit the Forms W-2 if you have
employees covered under the Federal Insurance
Contributions Act (FICA) (social security and Medicare)
and the Railroad Retirement Tax Act (RRTA).
For employees covered by RRTA tax. Check the
“CT-1” checkbox on Form W-3, box b, “Kind of Payer,” to
transmit Forms W-2 for employees with box 1 wages and
box 2 tax withholding. Use Form W-2, box 14, to report
total RRTA compensation, Tier 1, Tier 2, Medicare
(excluding Additional Medicare Tax), and any Additional
Medicare Tax withheld for each employee covered by
RRTA tax. Label them “RRTA compensation,” “Tier 1 tax,”
“Tier 2 tax,” “Medicare tax,” and “Additional Medicare
Tax.” Include tips reported by the employee to the
employer in “RRTA compensation.”
Employee stock options are not “money remuneration”
subject to the RRTA. Railroad employers should not
withhold Tier 1 and Tier 2 taxes when employees covered
by the RRTA exercise stock options. Employers should
still withhold federal income tax on taxable compensation
from railroad employees exercising their stock options.
For employees covered by social security and
Medicare. Check the “941” checkbox on Form W-3, box
b, “Kind of Payer,” to transmit Forms W-2 with box 1
wages and box 2 tax withholding for employees covered
by social security and Medicare. Use Form W-2, boxes 3,
4, 5, 6, and 7 to report each employee’s social security
and Medicare wages and taxes, including Additional
Medicare Tax. These boxes are not to be used to report
railroad retirement compensation and taxes.
Railroad employers must withhold social security
and Medicare taxes from taxable compensation of
CAUTION employees covered by social security and
Medicare exercising their employee stock options.
!
Repayments. If an employee repays you for wages
received in error, do not offset the repayments against
current year wages unless the repayments are for
amounts received in error in the current year. Repayments
made in the current year, but related to a prior year or
years, must be repaid in gross, not net, and require
special tax treatment by employees in some cases. You
may advise the employee of the total repayments made
during the current year and the amount (if any) related to
prior years. This information will help the employee
account for such repayments on his or her federal income
tax return.
If the repayment was for a prior year, you must file
Form W-2c with the SSA to correct only social security
and Medicare wages and taxes, and furnish a copy to the
employee. Do not correct "Wages, tips, other
compensation" in box 1, or "Federal income tax withheld"
in box 2, on Form W-2c. Also, do not correct any
Additional Medicare Tax withheld on the repaid wages
(reported with Medicare tax withheld in box 6) on Form
W-2c. File the “X” return that is appropriate for the return
on which the wages or compensation was originally
reported (Forms 941-X, 943-X, 944-X, or CT-1X). Correct
the social security and Medicare wages and taxes for the
period during which the wages or compensation was
originally paid. For information on reporting adjustments to
Forms 941, 941-SS, 943, 944, or Form CT-1, see section
13 of Pub. 15 (Circular E), the Instructions for Form
CT-1X, or section 9 of Pub. 51 (Circular A).
Tell your employee that the wages paid in error in
TIP a prior year remain taxable to him or her for that
year. This is because the employee received and
had use of those funds during that year. The employee is
not entitled to file an amended return (Form 1040X) to
recover the income tax on these wages. Instead, the
employee may be entitled to a deduction (or a credit) for
the repaid wages on his or her Form 1040 for the year of
repayment. However, the employee is entitled to file an
amended return (Form 1040X) to recover Additional
Medicare Tax on these wages, if any. Refer your
employee to Repayments in Pub. 525.
Scholarship and fellowship grants. Give a Form W-2
to each recipient of a scholarship or fellowship grant only
if you are reporting amounts includible in income under
section 117(c) (relating to payments for teaching,
research, or other services required as a condition for
receiving the qualified scholarship). Also see Pub. 15-A
and Pub. 970. These payments are subject to federal
income tax withholding. However, their taxability for social
security and Medicare taxes (or railroad retirement taxes,
if applicable) depends on the nature of the employment
and the status of the organization. See Students,
scholars, trainees, teachers, etc., in section 15 of Pub. 15
(Circular E).
Sick pay. If you had employees who received sick pay in
2019 from an insurance company or other third-party
payer and the third party notified you of the amount of sick
pay involved, you may be required to report the
information on the employees' Forms W-2. If the
insurance company or other third-party payer did not
notify you in a timely manner about the sick pay
payments, it must prepare Forms W-2 and W-3 for your
employees showing the sick pay. For specific reporting
instructions, see section 6 of Pub. 15-A.
SIMPLE retirement account. An employee's salary
reduction contributions to a SIMPLE (savings incentive
match plan for employees) retirement account are not
subject to federal income tax withholding but are subject
to social security, Medicare, and railroad retirement taxes.
Do not include an employee's contribution in box 1, but do
include it in boxes 3 and 5. (Use box 14 if railroad
retirement taxes apply.) An employee's total contribution
also must be included in box 12 with code D or S.
An employer's matching or nonelective contribution to
an employee's SIMPLE retirement account is not subject
to federal income tax withholding or social security,
Medicare, or railroad retirement taxes, and is not to be
shown on Form W-2.
For more information on SIMPLE retirement accounts,
see Notice 98-4, 1998-1 C.B. 269. You can find Notice
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General Instructions for Forms W-2 and W-3 (2019)
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Appendix
98-4 on page 25 of Internal Revenue Bulletin 1998-2 at
IRS.gov/pub/irs-irbs/irb98-02.pdf.
Successor/predecessor employers. If you buy or sell a
business during the year, see Rev. Proc. 2004-53 for
information on who must file Forms W-2 and employment
tax returns. Rev. Proc. 2004-53, 2004-34 I.R.B. 320, is
available at IRS.gov/irb/2004-34_IRB#RP-2004-53.
Terminating a business. If you terminate your business,
you must provide Forms W-2 to your employees for the
calendar year of termination by the due date of your final
Form 941, 944, or 941-SS. You also must file Forms W-2
with the SSA by the due date of your final Form 941, 944,
or 941-SS. If filing on paper, make sure you obtain Forms
W-2 and W-3 preprinted with the correct year. If e-filing,
make sure your software has been updated for the current
tax year.
However, if any of your employees are immediately
employed by a successor employer, see Successor/
predecessor employers above. Also, for information on
automatic extensions for furnishing Forms W-2 to
employees and filing Forms W-2, see Rev. Proc. 96-57,
which is on page 14 of Internal Revenue Bulletin 1996-53
at IRS.gov/pub/irs-irbs/irb96-53.pdf.
Get Schedule D (Form 941), Report of
TIP Discrepancies Caused by Acquisitions, Statutory
Mergers, or Consolidations, for information on
reconciling wages and taxes reported on Forms W-2 with
amounts reported on Forms 941, 941-SS, or 944.
Uniformed Services Employment and Reemployment
Rights Act of 1994 (USERRA) makeup amounts to a
pension plan. If an employee returned to your
employment after military service and certain makeup
amounts were contributed to a pension plan for a prior
year(s) under the USERRA, report the prior year
contributions separately in box 12. See the TIP above
Code D in Box 12—Codes. You also may report certain
makeup amounts in box 14. See Box 14—Other in
Specific Instructions for Form W-2.
Instead of reporting in box 12 (or box 14), you may
choose to provide a separate statement to your employee
showing USERRA makeup contributions. The statement
must identify the type of plan, the year(s) to which the
contributions relate, and the amount contributed for each
year.
Virtual currency. For federal tax purposes, virtual
currency is treated as property. Bitcoin is an example of
virtual currency. Transactions using virtual currency (such
as Bitcoin) must be reported in U.S. dollars.
The fair market value of virtual currency (such as
Bitcoin) paid as wages is subject to federal income tax
withholding, FICA tax, and FUTA tax and must be
reported on Form W-2. Notice 2014-21, 2014-16 I.R.B.
938 describes how virtual currency is treated for federal
tax purposes and is available at IRS.gov/irb/
2014-16_IRB#NOT-2014-21.
Penalties
The following penalties apply to the person or employer
required to file Form W-2. The penalties apply to both
paper filers and e-filers.
General Instructions for Forms W-2 and W-3 (2019)
Employers are responsible for ensuring that
Forms W-2 are furnished to employees and that
CAUTION Forms W-2 and W-3 are filed with the SSA
correctly and on time, even if the employer contracts with
a third party to perform these acts. The IRS strongly
suggests that the employer's address, not the third party's
address, be the address on record with the IRS. This will
ensure that you remain informed of tax matters involving
your business because the IRS will correspond to the
employer's address of record if there are any issues with
an account. If you choose to outsource any of your payroll
and related tax duties (that is, withholding, reporting, and
paying over social security, Medicare, FUTA, and income
taxes) to a third-party payer, go to IRS.gov/
OutsourcingPayrollDuties for helpful information on this
topic.
!
Failure to file correct information returns by the due
date. If you fail to file a correct Form W-2 by the due date
and cannot show reasonable cause, you may be subject
to a penalty as provided under section 6721. The penalty
applies if you:
• Fail to file timely,
• Fail to include all information required to be shown on
Form W-2,
• Include incorrect information on Form W-2,
• File on paper forms when you are required to e-file,
• Report an incorrect TIN,
• Fail to report a TIN, or
• Fail to file paper Forms W-2 that are machine readable.
The amount of the penalty is based on when you file
the correct Form W-2. Penalties are indexed for inflation.
The penalty amounts shown below apply for filings due
after December 31, 2019. The penalty is:
• $50 per Form W-2 if you correctly file within 30 days of
the due date; the maximum penalty is $556,500 per year
($194,500 for small businesses, defined in Small
businesses).
• $110 per Form W-2 if you correctly file more than 30
days after the due date but by August 1; the maximum
penalty is $1,669,500 per year ($556,500 for small
businesses).
• $270 per Form W-2 if you file after August 1, do not file
corrections, or do not file required Forms W-2; the
maximum penalty is $3,339,000 per year ($1,113,000 for
small businesses).
If you do not file corrections and you do not meet
any of the exceptions to the penalty, the penalty is
CAUTION $270 per information return. The maximum
penalty is $3,339,000 per year ($1,113,000 for small
businesses).
!
Exceptions to the penalty. The following are
exceptions to the failure to file correct information returns
penalty.
1. The penalty will not apply to any failure that you can
show was due to reasonable cause and not to willful
neglect. In general, you must be able to show that your
failure was due to an event beyond your control or due to
significant mitigating factors. You also must be able to
show that you acted in a responsible manner and took
steps to avoid the failure.
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The Payroll Source
2. An inconsequential error or omission is not
considered a failure to include correct information. An
inconsequential error or omission is an error that does not
prevent or hinder the SSA/IRS from processing the Form
W-2, from correlating the information required to be
shown on the form with the information shown on the
payee's tax return, or from otherwise putting the form to its
intended use. Errors and omissions that are never
inconsequential are those relating to:
• A TIN,
• A payee's surname, and
• Any money amounts.
3. De minimis rule for corrections. Even though you
cannot show reasonable cause, the penalty for failure to
file correct Forms W-2 will not apply to a certain number of
returns if you:
• Filed those Forms W-2 on or before the required filing
date,
• Either failed to include all of the information required on
the form or included incorrect information, and
• Filed corrections of these forms by August 1.
If you meet all of the de minimis rule conditions, the
penalty for filing incorrect information returns (including
Form W-2) will not apply to the greater of 10 information
returns (including Form W-2) or one-half of 1% of the total
number of information returns (including Form W-2) that
you are required to file for the calendar year.
4. Forms W-2 issued with incorrect dollar amounts
may fall under a safe harbor for certain de minimis errors.
The safe harbor generally applies if no single amount in
error differs from the correct amount by more than $100
and no single amount reported for tax withheld differs
from the correct amount by more than $25.
If the safe harbor applies, you will not have to correct
the Form W-2 to avoid penalties. However, if the payee
elects for the safe harbor not to apply, you may have to
issue a corrected return to avoid penalties. For more
information, see Notice 2017-9, 2017-4 I.R.B. 542,
available at IRS.gov/irb/2017-04_IRB#NOT-2017-09.
Small businesses. For purposes of the lower
maximum penalties shown in Failure to file correct
information returns by the due date, you are a small
business if your average annual gross receipts for the 3
most recent tax years (or for the period that you were in
existence, if shorter) ending before the calendar year in
which the Forms W-2 were due are $5 million or less.
Intentional disregard of filing requirements. If any
failure to timely file a correct Form W-2 is due to
intentional disregard of the filing or correct information
requirements, the penalty is at least $550 per Form W-2
with no maximum penalty.
Failure to furnish correct payee statements. If you fail
to provide correct payee statements (Forms W-2) to your
employees and cannot show reasonable cause, you may
be subject to a penalty as provided under section 6722.
The penalty applies if you fail to provide the statement by
January 31, 2020, if you fail to include all information
required to be shown on the statement, or if you include
incorrect information on the statement.
The amount of the penalty is based on when you
furnish the correct payee statement. This penalty is an
additional penalty and is applied in the same manner, and
with the same amounts, as in Failure to file correct
information returns by the due date.
Exceptions to the penalty. An inconsequential error
or omission is not considered a failure to include correct
information. An inconsequential error or omission is an
error that cannot reasonably be expected to prevent or
hinder the payee from timely receiving correct information
and reporting it on his or her income tax return or from
otherwise putting the statement to its intended use. Errors
and omissions that are never inconsequential are those
relating to:
• A dollar amount,
• A significant item in a payee's address, and
• The appropriate form for the information provided, such
as whether the form is an acceptable substitute for the
official IRS form.
See Exceptions to the penalty in Failure to file correct
information returns by the due date, for additional
exceptions to the penalty for failure to furnish correct
payee statements.
Intentional disregard of payee statement
requirements. If any failure to provide a correct payee
statement (Form W-2) to an employee is due to intentional
disregard of the requirements to furnish a correct payee
statement, the penalty is $550 per Form W-2 with no
maximum penalty.
Civil damages for fraudulent filing of Forms W-2. If
you willfully file a fraudulent Form W-2 for payments that
you claim you made to another person, that person may
be able to sue you for damages. If you are found liable,
you may have to pay $5,000 or more in damages. You
also may be subject to criminal sanctions.
Specific Instructions for Form W-2
How to complete Form W-2. Form W-2 is a multi-part
form. Ensure all copies are legible. Send Copy A to the
SSA; Copy 1, if required, to your state, city, or local tax
department; and Copies B, C, and 2 to your employee.
Keep Copy D, and a copy of Form W-3, with your records
for 4 years.
Enter the information on Form W-2 using black ink in
12-point Courier font. Copy A is read by machine and
must be typed clearly with no corrections made to the
entries and with no entries exceeding the size of the
boxes. Entries completed by hand, in script or italic fonts,
or in colors other than black cannot be read by the
machines. Make all dollar entries on Copy A without the
dollar sign and comma but with the decimal point
(00000.00). Show the cents portion of the money
amounts. If a box does not apply, leave it blank.
Send the whole Copy A page of Form W-2 with Form
W-3 to the SSA even if one of the Forms W-2 on the page
is blank or void. Do not staple Forms W-2 together or to
Form W-3. File Forms W-2 either alphabetically by
employees' last names or numerically by employees'
SSNs.
Also see the Caution in How To Get Forms and
Publications.
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General Instructions for Forms W-2 and W-3 (2019)
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Appendix
Calendar year basis. The entries on Form W-2 must be
based on wages paid during the calendar year. Use Form
W-2 for the correct tax year. For example, if the employee
worked from December 22, 2019, through January 4,
2020, and the wages for that period were paid on January
7, 2020, include those wages on the 2020 Form W-2.
Multiple forms. If necessary, you can issue more than
one Form W-2 to an employee. For example, you may
need to report more than four coded items in box 12 or
you may want to report other compensation on a second
form. If you issue a second Form W-2, complete boxes a,
b, c, d, e, and f with the same information as on the first
Form W-2. Show any items that were not included on the
first Form W-2 in the appropriate boxes.
Do not report the same federal, American Samoa,
CNMI, Guam, or U.S. Virgin Islands tax data to the SSA
on more than one Copy A.
For each Form W-2 showing an amount in box 3
TIP or box 7, make certain that box 5 equals or
exceeds the sum of boxes 3 and 7.
Void. Check this box when an error is made on Form W-2
and you are voiding it because you are going to complete
a new Form W-2. Do not include any amounts shown on
“Void” forms in the totals you enter on Form W-3. See
Corrections.
Box a—Employee's social security number. Enter the
number shown on the employee's social security card.
If the employee does not have a card, he or she should
apply for one by completing Form SS-5, Application for a
Social Security Card. The SSA lets you verify employee
names and SSNs online. For information about these free
services, visit the Employer W-2 Filing Instructions &
Information website at SSA.gov/employer. If you have
questions about using these services, call 800-772-6270
(toll free) to speak with an employer reporting technician
at the SSA.
If the employee has applied for a card but the number
is not received in time for filing, enter “Applied For” in box
a on paper Forms W-2 filed with the SSA. If e-filing, enter
zeros (000-00-0000 if creating forms online or 000000000
if uploading a file).
Ask the employee to inform you of the number and
name as they are shown on the social security card when
it is received. Then correct your previous report by filing
Form W-2c showing the employee's SSN. If the employee
needs to change his or her name from that shown on the
card, the employee should call the SSA at 800-772-1213.
If you do not provide the correct employee name and
SSN on Form W-2, you may owe a penalty unless you
have reasonable cause. For more information, see Pub.
1586, Reasonable Cause Regulations & Requirements for
Missing and Incorrect Name/TINs.
ITINs for aliens. Do not accept an ITIN in place of an
SSN for employee identification or for work. An ITIN is
only available to resident and nonresident aliens who are
not eligible for U.S. employment and need identification
for other tax purposes. You can identify an ITIN because it
is a 9-digit number formatted like an SSN beginning with
the number “9” and with a number in one of the following
General Instructions for Forms W-2 and W-3 (2019)
ranges in the fourth and fifth digit: 50–65, 70–88, 90–92,
and 94–99 (for example, 9NN-70-NNNN). An individual
with an ITIN who later becomes eligible to work in the
United States must obtain an SSN.
!
Do not auto-populate an ITIN into box a.
CAUTION
Box b—Employer identification number (EIN). Show
the EIN assigned to you by the IRS (00-0000000). This
should be the same number that you used on your federal
employment tax returns (Forms 941, 941-SS, 943, 944,
CT-1, or Schedule H (Form 1040)). Do not use a prior
owner's EIN. If you do not have an EIN when filing Forms
W-2, enter “Applied For” in box b; do not use your SSN.
You can get an EIN by applying online at IRS.gov/
Businesses/Small-Businesses-Self-Employed/Apply-foran-Employer-Identification-Number-EIN-Online, or by
filing Form SS-4, Application for Employer Identification
Number. Also see Agent reporting.
Box c—Employer's name, address, and ZIP code.
This entry should be the same as shown on your Forms
941, 941-SS, 943, 944, CT-1, or Schedule H (Form 1040).
The U.S. Postal Service recommends that no commas or
periods be used in return addresses. Also see Agent
reporting.
Box d—Control number. You may use this box to
identify individual Forms W-2. You do not have to use this
box.
Boxes e and f—Employee's name and address. Enter
the name as shown on your employee's social security
card (first name, middle initial, last name). If the name
does not fit in the space allowed on the form, you may
show the first and middle name initials and the full last
name. It is especially important to report the exact last
name of the employee. If you are unable to determine the
correct last name, use of the SSA's Social Security
Number Verification System may be helpful.
Separate parts of a compound name with either a
hyphen or a blank. Do not join them into a single word.
Include all parts of a compound name in the appropriate
name field. For example, for the name “John R
Smith-Jones,” enter “Smith-Jones” or “Smith Jones” in the
last name field.
If the name has changed, the employee must get a
corrected social security card from any SSA office. Use
the name on the original card until you see the corrected
card.
Do not show titles or academic degrees, such as “Dr.,”
“RN,” or “Esq.,” at the beginning or end of the employee's
name. Generally, do not enter “Jr.,” “Sr.,” or other suffix in
the “Suff.” box on Copy A unless the suffix appears on the
card. However, the SSA still prefers that you do not enter
the suffix on Copy A.
Include in the address the number, street, and
apartment or suite number (or P.O. box number if mail is
not delivered to a street address). The U.S. Postal Service
recommends that no commas or periods be used in
delivery addresses. For a foreign address, give the
information in the following order: city, province or state,
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The Payroll Source
and country. Follow the country's practice for entering the
postal code. Do not abbreviate the country name.
Box 1—Wages, tips, other compensation. Show the
total taxable wages, tips, and other compensation that you
paid to your employee during the year. However, do not
include elective deferrals (such as employee contributions
to a section 401(k) or 403(b) plan) except section 501(c)
(18) contributions. Include the following.
1. Total wages, bonuses (including signing bonuses),
prizes, and awards paid to employees during the year.
See Calendar year basis.
2. Total noncash payments, including certain fringe
benefits. See Fringe benefits.
3. Total tips reported by the employee to the employer
(not allocated tips).
4. Certain employee business expense
reimbursements. See Employee business expense
reimbursements.
5. The cost of accident and health insurance
premiums for 2%-or-more shareholder-employees paid by
an S corporation.
6. Taxable benefits from a section 125 (cafeteria) plan
if the employee chooses cash.
7. Employee contributions to an Archer MSA.
8. Employer contributions to an Archer MSA if
includible in the income of the employee. See Archer
MSA.
9. Employer contributions for qualified long-term care
services to the extent that such coverage is provided
through a flexible spending or similar arrangement.
10. Taxable cost of group-term life insurance in excess
of $50,000. See Group-term life insurance.
11. Unless excludable under Educational assistance
programs, payments for non-job-related education
expenses or for payments under a nonaccountable plan.
See Pub. 970.
12. The amount includible as wages because you paid
your employee's share of social security and Medicare
taxes (or railroad retirement taxes, if applicable). See
Employee's social security and Medicare taxes (or
railroad retirement taxes, if applicable) paid by employer.
If you also paid your employee's income tax withholding,
treat the grossed-up amount of that withholding as
supplemental wages and report those wages in boxes 1,
3, 5, and 7. (Use box 14 if railroad retirement taxes apply.)
No exceptions to this treatment apply to household or
agricultural wages.
13. Designated Roth contributions made under a
section 401(k) plan, a section 403(b) salary reduction
agreement, or a governmental section 457(b) plan. See
Designated Roth contributions.
14. Distributions to an employee or former employee
from an NQDC plan (including a rabbi trust) or a
nongovernmental section 457(b) plan.
15. Amounts includible in income under section 457(f)
because the amounts are no longer subject to a
substantial risk of forfeiture.
16. Payments to statutory employees who are subject
to social security and Medicare taxes but not subject to
federal income tax withholding must be shown in box 1 as
other compensation. See Statutory employee.
17. Cost of current insurance protection under a
compensatory split-dollar life insurance arrangement.
18. Employee contributions to a health savings account
(HSA).
19. Employer contributions to an HSA if includible in the
income of the employee. See Health savings account
(HSA).
20. Amounts includible in income under an NQDC plan
because of section 409A. See Nonqualified deferred
compensation plans under Special Reporting Situations
for Form W-2.
21. Nonqualified moving expenses and expense
reimbursements. See Moving expenses.
22. Payments made to former employees while they are
on active duty in the Armed Forces or other uniformed
services.
23. All other compensation, including certain
scholarship and fellowship grants. See Scholarship and
fellowship grants. Other compensation includes taxable
amounts that you paid to your employee from which
federal income tax was not withheld. You may show other
compensation on a separate Form W-2. See Multiple
forms.
Box 2—Federal income tax withheld. Show the total
federal income tax withheld from the employee's wages
for the year. Include the 20% excise tax withheld on
excess parachute payments. See Golden parachute
payments.
For Forms W-2AS, W-2CM, W-2GU, or W-2VI, show
the total American Samoa, CNMI, Guam, or U.S. Virgin
Islands income tax withheld.
Box 3—Social security wages. Show the total wages
paid (before payroll deductions) subject to employee
social security tax but not including social security tips and
allocated tips. If reporting these amounts in a subsequent
year (due to lapse of risk of forfeiture), the amount must
be adjusted by any gain or loss. See Box 7—Social
security tips and Box 8—Allocated tips. Generally,
noncash payments are considered to be wages. Include
employee business expense reimbursements and moving
expenses reported in box 1. If you paid the employee's
share of social security and Medicare taxes rather than
deducting them from wages, see Employee's social
security and Medicare taxes (or railroad retirement taxes,
if applicable) paid by employer. The total of boxes 3 and 7
cannot exceed $132,900 (2019 maximum social security
wage base).
Report in box 3 elective deferrals to certain qualified
cash or deferred compensation arrangements and to
retirement plans described in box 12 (codes D, E, F, G,
and S) even though the deferrals are not includible in
box 1. Also report in box 3 designated Roth contributions
made under a section 401(k) plan, under a section 403(b)
salary reduction agreement, or under a governmental
section 457(b) plan described in box 12 (codes AA, BB,
and EE).
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Appendix
Amounts deferred (plus earnings or less losses) under
a section 457(f) or nonqualified plan or nongovernmental
section 457(b) plan must be included in boxes 3 and/or 5
as social security and/or Medicare wages as of the later of
when the services giving rise to the deferral are performed
or when there is no substantial forfeiture risk of the rights
to the deferred amount. Include both elective and
nonelective deferrals for purposes of nongovernmental
section 457(b) plans.
Wages reported in box 3 also include:
• Signing bonuses an employer pays for signing or
ratifying an employment contract. See Rev. Rul.
2004-109, 2004-50 I.R.B. 958, available at IRS.gov/irb/
2004-50_IRB#RR-2004-109.
• Taxable cost of group-term life insurance over $50,000
included in box 1. See Group-term life insurance.
• Cost of accident and health insurance premiums for
2%-or-more shareholder-employees paid by an S
corporation, but only if not excludable under section
3121(a)(2)(B).
• Employee and nonexcludable employer contributions to
an MSA or HSA. However, do not include employee
contributions to an HSA that were made through a
cafeteria plan. See Archer MSA and Health savings
account (HSA).
• Employee contributions to a SIMPLE retirement
account. See SIMPLE retirement account.
• Adoption benefits. See Adoption benefits.
Box 4—Social security tax withheld. Show the total
employee social security tax (not your share) withheld,
including social security tax on tips. For 2019, the amount
should not exceed $8,239.80 ($132,900 × 6.2%). Include
only taxes withheld (or paid by you for the employee) for
2019 wages and tips. If you paid your employee's share,
see Employee's social security and Medicare taxes (or
railroad retirement taxes, if applicable) paid by employer.
Box 5—Medicare wages and tips. The wages and tips
subject to Medicare tax are the same as those subject to
social security tax (boxes 3 and 7) except that there is no
wage base limit for Medicare tax. Enter the total Medicare
wages and tips in box 5. Be sure to enter tips that the
employee reported even if you did not have enough
employee funds to collect the Medicare tax for those tips.
See Box 3—Social security wages, for payments to report
in this box. If you paid your employee's share of taxes, see
Employee's social security and Medicare taxes (or
railroad retirement taxes, if applicable) paid by employer.
If you are a federal, state, or local governmental agency
with employees paying only Medicare tax, enter the
Medicare wages in this box. See Government employers.
Example of how to report social security and
Medicare wages. You paid your employee $140,000 in
wages. Enter in box 3 (social security wages) 132900.00
but enter in box 5 (Medicare wages and tips) 140000.00.
There is no limit on the amount reported in box 5. If the
amount of wages paid was $132,900 or less, the amounts
entered in boxes 3 and 5 will be the same.
Box 6—Medicare tax withheld. Enter the total
employee Medicare tax (including any Additional
Medicare Tax) withheld. Do not include your share.
Include only tax withheld for 2019 wages and tips. If you
General Instructions for Forms W-2 and W-3 (2019)
paid your employee's share of the taxes, see Employee's
social security and Medicare taxes (or railroad retirement
taxes, if applicable) paid by employer.
For more information on Additional Medicare Tax, go to
IRS.gov/ADMT.
Box 7—Social security tips. Show the tips that the
employee reported to you even if you did not have enough
employee funds to collect the social security tax for the
tips. The total of boxes 3 and 7 should not be more than
$132,900 (the maximum social security wage base for
2019). Report all tips in box 1 along with wages and other
compensation. Include any tips reported in box 7 in box 5
also.
Box 8—Allocated tips (not applicable to Forms
W-2AS, W-2CM, W-2GU, or W-2VI). If you operate a
large food or beverage establishment, show the tips
allocated to the employee. See the Instructions for Form
8027, Employer's Annual Information Return of Tip
Income and Allocated Tips. Do not include this amount in
box 1, 3, 5, or 7.
Box 10—Dependent care benefits (not applicable to
Forms W-2AS, W-2CM, W-2GU, or W-2VI). Show the
total dependent care benefits under a dependent care
assistance program (section 129) paid or incurred by you
for your employee. Include the fair market value (FMV) of
care in a daycare facility provided or sponsored by you for
your employee and amounts paid or incurred for
dependent care assistance in a section 125 (cafeteria)
plan. Report all amounts paid or incurred (regardless of
any employee forfeitures), including those in excess of the
$5,000 exclusion. This may include (a) the FMV of
benefits provided in kind by the employer, (b) an amount
paid directly to a daycare facility by the employer or
reimbursed to the employee to subsidize the benefit, or (c)
benefits from the pre-tax contributions made by the
employee under a section 125 dependent care flexible
spending account. Include any amounts over $5,000 in
boxes 1, 3, and 5. For more information, see Pub. 15-B.
An employer that amends its cafeteria plan to
TIP provide a grace period for dependent care
assistance may continue to rely on Notice 89-111
by reporting in box 10 the salary reduction amount elected
by the employee for the year for dependent care
assistance (plus any employer matching contributions
attributable to dependent care). Also see Notice 2005-42,
2005-23 I.R.B. 1204, available at IRS.gov/irb/
2005-23_IRB#NOT-2005-42 and Notice 2005-61,
2005-39 I.R.B. 607, available at IRS.gov/node/
51071#NOT-2005-61.
Box 11—Nonqualified plans. The purpose of box 11 is
for the SSA to determine if any part of the amount
reported in box 1 or boxes 3 and/or 5 was earned in a
prior year. The SSA uses this information to verify that
they have properly applied the social security earnings
test and paid the correct amount of benefits.
Report distributions to an employee from a nonqualified
plan or nongovernmental section 457(b) plan in box 11.
Also report these distributions in box 1. Make only one
entry in this box. Distributions from governmental section
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The Payroll Source
457(b) plans must be reported on Form 1099-R, not in
box 1 of Form W-2.
Under nonqualified plans or nongovernmental 457(b)
plans, deferred amounts that are no longer subject to a
substantial risk of forfeiture are taxable even if not
distributed. Report these amounts in boxes 3 (up to the
social security wage base) and 5. Do not report in box 11
deferrals included in boxes 3 and/or 5 and deferrals for
current year services (such as those with no risk of
forfeiture).
If you made distributions and also are reporting
any deferrals in boxes 3 and/or 5, do not complete
CAUTION box 11. See Pub. 957, Reporting Back Pay and
Special Wage Payments to the Social Security
Administration, and Form SSA-131, Employer Report of
Special Wage Payments, for instructions on reporting
these and other kinds of compensation earned in prior
years. However, do not file Form SSA-131 if this
situation applies and the employee was not 61 years
old or more during the tax year for which you are
filing Form W-2.
!
Unlike qualified plans, NQDC plans do not meet the
qualification requirements for tax-favored status for this
purpose. NQDC plans include those arrangements
traditionally viewed as deferring the receipt of current
compensation. Accordingly, welfare benefit plans, stock
option plans, and plans providing dismissal pay,
termination pay, or early retirement pay generally are not
NQDC plans.
Report distributions from NQDC or section 457 plans to
beneficiaries of deceased employees on Form
1099-MISC, not on Form W-2.
Military employers must report military retirement
payments on Form 1099-R.
Do not report special wage payments, such as
TIP accumulated sick pay or vacation pay, in box 11.
For more information on reporting special wage
payments, see Pub. 957.
Box 12—Codes. Complete and code this box for all
items described below. Note that the codes do not relate
to where they should be entered in boxes 12a through 12d
on Form W-2. For example, if you are only required to
report code D in box 12, you can enter code D and the
amount in box 12a of Form W-2. Report in box 12 any
items that are listed as codes A through HH. Do not report
in box 12 section 414(h)(2) contributions (relating to
certain state or local government plans). Instead, use
box 14 for these items and any other information that you
wish to give to your employee. For example, union dues
and uniform payments may be reported in box 14.
On Copy A (Form W-2), do not enter more
TIP than four items in box 12. If more than four
items need to be reported in box 12, use a
separate Form W-2 to report the additional items (but
enter no more than four items on each Copy A (Form
W-2)). On all other copies of Form W-2 (Copies B, C,
etc.), you may enter more than four items in box 12 when
using an approved substitute Form W-2. See Multiple
forms.
Use the IRS code designated below for the item you
are entering, followed by the dollar amount for that item.
Even if only one item is entered, you must use the IRS
code designated for that item. Enter the code using a
capital letter(s). Use decimal points but not dollar signs or
commas. For example, if you are reporting $5,300.00 in
elective deferrals under a section 401(k) plan, the entry
would be D 5300.00 (not A 5300.00 even though it is the
first or only entry in this box). Report the IRS code to the
left of the vertical line in boxes 12a through 12d and the
money amount to the right of the vertical line.
See the Form W-2 Reference Guide for Box 12 Codes.
The detailed instructions for each code are next.
Code A—Uncollected social security or RRTA tax
on tips. Show the employee social security or Railroad
Retirement Tax Act (RRTA) tax on all of the employee's
tips that you could not collect because the employee did
not have enough funds from which to deduct it. Do not
include this amount in box 4.
Code B—Uncollected Medicare tax on tips. Show
the employee Medicare tax or RRTA Medicare tax on tips
that you could not collect because the employee did not
have enough funds from which to deduct it. Do not show
any uncollected Additional Medicare Tax. Do not include
this amount in box 6.
Code C—Taxable cost of group-term life insurance
over $50,000. Show the taxable cost of group-term life
insurance coverage over $50,000 provided to your
employee (including a former employee). See Group-term
life insurance. Also include this amount in boxes 1, 3 (up
to the social security wage base), and 5. Include the
amount in box 14 if you are a railroad employer.
Codes D through H, S, Y, AA, BB, and EE. Use
these codes to show elective deferrals and designated
Roth contributions made to the plans listed. Do not report
amounts for other types of plans. See the example for
reporting elective deferrals under a section 401(k) plan,
later.
The amount reported as elective deferrals and
designated Roth contributions is only the part of the
employee's salary (or other compensation) that he or she
did not receive because of the deferrals or designated
Roth contributions. Only elective deferrals and designated
Roth contributions should be reported in box 12 for all
coded plans; except, when using code G for section
457(b) plans, include both elective and nonelective
deferrals.
For employees who were 50 years of age or older at
any time during the year and made elective deferral
and/or designated Roth “catch-up” contributions, report
the elective deferrals and the elective deferral “catch-up”
contributions as a single sum in box 12 using the
appropriate code, and the designated Roth contributions
and designated Roth “catch-up” contributions as a single
sum in box 12 using the appropriate code.
If any elective deferrals, salary reduction amounts,
TIP or nonelective contributions under a section
457(b) plan during the year are makeup amounts
under the Uniformed Services Employment and
Reemployment Rights Act of 1994 (USERRA) for a prior
year, you must enter the prior year contributions
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Appendix
separately. Beginning with the earliest year, enter the
code, the year, and the amount. For example, elective
deferrals of $2,250 for 2017 and $1,250 for 2018 under
USERRA under a section 401(k) plan are reported in
box 12 as follows:
D 17 2250.00, D 18 1250.00. A 2019 contribution of
$7,000 does not require a year designation; enter it as D
7000.00. Report the code (and year for prior year
USERRA contributions) to the left of the vertical line in
boxes 12a through 12d.
The following are not elective deferrals and may be
reported in box 14, but not in box 12.
• Nonelective employer contributions made on behalf of
an employee.
• After-tax contributions that are not designated Roth
contributions, such as voluntary contributions to a pension
plan that are deducted from an employee's pay. See the
box 12 instructions for Code AA—Designated Roth
contributions under a section 401(k) plan, Code
BB—Designated Roth contributions under a section
403(b) plan, and Code EE—Designated Roth
contributions under a governmental section 457(b) plan
for reporting designated Roth contributions.
• Required employee contributions.
• Employer matching contributions.
Code D—Elective deferrals under a section 401(k)
cash or deferred arrangement (plan). Also show
deferrals under a SIMPLE retirement account that is part
of a section 401(k) arrangement.
Example of reporting excess elective deferrals
and designated Roth contributions under a section
401(k) plan. For 2019, Employee A (age 45) elected to
defer $21,500 under a section 401(k) plan. The employee
also made a designated Roth contribution to the plan of
$1,000, and made a voluntary (non-Roth) after-tax
contribution of $600. In addition, the employer, on A's
behalf, made a qualified nonelective contribution of
$2,000 to the plan and a nonelective profit-sharing
employer contribution of $3,000.
Even though the 2019 limit for elective deferrals and
designated Roth contributions is $19,000, the employee's
total elective deferral amount of $21,500 is reported in
box 12 with code D (D 21500.00). The designated Roth
contribution is reported in box 12 with code AA (AA
1000.00). The employer must separately report the actual
amounts of $21,500 and $1,000 in box 12 with the
appropriate codes. The amount deferred in excess of the
limit is not reported in box 1. The return of excess elective
deferrals and excess designated Roth contributions,
including earnings on both, is reported on Form 1099-R.
The $600 voluntary after-tax contribution may be
reported in box 14 (this is optional) but not in box 12. The
$2,000 qualified nonelective contribution and the $3,000
nonelective profit-sharing employer contribution are not
required to be reported on Form W-2, but may be reported
in box 14.
Check the “Retirement plan” box in box 13.
Code E—Elective deferrals under a section 403(b)
salary reduction agreement.
Code F—Elective deferrals under a section 408(k)
(6) salary reduction SEP.
General Instructions for Forms W-2 and W-3 (2019)
Code G—Elective deferrals and employer
contributions (including nonelective deferrals) to
any governmental or nongovernmental section
457(b) deferred compensation plan. Do not report
either section 457(b) or section 457(f) amounts that are
subject to a substantial risk of forfeiture.
Code H—Elective deferrals under section 501(c)
(18)(D) tax-exempt organization plan. Be sure to
include this amount in box 1 as wages. The employee will
deduct the amount on his or her Form 1040.
Code J—Nontaxable sick pay. Show any sick pay
that was paid by a third party and was not includible in
income (and not shown in boxes 1, 3, and 5) because the
employee contributed to the sick pay plan. Do not include
nontaxable disability payments made directly by a state.
Code K—20% excise tax on excess golden
parachute payments (not applicable to Forms
W-2AS, W-2CM, W-2GU, or W-2VI). If you made excess
golden parachute payments to certain key corporate
employees, report the 20% excise tax on these payments.
If the excess payments are considered to be wages,
report the 20% excise tax withheld as income tax withheld
in box 2.
Code L—Substantiated employee business
expense reimbursements. Use this code only if you
reimbursed your employee for employee business
expenses using a per diem or mileage allowance and the
amount that you reimbursed exceeds the amount treated
as substantiated under IRS rules. See Employee business
expense reimbursements.
Report in box 12 only the amount treated as
substantiated (such as the nontaxable part). Include in
boxes 1, 3 (up to the social security wage base), and 5 the
part of the reimbursement that is more than the amount
treated as substantiated. Report the unsubstantiated
amounts in box 14 if you are a railroad employer.
Code M—Uncollected social security or RRTA tax
on taxable cost of group-term life insurance over
$50,000 (for former employees). If you provided your
former employees (including retirees) more than $50,000
of group-term life insurance coverage for periods during
which an employment relationship no longer exists, enter
the amount of uncollected social security or RRTA tax on
the coverage in box 12. Do not include this amount in
box 4. Also see Group-term life insurance.
Code N—Uncollected Medicare tax on taxable cost
of group-term life insurance over $50,000 (for former
employees). If you provided your former employees
(including retirees) more than $50,000 of group-term life
insurance coverage for periods during which an
employment relationship no longer exists, enter the
amount of uncollected Medicare tax or RRTA Medicare
tax on the coverage in box 12. Do not show any
uncollected Additional Medicare Tax. Do not include this
amount in box 6. Also see Group-term life insurance.
Code P—Excludable moving expense
reimbursements paid directly to a member of the
U.S. Armed Forces. The exclusion for qualified moving
expense reimbursements applies only to members of the
U.S. Armed Forces on active duty who move pursuant to
a military order and incident to a permanent change of
station.
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The Payroll Source
Show the total moving expense reimbursements that
you paid directly to your employee for qualified (allowable)
moving expenses. See Moving expenses.
Code Q—Nontaxable combat pay. If you are a
military employer, report any nontaxable combat pay in
box 12.
Code R—Employer contributions to an Archer
MSA. Show any employer contributions to an Archer
MSA. See Archer MSA.
Code S—Employee salary reduction contributions
under a section 408(p) SIMPLE plan. Show deferrals
under a section 408(p) salary reduction SIMPLE
retirement account. However, if the SIMPLE plan is part of
a section 401(k) arrangement, use code D. If you are
reporting prior year contributions under USERRA, see the
TIP above Code D in Box 12—Codes.
Code T—Adoption benefits. Show the total that you
paid or reimbursed for qualified adoption expenses
furnished to your employee under an adoption assistance
program. Also include adoption benefits paid or
reimbursed from the pre-tax contributions made by the
employee under a section 125 (cafeteria) plan. However,
do not include adoption benefits forfeited from a section
125 (cafeteria) plan. Report all amounts including those in
excess of the $14,080 exclusion. For more information,
see Adoption benefits.
Code V—Income from the exercise of nonstatutory
stock option(s). Show the spread (that is, the fair market
value of stock over the exercise price of option(s) granted
to your employee with respect to that stock) from your
employee's (or former employee's) exercise of
nonstatutory stock option(s). Include this amount in boxes
1, 3 (up to the social security wage base), and 5. If you are
a railroad employer, do not include this amount in box 14
for railroad employees covered by RRTA. See For
employees covered by RRTA tax, above.
This reporting requirement does not apply to the
exercise of a statutory stock option, or the sale or
disposition of stock acquired pursuant to the exercise of a
statutory stock option. For more information about the
taxability of employee stock options, see Pub. 15-B.
Code W—Employer contributions to a health
savings account (HSA). Show any employer
contributions (including amounts the employee elected to
contribute using a section 125 (cafeteria) plan) to an HSA.
See Health savings account (HSA).
Code Y—Deferrals under a section 409A
nonqualified deferred compensation plan. It is not
necessary to show deferrals in box 12 with code Y. For
more information, see Notice 2008-115. However, if you
report these deferrals, show current year deferrals,
including earnings during the year on current year and
prior year deferrals. See Nonqualified deferred
compensation plans under Special Reporting Situations
for Form W-2.
Code Z—Income under a nonqualified deferred
compensation plan that fails to satisfy section 409A.
Enter all amounts deferred (including earnings on
amounts deferred) that are includible in income under
section 409A because the NQDC plan fails to satisfy the
requirements of section 409A. Do not include amounts
properly reported on a Form 1099-MISC, corrected Form
1099-MISC, Form W-2, or Form W-2c for a prior year.
Also, do not include amounts that are considered to be
subject to a substantial risk of forfeiture for purposes of
section 409A. For more information, see Regulations
sections 1.409A-1, -2, -3, and -6; and Notice 2008-115.
The amount reported in box 12 using code Z also is
reported in box 1 and is subject to an additional tax
reported on the employee's Form 1040. See Nonqualified
deferred compensation plans under Special Reporting
Situations for Form W-2.
For information regarding correcting section 409A
errors and related reporting, see Notice 2008-113, Notice
2010-6, and Notice 2010-80.
Code AA—Designated Roth contributions under a
section 401(k) plan. Use this code to report designated
Roth contributions under a section 401(k) plan. Do not
use this code to report elective deferrals under code D.
See Designated Roth contributions.
Code BB—Designated Roth contributions under a
section 403(b) plan. Use this code to report designated
Roth contributions under a section 403(b) plan. Do not
use this code to report elective deferrals under code E.
See Designated Roth contributions.
Code DD—Cost of employer-sponsored health
coverage. Use this code to report the cost of
employer-sponsored health coverage. The amount
reported with code DD is not taxable. Additional
reporting guidance, including information about the
transitional reporting rules that apply, is available on
IRS.gov at Affordable Care Act (ACA) Tax Provisions.
Code EE—Designated Roth contributions under a
governmental section 457(b) plan. Use this code to
report designated Roth contributions under a
governmental section 457(b) plan. Do not use this code to
report elective deferrals under code G. See Designated
Roth contributions.
Code FF—Permitted benefits under a qualified
small employer health reimbursement arrangement.
Use this code to report the total amount of permitted
benefits under a QSEHRA. The maximum reimbursement
for an eligible employee under a QSEHRA for 2019 is
$5,150 ($10,450 if it also provides reimbursements for
family members).
Report the amount of payments and reimbursements
the employee is entitled to receive under the QSEHRA for
the calendar year, not the amount the employee actually
receives. For example, a QSEHRA provides a permitted
benefit of $3,000. If the employee receives
reimbursements of $2,000, report a permitted benefit of
$3,000 in box 12 with code FF.
If your QSEHRA provides benefits that vary based on
the number of family members covered under the
arrangement or their ages and an eligible employee
receives no payments or reimbursements and provides no
proof of minimum essential coverage (MEC), report the
highest value permitted benefits that the QSEHRA
provides. If the employee later provides proof of MEC
establishing eligibility for a lesser value permitted benefit,
report this lesser value permitted benefit on Form W-2.
Do not include carryover amounts from prior years in
the permitted benefit.
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Appendix
You may need to calculate a prorated permitted benefit
under some circumstances.
• If your QSEHRA provides a permitted benefit prorated
by month for employees not eligible for the full year, report
the prorated permitted benefit. For example, a QSEHRA
provides a permitted benefit of $3,000 prorated by the
number of months the employee is eligible. If an employee
becomes eligible on May 1, the employee’s permitted
benefit is $2,000 ($3,000 x 8/12) for the calendar year.
The employer reports the permitted benefit of $2,000 for
that employee in box 12 using code FF.
• If your QSEHRA is not based on a calendar year,
prorate the permitted benefit for each part of the
QSEHRA’s plan year that falls within the calendar year.
Report the sum of the prorated permitted benefits for the
two portions of the calendar year. For example, a
non-calendar year QSEHRA has a plan year that begins
on April 1 and ends on March 31 of the following year.
From April 1, 2018 through March 31, 2019, the QSEHRA
provides a permitted benefit of $2,000. From April 1, 2019
through March 31, 2020, the QSEHRA provides a
permitted benefit of $3,000. The employer reports a
permitted benefit of $2,750 (($2,000 x 3/12) + ($3,000 x
9/12)) for calendar year 2019.
You also may have to follow special reporting rules for
certain taxable reimbursements.
• If an employee who failed to have MEC for one or more
months during the year mistakenly received
reimbursements for expenses incurred in one of those
months, those reimbursements are taxable to the
employee. Report the taxable reimbursement as other
compensation in box 1, but not in boxes 3 or 5. The
taxable reimbursements are not wages for income, social
security, or Medicare tax, so do not withhold these taxes.
Report the permitted benefit that you would have reported
for the employee as though there was no failure to have
MEC. If you discover the lapse in MEC after filing with the
SSA, furnish the employee a correction on Form W-2c
and file the Form W-2c with the SSA.
• If your QSEHRA provides for taxable reimbursements
of either (a) over-the-counter drugs bought without a
prescription, or (b) premiums paid on a pre-tax basis for
coverage under a group health plan sponsored by the
employer of the employee’s spouse, include the amount
of the taxable reimbursements in boxes 1, 3, and 5 and
treat as wages for purposes of income, social security,
and Medicare taxes. Report the permitted benefit the
employee is entitled to receive under the QSEHRA for the
calendar year in box 12 using code FF. Although a part of
the permitted benefit is a taxable reimbursement, that
does not change the amount you report in box 12 with
code FF.
For more details on reporting the total amount of
QSEHRA permitted benefits, see Notice 2017-67, Q and
A 57 through 63, 2017-47 I.R.B. 517 at IRS.gov/irb/
2017-47_IRB#NOT-2017-67.
Code GG—Income from qualified equity grants
under section 83(i). Report the amount includible in
gross income from qualified equity grants under section
83(i)(1)(A) for the calendar year. See Qualified equity
grants under section 83(i) for more information.
Code HH—Aggregate deferrals under section 83(i)
elections as of the close of the calendar year. Report
General Instructions for Forms W-2 and W-3 (2019)
the aggregate amount of income deferred under section
83(i) elections as of the close of the calendar year.
Box 13—Checkboxes. Check all boxes that apply.
Statutory employee. Check this box for statutory
employees whose earnings are subject to social security
and Medicare taxes but not subject to federal income tax
withholding. Do not check this box for common-law
employees. There are workers who are independent
contractors under the common-law rules but are treated
by statute as employees. They are called statutory
employees.
1. A driver who distributes beverages (other than milk)
or meat, vegetable, fruit, or bakery products; or who picks
up and delivers laundry or dry cleaning, if the driver is your
agent or is paid on commission.
2. A full-time life insurance sales agent whose
principal business activity is selling life insurance or
annuity contracts, or both, primarily for one life insurance
company.
3. An individual who works at home on materials or
goods that you supply and that must be returned to you or
to a person you name, if you also furnish specifications for
the work to be done.
4. A full-time traveling or city salesperson who works
on your behalf and turns in orders to you from
wholesalers, retailers, contractors, or operators of hotels,
restaurants, or other similar establishments. The goods
sold must be merchandise for resale or supplies for use in
the buyer's business operation. The work performed for
you must be the salesperson's principal business activity.
For details on statutory employees and common-law
employees, see section 1 in Pub. 15-A.
Retirement plan. Check this box if the employee was
an “active participant” (for any part of the year) in any of
the following.
1. A qualified pension, profit-sharing, or stock-bonus
plan described in section 401(a) (including a 401(k) plan).
2. An annuity plan described in section 403(a).
3. An annuity contract or custodial account described
in section 403(b).
4. A simplified employee pension (SEP) plan
described in section 408(k).
5. A SIMPLE retirement account described in section
408(p).
6. A trust described in section 501(c)(18).
7. A plan for federal, state, or local government
employees or by an agency or instrumentality thereof
(other than a section 457(b) plan).
Generally, an employee is an active participant if
covered by (a) a defined benefit plan for any tax year that
he or she is eligible to participate in or (b) a defined
contribution plan (for example, a section 401(k) plan) for
any tax year that employer or employee contributions (or
forfeitures) are added to his or her account. For additional
information on employees who are eligible to participate in
a plan, contact your plan administrator. For details on the
active participant rules, see Notice 87-16, 1987-1 C.B.
446; Notice 98-49, 1998-2 C.B. 365; section 219(g)(5);
and Pub. 590-A, Contributions to Individual Retirement
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The Payroll Source
Arrangements (IRAs). You can find Notice 98-49 on
page 5 of Internal Revenue Bulletin 1998-38 at IRS.gov/
pub/irs-irbs/irb98-38.pdf.
Do not check this box for contributions made to a
TIP nonqualified or section 457(b) plan.
See the Form W-2 Box 13 Retirement Plan Checkbox
Decision Chart.
Third-party sick pay. Check this box only if you are a
third-party sick pay payer filing a Form W-2 for an
insured's employee or are an employer reporting sick pay
payments made by a third party. See section 6 of Pub.
15-A.
Box 14—Other. If you included 100% of a vehicle's
annual lease value in the employee's income, it also must
be reported here or on a separate statement to your
employee.
You also may use this box for any other information that
you want to give to your employee. Label each item.
Examples include state disability insurance taxes
withheld, union dues, uniform payments, health insurance
premiums deducted, nontaxable income, educational
assistance payments, or a minister's parsonage
allowance and utilities. In addition, you may enter the
following contributions to a pension plan: (a) nonelective
employer contributions made on behalf of an employee,
(b) voluntary after-tax contributions (but not designated
Roth contributions) that are deducted from an employee's
pay, (c) required employee contributions, and (d)
employer matching contributions.
If you are reporting prior year contributions under
USERRA (see the TIP above Code D in Box 12—Codes
and Uniformed Services Employment and Reemployment
Rights Act of 1994 (USERRA) makeup amounts to a
pension plan), you may report in box 14 makeup amounts
for nonelective employer contributions, voluntary after-tax
contributions, required employee contributions, and
employer matching contributions. Report such amounts
separately for each year.
Railroad employers, see Railroad employers for
amounts reportable in box 14.
Boxes 15 through 20—State and local income tax information (not applicable to Forms W-2AS, W-2CM,
W-2GU, or W-2VI). Use these boxes to report state and
local income tax information. Enter the two-letter
abbreviation for the name of the state. The employer's
state ID numbers are assigned by the individual states.
The state and local information boxes can be used to
report wages and taxes for two states and two localities.
Keep each state's and locality's information separated by
the broken line. If you need to report information for more
than two states or localities, prepare a second Form W-2.
See Multiple forms. Contact your state or locality for
specific reporting information.
Federal employers reporting income taxes paid to the
CNMI under the 5517 agreement, enter the employer’s
identification number in box 15. Enter the employee’s
CNMI wages in box 16. Enter the income taxes paid to the
CNMI in box 17. See Federal employers in the CNMI,
earlier, for more information.
Specific Instructions for Form W-3
How to complete Form W-3. The instructions under
How to complete Form W-2 generally apply to Form W-3.
Use black ink for all entries. Scanners cannot read entries
if the type is too light. Be sure to send the entire page of
the Form W-3.
Amounts reported on related employment tax
TIP forms (for example, Forms W-2, 941, 941-SS,
943, or 944) should agree with the amounts
reported on Form W-3. If there are differences, you may
be contacted by the IRS and SSA. Retain your
reconciliation information for future reference. See
Reconciling Forms W-2, W-3, 941, 941-SS, 943, 944,
CT-1, and Schedule H (Form 1040).
Box a—Control number. This is an optional box that
you may use for numbering the whole transmittal.
Box b—Kind of Payer. Check the box that applies to
you. Check only one box. If you have more than one type
of Form W-2, send each type with a separate Form W-3.
Note. The “Third-party sick pay” indicator box does not
designate a separate kind of payer.
941. Check this box if you file Forms 941 or 941-SS
and no other category applies. A church or church
organization should check this box even if it is not
required to file Forms 941, 941-SS, or 944. If you are a
railroad employer sending Forms W-2 for employees
covered under the Railroad Retirement Tax Act (RRTA),
check the “CT-1” box.
Military. Check this box if you are a military employer
sending Forms W-2 for members of the uniformed
services.
943. Check this box if you are an agricultural employer
and file Form 943 and you are sending Forms W-2 for
agricultural employees. For nonagricultural employees,
send their Forms W-2 with a separate Form W-3,
checking the appropriate box.
944. Check this box if you file Form 944 (or Formulario
944(SP), its Spanish-language version), and no other
category applies.
CT-1. Check this box if you are a railroad employer
sending Forms W-2 for employees covered under the
RRTA. Do not show employee RRTA tax in boxes 3
through 7. These boxes are only for social security and
Medicare information. If you also have employees who
are subject to social security and Medicare taxes, send
that group's Forms W-2 with a separate Form W-3 and
check the “941” checkbox on that Form W-3.
Hshld. emp. Check this box if you are a household
employer sending Forms W-2 for household employees
and you did not include the household employee's taxes
on Forms 941, 941-SS, 943, or 944.
Medicare govt. emp. Check this box if you are a U.S.,
state, or local agency filing Forms W-2 for employees
subject only to Medicare tax. See Government employers.
Box b—Kind of Employer. Check the box that applies
to you. Check only one box unless the second checked
box is “Third-party sick pay.” See Pub. 557, Tax-Exempt
Status for Your Organization, for information about 501(c)
(3) tax-exempt organizations.
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General Instructions for Forms W-2 and W-3 (2019)
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Appendix
None apply. Check this box if none of the checkboxes
discussed next apply to you.
501c non-govt. Check this box if you are a
non-governmental tax-exempt section 501(c)
organization. Types of 501(c) non-governmental
organizations include private foundations, public charities,
social and recreation clubs, and veterans organizations.
For additional examples of 501(c) non-governmental
organizations, see chapters 3 and 4 of Pub. 557.
State/local non-501c. Check this box if you are a state
or local government or instrumentality. This includes
cities, townships, counties, special-purpose districts,
public school districts, or other publicly owned entities
with governmental authority.
State/local 501c. Check this box if you are a state or
local government or instrumentality, and you have
received a determination letter from the IRS indicating that
you also are a tax-exempt organization under section
501(c)(3).
Federal govt. Check this box if you are a federal
government entity or instrumentality.
Box b—Third-party sick pay. Check this box if you are
a third-party sick pay payer (or are reporting sick pay
payments made by a third party) filing Forms W-2 with the
“Third-party sick pay” checkbox in box 13 checked. File a
single Form W-3 for the regular and “Third-party sick pay”
Forms W-2. See 941.
Box c—Total number of Forms W-2. Show the number
of completed individual Forms W-2 that you are
transmitting with this Form W-3. Do not count “Void”
Forms W-2.
Box d—Establishment number. You may use this box
to identify separate establishments in your business. You
may file a separate Form W-3, with Forms W-2, for each
establishment even if they all have the same EIN; or you
may use a single Form W-3 for all Forms W-2 of the same
type.
Box e—Employer identification number (EIN). Enter
the nine-digit EIN assigned to you by the IRS. The number
should be the same as shown on your Forms 941,
941-SS, 943, 944, CT-1, or Schedule H (Form 1040) and
in the following format: 00-0000000. Do not use a prior
owner's EIN. See Box h—Other EIN used this year.
If you do not have an EIN when filing your Form W-3,
enter “Applied For” in box e, not your social security
number (SSN), and see Box b—Employer identification
number (EIN).
Box f—Employer's name. Enter the same name as
shown on your Forms 941, 941-SS, 943, 944, CT-1, or
Schedule H (Form 1040).
Box g—Employer's address and ZIP code. Enter your
address.
Box h—Other EIN used this year. If you have used an
EIN (including a prior owner's EIN) on Forms 941,
941-SS, 943, 944, or CT-1 submitted for 2019 that is
different from the EIN reported on Form W-3 in box e,
enter the other EIN used. Agents generally report the
employer's EIN in box h. See Agent reporting.
General Instructions for Forms W-2 and W-3 (2019)
Employer's contact person, Employer's telephone
number, Employer's fax number, and Employer's
email address. Include this information for use by the
SSA if any questions arise during processing. SSA will
notify the employer by email or postal mail to correct and
resubmit reports from the information provided on Form
W-3.
!
CAUTION
Payroll service providers enter your client's
information for these fields.
The amounts to enter in boxes 1 through 19,
TIP described next, are totals from only the Forms
W-2 (excluding any Forms W-2 marked “Void”)
that you are sending with this Form W-3.
Boxes 1 through 8. Enter the totals reported in boxes 1
through 8 on the Forms W-2.
Box 9. Do not enter an amount in box 9.
Box 10—Dependent care benefits (not applicable to
Forms W-2AS, W-2CM, W-2GU, and W-2VI). Enter the
total reported in box 10 on Forms W-2.
Box 11—Nonqualified plans. Enter the total reported in
box 11 on Forms W-2.
Box 12a—Deferred compensation. Enter the total of all
amounts reported with codes D through H, S, Y, AA, BB,
and EE in box 12 on Forms W-2. Do not enter a code.
The total of Form W-2 box 12 amounts reported
with codes A through C, J through R, T through
CAUTION W, Z, DD, FF, GG, and HH is not reported on
Form W-3.
!
Box 13—For third-party sick pay use only. Leave this
box blank. See Form 8922.
Box 14—Income tax withheld by payer of third-party
sick pay. Complete this box only if you are the employer
and have employees who had federal income tax withheld
on third-party payments of sick pay. Show the total
income tax withheld by third-party payers on payments to
all of your employees. Although this tax is included in the
box 2 total, it must be separately shown here.
Box 15—State/Employer's state ID number (territorial
ID number for Forms W-2AS, W-2CM, W-2GU, and
W-2VI). Enter the two-letter abbreviation for the name of
the state or territory being reported on Form(s) W-2. Also
enter your state- or territory-assigned ID number. If the
Forms W-2 being submitted with this Form W-3 contain
wage and income tax information from more than one
state or territory, enter an “X” under “State” and do not
enter any state or territory ID number.
Federal employers reporting income taxes paid to the
CNMI under the 5517 agreement, enter the employer’s
identification number in box 15. See Federal employers in
the CNMI, earlier, for more information.
Boxes 16 through 19 (not applicable to Forms
W-2AS, W-2CM, W-2GU, and W-2VI). Enter the total of
state/local wages and income tax shown in their
corresponding boxes on the Forms W-2 included with this
Form W-3. If the Forms W-2 show amounts from more
than one state or locality, report them as one sum in the
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The Payroll Source
appropriate box on Form W-3. Verify that the amount
reported in each box is an accurate total of the Forms
W-2.
Federal employers reporting income taxes paid to the
CNMI under the 5517 agreement, enter the total of CNMI
wages on the Forms W-2 in box 16. Enter the total of
income taxes shown on the Forms W-2 paid to the CNMI
in box 17. See Federal employers in the CNMI, earlier, for
more information.
Reconciling Forms W-2, W-3, 941, 941-SS, 943,
944, CT-1, and Schedule H (Form 1040)
Reconcile the amounts shown in boxes 2, 3, 5, and 7 from
all 2019 Forms W-3 with their respective amounts from
the 2019 yearly totals from the quarterly Forms 941 or
941-SS or annual Forms 943, 944, CT-1 (box 2 only), and
Schedule H (Form 1040). When there are discrepancies
between amounts reported on Forms W-2 and W-3 filed
with the SSA and on Forms 941, 941-SS, 943, 944, CT-1,
or Schedule H (Form 1040) filed with the IRS, you will be
contacted to resolve the discrepancies.
!
To help reduce discrepancies on Forms W-2:
CAUTION
• Report bonuses as wages and as social security and
Medicare wages on Form W-2, and on Forms 941,
941-SS, 943, 944, and Schedule H (Form 1040).
• Report both social security and Medicare wages and
taxes separately on Forms W-2 and W-3, and on Forms
941, 941-SS, 943, 944, and Schedule H (Form 1040).
• Report social security taxes withheld on Form W-2 in
box 4, not in box 3.
• Report Medicare taxes withheld on Form W-2 in box 6,
not in box 5.
• Do not report a nonzero amount in box 4 if boxes 3 and
7 are both zero.
• Do not report a nonzero amount in box 6 if box 5 is
zero.
• Do not report an amount in box 5 that is less than the
sum of boxes 3 and 7.
• Make sure that the social security wage amount for
each employee does not exceed the annual social
security wage base limit ($132,900 for 2019).
• Do not report noncash wages that are not subject to
social security or Medicare taxes as social security or
Medicare wages.
• If you use an EIN on any quarterly Forms 941 or 941-SS
for the year (or annual Forms 943, 944, CT-1, or
Schedule H (Form 1040)) that is different from the EIN
reported in box e on Form W-3, enter the other EIN in box
h on Form W-3.
To reduce the discrepancies between amounts
reported on Forms W-2 and W-3, and Forms 941,
941-SS, 943, 944, CT-1, and Schedule H (Form 1040):
• Be sure that the amounts on Form W-3 are the total
amounts from Forms W-2.
• Reconcile Form W-3 with your four quarterly Forms 941
or 941-SS (or annual Forms 943, 944, CT-1, or
Schedule H (Form 1040)) by comparing amounts reported
for:
1. Income tax withholding (box 2).
2. Social security wages, Medicare wages and tips,
and social security tips (boxes 3, 5, and 7). Form W-3
should include Forms 941 or 941-SS or Forms 943, 944,
or Schedule H (Form 1040) adjustments only for the
current year. If the Forms 941, 941-SS, 943, or 944
adjustments include amounts for a prior year, do not
report those prior year adjustments on the current year
Forms W-2 and W-3.
3. Social security and Medicare taxes (boxes 4 and 6).
The amounts shown on the four quarterly Forms 941 or
941-SS (or annual Forms 943, 944, or Schedule H (Form
1040)), including current year adjustments, should be
approximately twice the amounts shown on Form W-3.
Amounts reported on Forms W-2 and W-3, and Forms
941, 941-SS, 943, 944, CT-1, or Schedule H (Form 1040)
may not match for valid reasons. If they do not match, you
should determine that the reasons are valid. Retain your
reconciliation information in case you receive inquiries
from the IRS or the SSA.
General Instructions for Forms W-2c
and W-3c
Applicable forms. Use with the current version of Form
W-2c and the current version of Form W-3c.
Purpose of forms. Use Form W-2c to correct errors on
Forms W-2, W-2AS, W-2CM, W-2GU, W-2VI, or W-2c
filed with the SSA. Also use Form W-2c to provide
corrected Forms W-2, W-2AS, W-2CM, W-2GU, W-2VI,
or W-2c to employees.
Corrections reported on Form W-2c may require you to
make corrections to your previously filed employment tax
returns using the corresponding “X” form, such as Form
941-X, Adjusted Employer's QUARTERLY Federal Tax
Return or Claim for Refund; Form 943-X, Adjusted
Employer's Annual Federal Tax Return for Agricultural
Employees or Claim for Refund; Form 944-X, Adjusted
Employer's ANNUAL Federal Tax Return or Claim for
Refund; or Form CT-1X, Adjusted Employer's Annual
Railroad Retirement Tax Return or Claim for Refund. See
section 13 of Pub. 15 (Circular E) and the Instructions for
Form CT-1X for more information. If you are making
corrections to a previously filed Schedule H (Form 1040),
see Pub. 926, Household Employer's Tax Guide. If an
employee repaid you for wages received in a prior year,
also see Repayments.
Do not use Form W-2c to report corrections to back
pay. Instead, see Pub. 957, Reporting Back Pay and
Special Wage Payments to the Social Security
Administration, and Form SSA-131, Employer Report of
Special Wage Payments.
Do not use Form W-2c to correct Form W-2G, Certain
Gambling Winnings. Instead, see the General Instructions
for Certain Information Returns for the current reporting
year.
Use Form W-3c to send Copy A of Form W-2c to the
SSA. Always file Form W-3c when submitting one or more
Forms W-2c.
E-filing Forms W-2c and W-3c. The SSA encourages
all employers to e-file using its secure BSO website.
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General Instructions for Forms W-2 and W-3 (2019)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
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Appendix
E-filing can save you effort and helps ensure accuracy.
See E-filing.
Where to file paper Forms W-2c and W-3c. If you use
the U.S. Postal Service, send Forms W-2c and W-3c to:
Social Security Administration
Direct 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:
Social Security Administration
Direct Operations Center
Attn: W-2c Process
1150 E. Mountain Drive
Wilkes-Barre, PA 18702-7997
Go to IRS.gov/PDS for a list of IRS-designated private
delivery services.
Do not send Forms W-2, W-2AS, W-2CM,
TIP W-2GU, or W-2VI to either of these addresses.
W-3.
Instead, see Where to file paper Forms W-2 and
When to file. File Forms W-2c and W-3c as soon as
possible after you discover an error. Also provide Form
W-2c to employees as soon as possible.
How to complete. If you file Forms W-2c and W-3c on
paper, make all entries using dark or black ink in 12-point
Courier font, if possible, and make sure all copies are
legible. See How to complete Form W-2.
If any item shows a change in the dollar amount and
one of the amounts is zero, enter “-0-.” Do not leave the
box blank.
Who may sign Form W-3c. Generally, employers must
sign Form W-3c. See Who may sign Form W-3.
Special Situations for Forms W-2c
and W-3c
Undeliverable Forms W-2c. See Undeliverable Forms
W-2.
Correcting Forms W-2 and W-3
Corrections. Use the current version of Form W-2c to
correct errors (such as incorrect name, SSN, or amount)
on a previously filed Form W-2 or Form W-2c. File Copy A
of Form W-2c with the SSA. To e-file your corrections, see
Correcting wage reports.
If the SSA issues your employee a replacement card
after a name change, or a new card with a different social
security number after a change in alien work status, file a
Form W-2c to correct the name/SSN reported on the most
recently filed Form W-2. It is not necessary to correct the
prior years if the previous name and number were used
for the years prior to the most recently filed Form W-2.
File Form W-3c whenever you file a Form W-2c with the
SSA, even if you are only filing a Form W-2c to correct an
General Instructions for Forms W-2 and W-3 (2019)
employee's name or SSN. However, see Employee's
incorrect address on Form W-2, later, for information on
correcting an employee's address. See Correcting an
incorrect tax year and/or EIN incorrectly reported on Form
W-2 or Form W-3, later, if an error was made on a
previously filed Form W-3.
If you discover an error on Form W-2 after you issue it
to your employee but before you send it to the SSA, check
the “Void” box at the top of the incorrect Form W-2 on
Copy A. Prepare a new Form W-2 with the correct
information, and send Copy A to the SSA. Write
“CORRECTED” on the employee's new copies (B, C, and
2), and furnish them to the employee. If the “Void” Form
W-2 is on a page with a correct Form W-2, send the entire
page to the SSA. The “Void” form will not be processed.
Do not write “CORRECTED” on Copy A of Form W-2.
If you are making a correction for previously filed Forms
941, 941-SS, 943, 944, or CT-1, use the corresponding
“X” forms, such as Forms 941-X, 943-X, 944-X, or CT-1X
for the return period in which you found the error. See
section 13 of Pub. 15 (Circular E) and the Instructions for
Form CT-1X for more details. If you are making
corrections to a previously filed Schedule H (Form 1040),
see Pub. 926. Issue the employee a Form W-2c if the
error discovered was for the prior year and Form W-2 was
filed with the SSA.
Correcting an employee's name and/or SSN only. If
you are correcting only an employee's name and/or SSN,
complete Form W-2c boxes d through i. Do not complete
boxes 1 through 20. Advise your employee to correct the
SSN and/or name on his or her original Form W-2.
If your employee is given a new social security card
following an adjustment to his or her resident status that
shows a different name or SSN, file a Form W-2c for the
most current year only.
Correcting an employee's name and SSN if the SSN
was reported as blanks or zeros and the employee
name was reported as blanks. If you need to correct an
employee's name and SSN, and the SSN was reported as
blanks or zeros and the employee's name was reported
as blanks, do not use Form W-2c to report the corrections.
You must contact the SSA at 800-772-6270 for
instructions.
Correcting an incorrect tax year and/or EIN incorrectly reported on Form W-2 or Form W-3. To correct an
incorrect tax year and/or EIN on a previously submitted
Form W-2 or Form W-3, you must prepare two sets of
Forms W-2c and W-3c.
• Prepare one Form W-3c along with a Form W-2c for
each affected employee. On the Form W-3c, enter the
incorrect tax year in box a, and the incorrect EIN originally
reported in box h. Enter in the “Previously reported” boxes
the money amounts that were on the original Form W-2. In
the “Correct information” boxes, enter zeros.
• Prepare a second Form W-3c along with a second
Form W-2c for each affected employee. On the Form
W-3c, enter the correct tax year in box a and/or the
correct EIN in box e. Enter zeros in the “Previously
reported” boxes, and enter the correct money amounts in
the “Correct information” boxes.
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The Payroll Source
Correcting more than one Form W-2 for an employee.
There are two ways to prepare a correction for an
employee for whom more than one Form W-2 was filed
under the same EIN for the tax year. You can (1) consider
all the Forms W-2 when determining the amounts to enter
on Form W-2c or (2) file a single Form W-2c to correct
only the incorrect Form W-2.
However, state, local, and federal government
employers who are preparing corrections for Medicare
Qualified Government Employment (MQGE) employees
also must follow the instructions in the Caution for state,
local, and federal government employers in the Specific
Instructions for Form W-2c.
Correcting more than one kind of form. You must use
a separate Form W-3c for each type of Form W-2 (Forms
W-2, W-2AS, W-2CM, W-2GU, W-2VI, or W-2c) being
corrected. You also must use a separate Form W-3c for
each kind of payer/employer combination in box c. If you
are correcting more than one kind of form, please group
forms of the same kind of payer/employer combination,
and send them in separate groups.
Employee's incorrect address on Form W-2. If you
filed a Form W-2 with the SSA that reported an incorrect
address for the employee, but all other information on the
Form W-2 was correct, do not file Form W-2c with the
SSA merely to correct the address.
However, if the address was incorrect on the Form W-2
furnished to the employee, you must do one of the
following.
• Issue a new, corrected Form W-2 to the employee that
includes the new address. Indicate “REISSUED
STATEMENT” on the new copies. Do not send Copy A of
Form W-2 to the SSA.
• Issue a Form W-2c to the employee that shows the
correct address in box i and all other correct information.
Do not send Copy A of Form W-2c to the SSA.
• Reissue the Form W-2 with the incorrect address to the
employee in an envelope showing the correct address or
otherwise deliver it to the employee.
Two Forms W-2 were filed under the same EIN, but
only one should have been filed.
Example. Two Forms W-2 were submitted for Mary
Smith under the same EIN for the same tax year. One
Form W-2 correctly reported social security wages of
$20,000. The other Form W-2 incorrectly reported social
security wages of $30,000. There are two ways to correct
this situation.
• File a Form W-3c along with one Form W-2c, entering
$50,000 in box 3 under “Previously reported” and $20,000
in box 3 under “Correct information,” or
• File a Form W-3c along with one Form W-2c, entering
$30,000 in box 3 under “Previously reported” and $0.00 in
box 3 under “Correct information.”
Two Forms W-2 were filed under the same EIN, but
wages on one were incorrect.
Example. Two Forms W-2 were submitted for Mary
Smith under the same EIN for the same tax year. One
Form W-2 correctly reported social security wages of
$20,000. The other Form W-2 incorrectly reported social
security wages of $30,000, whereas $25,000 should have
been reported. There are two ways to correct this
situation.
• File a Form W-3c along with one Form W-2c, entering
$50,000 in box 3 under “Previously reported” and $45,000
in box 3 under “Correct information,” or
• File a Form W-3c along with one Form W-2c, entering
$30,000 in box 3 under “Previously reported” and $25,000
in box 3 under “Correct information.”
Specific Instructions for Form W-2c
Box a—Employer's name, address, and ZIP code.
This entry should be the same as shown on your Forms
941, 941-SS, 943, 944, CT-1, or Schedule H (Form 1040).
Box b—Employer's Federal EIN. Show the correct nine
digit EIN assigned to you by the IRS in the format
00-0000000.
Box c—Tax year/Form corrected. If you are correcting
Form W-2, enter all four digits of the year of the form you
are correcting. If you are correcting Form W-2AS, W-2CM,
W-2GU, W-2VI, or W-2c, enter all four digits of the year
you are correcting, and also enter “AS,” “CM,” “GU,” “VI,”
or “c” to designate the form you are correcting. For
example, “2017” and “GU” shows that you are correcting a
2017 Form W-2GU.
Box d—Employee's correct SSN. You must enter the
employee's correct SSN even if it was correct on the
original Form W-2. If you are correcting an employee's
SSN, you also must complete boxes e through i.
Box e—Corrected SSN and/or name. Check this box
only if you are correcting the employee’s SSN, name, or
both SSN and name. You also must complete boxes d
and f through i.
Box f—Employee's previously reported SSN.
Complete this box if you are correcting an employee’s
previously reported incorrect SSN and/or name. If the
previous SSN was reported as blanks or not available,
then box f should be all zeroes.
Box g—Employee's previously reported name.
Complete this box if you are correcting an employee’s
previously reported incorrect SSN and/or name. You must
enter the employee’s previously reported full name in box
g exactly as it was previously reported. If the previous
reported name was reported as blanks or not available,
then box g should be all blanks.
For boxes f and g, if both the previous SSN and
the previous name were reported as blanks, do
CAUTION not use Form W-2c. Contact the SSA at
800-772-6270.
!
Box h—Employee's first name and initial, Last name,
Suff. Always enter the employee's correct name. See
Boxes e and f—Employee's name and address for name
formatting information.
Box i—Employee's address and ZIP code. Always
enter the employee’s correct address. See Boxes e and
f—Employee's name and address for address formatting
information.
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Appendix
!
CAUTION
“Retirement plan” checkbox in box 13 under “Correct
information.”
You must enter the employee's full name in boxes
g and h.
Boxes 1 through 20. For the items you are changing,
enter under “Previously reported” the amount reported on
the original Form W-2 or the amount reported on a
previously filed Form W-2c. Enter the correct amount
under “Correct information.”
Do not make an entry in any of these boxes on Copy A
unless you are making a change. However, see the
Caution for state, local, or federal government employers
below.
Box 14. Use this box to correct items reported in box 14
of the original Form W-2 or on a prior Form W-2c. If
possible, complete box 14 on Copies B, C, 1, and 2 of
Form W-2c only, not on Copy A.
Boxes 15 through 20—State/local taxes. If your only
changes to the original Form W-2 are to state or local
data, do not send Copy A of Form W-2c to the SSA.
Instead, send Form W-2c to the appropriate state or local
agency and furnish copies to your employees.
Box 2—Federal income tax withheld. Use this box only
to make corrections because of an administrative error.
(An administrative error occurs only if the amount you
entered in box 2 of the incorrect Form W-2 was not the
amount you actually withheld.) If you are correcting Forms
W-2AS, W-2CM, W-2GU, or W-2VI, box 2 is for income
tax withheld for the applicable U.S. possession.
Boxes 5 and 6. Complete these boxes to correct
Medicare wages and tips and Medicare tax withheld.
(Exception—do not correct Additional Medicare Tax
withheld unless you need to correct an administrative
error. An administrative error occurs only if the amount
you entered in box 6 of the incorrect Form W-2 is not the
amount you actually withheld.) State, local, or federal
government employers also should use these boxes to
correct MQGE wages. Box 5 must equal or exceed the
sum of boxes 3 and 7.
A state, local, or federal government employer
correcting only social security wages and/or social
CAUTION security tips (boxes 3 and/or 7) for an MQGE
employee also must complete Medicare wages and tips in
box 5. Enter the total Medicare wages and tips, including
MQGE-only wages, even if there is no change to the total
Medicare wages and tips previously reported.
!
Boxes 8, 10, and 11. Use these boxes to correct
allocated tips, dependent care benefits, or deferrals and
distributions relating to nonqualified plans.
Box 12—Codes. Complete these boxes to correct any of
the coded items shown on Forms W-2. Examples include
uncollected social security and/or Medicare taxes on tips,
taxable cost of group-term life insurance coverage over
$50,000, elective deferrals (codes D through H, S, Y, AA,
BB, and EE), sick pay not includible as income, and
employee business expenses. See Box 12—Codes in
Specific Instructions for Form W-2 for the proper format to
use in reporting coded items from box 12 of Forms W-2.
Employers should enter both the code and dollar
amount for both fields on Form W-2c.
If a single Form W-2c does not provide enough blank
spaces for corrections, use additional Forms W-2c.
Box 13. Check the boxes in box 13, under “Previously
reported,” as they were checked on the original Form
W-2. Under “Correct information,” check them as they
should have been checked. For example, if you checked
the “Retirement plan” box on the original Form W-2 by
mistake, check the “Retirement plan” checkbox in box 13
under “Previously reported,” but do not check the
General Instructions for Forms W-2 and W-3 (2019)
Correcting state information. Contact your state or
locality for specific reporting information.
Specific Instructions for Form W-3c
Do not staple or tape the Forms W-2c to Form W-3c or to
each other. File a separate Form W-3c for each tax year,
for each type of form, and for each kind of payer/employer
combination. (The “Third-party sick pay” indicator box
does not designate a separate kind of payer or employer.)
Make a copy of Form W-3c for your records.
In the money boxes of Form W-3c, total the amounts
from each box and column on the Forms W-2c you are
sending.
Box a—Tax year/Form corrected. Enter all four digits
of the year of the form you are correcting and the type of
form you are correcting. For the type of form, enter “2,”
“2AS,” “2CM,” “2GU,” “2VI,” “2c,” “3,” “3SS,” or “3c.” For
example, entering “2017” and “2” indicates that all the
forms being corrected are 2017 Forms W-2.
Box b—Employer's name, address, and ZIP code.
This should be the same as shown on your Forms 941,
941-SS, 943, 944, CT-1, or Schedule H (Form 1040).
Include the suite, room, or other unit number after the
street address. If the post office does not deliver mail to
the street address and you use a P.O. box, show the P.O.
box number instead of the street address.
The IRS will not use Form W-3c to update your
TIP address of record. If you wish to change your
address, file Form 8822 or Form 8822-B.
Box c—Kind of Payer. Check the box that applies to
you. Check only one box. If your previous Form W-3 or
Form W-3SS was checked incorrectly, report your prior
incorrect payer type in the “Explain decreases here” area
below boxes 18 and 19.
941/941-SS. Check this box if you file Form 941 or
Form 941-SS. If you are a railroad employer sending
Forms W-2c for employees covered under the RRTA,
check the “CT-1” checkbox.
Military. Check this box if you are a military employer
correcting Forms W-2 for members of the uniformed
services.
943. Check this box if you file Form 943 and you are
correcting Forms W-2 for agricultural employees. For
nonagricultural employees, send Forms W-2c with a
separate Form W-3c, generally with the 941/941-SS box
checked.
944. Check this box if you file Form 944.
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The Payroll Source
CT-1. Check this box if you are a railroad employer
correcting Forms W-2 for employees covered under the
RRTA. If you also have to correct forms of employees who
are subject to social security and Medicare taxes,
complete a separate Form W-3c with the “941/941-SS”
box or “944” box checked instead.
Hshld. emp. Check this box if you are a household
employer correcting Forms W-2 for household employees
and you file Schedule H (Form 1040). If you also have to
correct forms of employees who are not household
employees, complete a separate Form W-3c.
Medicare govt. emp. Check this box if you are a U.S.,
state, or local agency filing corrections for employees
subject only to Medicare taxes.
Box c—Kind of Employer. Check the box that applies
to you. Check only one box. If your previous Form W-3 or
W-3SS was checked incorrectly, report your prior
incorrect employer type in the “Explain decreases here”
area below boxes 18 and 19.
None apply. Check this box if none of the checkboxes
described next apply to you.
501c non-govt. Check this box if you are a
non-governmental tax-exempt 501(c) organization. Types
of 501(c) non-governmental organizations include private
foundations, public charities, social and recreation clubs,
and veterans organizations. For additional examples of
501(c) non-governmental organizations, see chapters 3
and 4 of Pub. 557, Tax-Exempt Status for Your
Organization.
State/local non-501c. Check this box if you are a state
or local government or instrumentality. This includes
cities, townships, counties, special-purpose districts,
public school districts, or other publicly owned entities
with governmental authority.
State/local 501c. Check this box if you are a state or
local government or instrumentality, and you have
received a determination letter from the IRS indicating that
you are also a tax-exempt organization under section
501(c)(3).
Federal govt. Check this box if you are a federal
government entity or instrumentality.
Box c—Third-party sick pay. Check this box if you are
a third-party sick pay payer (or are reporting sick pay
payments made by a third party) correcting Forms W-2
with the “Third-party sick pay” checkbox in box 13 of Form
W-2c under “Correct information” checked. File a
separate Form W-3c for each payer/employer
combination reporting “Third-party sick pay” on Form
W-2c.
each establishment or you may use a single Form W-3c
for all Forms W-2c. You do not have to complete this item;
it is optional.
Box g—Employer's state ID number. You are not
required to complete this box. This number is assigned by
the individual state where your business is located.
However, you may want to complete this item if you use
copies of this form for your state returns.
Box h—Employer's originally reported Federal EIN.
Your correct number must appear in box e. Make an entry
here only if the number on the original form was incorrect.
Box i—Incorrect establishment number. You may use
this box to correct an establishment number.
Box j—Employer's incorrect state ID number. Use
this box to make any corrections to your previously
reported state ID number.
Boxes 1 through 8, 10, and 11. Enter the total of
amounts reported in boxes 1 through 8, 10, and 11 as
“Previously reported” and “Correct information” from
Forms W-2c.
Box 12a—Deferred compensation. Enter the total of
amounts reported with codes D through H, S, Y, AA, BB,
and EE as “Previously reported” and “Correct information”
from Forms W-2c.
The total of Form W-2c box 12 amounts reported
with codes A through C, J through R, T through
CAUTION W, Z, DD, FF, GG, and HH is not reported on
Form W-3c.
!
Box 14—Inc. tax w/h by third-party sick pay payer.
Enter the amount previously reported and the corrected
amount of income tax withheld on third-party payments of
sick pay. Although this tax is included in the box 2
amounts, it must be shown separately here.
Boxes 16 through 19. If your only changes to the Forms
W-2c and W-3c are to the state and local data, do not
send either Copy A of Form W-2c or Form W-3c to the
SSA. Instead, send the forms to the appropriate state or
local agency and furnish copies of Form W-2c to your
employees.
Explain decreases here. Explain any decrease to
amounts “Previously reported.” Also report here any
previous incorrect entry in box c, “Kind of Payer” or “Kind
of Employer.” Enclose (but do not attach) additional
sheets explaining your decreases, if necessary. Include
your name and EIN on any additional sheets.
Box d—Number of Forms W-2c. Show the number of
individual Forms W-2c filed with this Form W-3c or enter
“-0-” if you are correcting only a previously filed Form W-3
or Form W-3SS.
Signature. Sign and date the form. Also enter your title
and employer's contact person, employer's telephone
number, employer's fax number, and employer's email
address, if available. If you are not the employer, see Who
may sign Form W-3.
Box f—Establishment number. You may use this box
to identify separate establishments in your business. You
may file a separate Form W-3c, with Forms W-2c, for
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
Box e—Employer's Federal EIN. Enter the correct
number assigned to you by the IRS in the following format:
00-0000000. If you are correcting your EIN, enter the
originally reported federal EIN you used in box h.
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General Instructions for Forms W-2 and W-3 (2019)
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Appendix
Service. Section 6109 requires you to provide your
employer identification number (EIN). Failure to provide
this information in a timely manner 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;
Form W-3—28 minutes; Form W-2c—40 minutes; Form
W-3c—51 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 send us comments from IRS.gov/
FormComments. Or you can write to the Internal Revenue
Service, Tax Forms and Publications Division, 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 W-2 and W-3.
Form W-2 Reference Guide for Box 12 Codes
A
Uncollected social security or RRTA tax on tips
L
Substantiated employee business expense
reimbursements
Y
Deferrals under a section 409A nonqualified
deferred compensation plan
B
Uncollected Medicare tax on tips (but not
Additional Medicare Tax)
M
Uncollected social security or RRTA tax on
taxable cost of group-term life insurance over
$50,000 (former employees only)
Z
Income under a nonqualified deferred
compensation plan that fails to satisfy
section 409A
C
Taxable cost of group-term life insurance over
$50,000
N
Uncollected Medicare tax on taxable cost of
group-term life insurance over $50,000 (but not
Additional Medicare Tax) (former employees
only)
AA
Designated Roth contributions under a
section 401(k) plan
D
Elective deferrals under a section 401(k) cash
or deferred arrangement plan (including a
SIMPLE 401(k) arrangement)
P
Excludable moving expense reimbursements
paid directly to members of the Armed Forces
BB
Designated Roth contributions under a
section 403(b) plan
E
Elective deferrals under a section 403(b) salary
reduction agreement
Q
Nontaxable combat pay
DD
Cost of employer-sponsored health
coverage
F
Elective deferrals under a section 408(k)(6)
salary reduction SEP
R
Employer contributions to an Archer MSA
EE
Designated Roth contributions under a
governmental section 457(b) plan
G
Elective deferrals and employer contributions
(including nonelective deferrals) to a section
457(b) deferred compensation plan
S
Employee salary reduction contributions under
a section 408(p) SIMPLE plan
FF
Permitted benefits under a qualified small
employer health reimbursement
arrangement
H
Elective deferrals to a section 501(c)(18)(D)
tax-exempt organization plan
T
Adoption benefits
GG
Income from qualified equity grants under
section 83(i)
J
Nontaxable sick pay
V
Income from exercise of nonstatutory stock
option(s)
HH
Aggregate deferrals under section 83(i)
elections as of the close of the calendar year
K
20% excise tax on excess golden parachute
payments
W
Employer contributions (including employee
contributions through a cafeteria plan) to an
employee's health savings account (HSA)
See Box 12 Codes.
General Instructions for Forms W-2 and W-3 (2019)
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The Payroll Source
Form W-2 Box 13 Retirement Plan Checkbox Decision Chart
Type of Plan
Conditions
Check Retirement Plan Box?
Defined benefit plan (for example, a traditional pension
plan)
Employee qualifies for employer funding into the plan,
due to age/years of service—even though the
employee may not be vested or ever collect benefits
Yes
Defined contribution plan (for example, a 401(k) or
403(b) plan, a Roth 401(k) or 403(b) account, but not a
457 plan)
Employee is eligible to contribute but does not elect to
contribute any money in this tax year
No
Defined contribution plan (for example, a 401(k) or
403(b) plan, a Roth 401(k) or 403(b) account, but not a
457 plan)
Employee is eligible to contribute and elects to
contribute money in this tax year
Yes
Defined contribution plan (for example, a 401(k) or
403(b) plan, a Roth 401(k) or 403(b) account, but not a
457 plan)
Employee is eligible to contribute but does not elect to Yes
contribute any money in this tax year, but the employer
does contribute funds
Defined contribution plan (for example, a 401(k) or
403(b) plan, a Roth 401(k) or 403(b) account, but not a
457 plan)
Employee contributed in past years but not during the
current tax year under report
No (even if the account value grows due to gains in the
investments)
Profit-sharing plan
Plan includes a grace period after the close of the plan
year when profit sharing can be added to the
participant's account
Yes, unless the employer contribution is purely
discretionary and no contribution is made by end of
plan year
See Box 13 Checkboxes.
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General Instructions for Forms W-2 and W-3 (2019)
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Appendix
Nonqualified Deferred Compensation Reporting Example Chart
Example
How to report on Form W-2
Example 1—Deferral, immediately vested (no risk of forfeiture).
Regular wages: $200
Defer, vested: $20
Employer match, vested: $10
Box 1 = $180 ($200 – $20)
Boxes 3 and 5 = $210 ($200 + $10)
Box 11 = $0
Example 2—Deferral, delayed vesting (risk of forfeiture) of employee and employer
portions.
Regular wages: $200
Defer, not vested: $20
Employer match, not vested: $10
Box 1 = $180 ($200 – $20)
Boxes 3 and 5 = $180 ($200 – $20)
Box 11 = $0
Example 3—Deferral, immediately vested. Prior year deferrals and employer
matches are now vesting.
Regular wages: $200
Defer, vested: $20
Vesting of prior-year deferrals and employer matches: $100 + $15 (earnings on
$100)
Box 1 = $180 ($200 – $20)
Boxes 3 and 5 = $315 ($200 + $100 + $15)
Box 11 = $115 ($100 + $15)
Example 4—No deferrals, but there are distributions. No vesting of prior year
deferrals.
Regular wages: $100
Distribution: $50
Box 1 = $150 ($100 + $50)
Boxes 3 and 5 = $100
Box 11 = $50
Special Rule for W-2 Box 11: Distributions and Deferrals in the Same Year—Form
SSA-131
If, in the same year, there are NQDC distributions and deferrals that are reportable
in boxes 3 and/or 5 (current or prior year deferrals), do not complete box 11.
Instead, report on Form SSA-131 the total amount the employee earned during the
year. Generally, the amount earned by the employee during the tax year for
purposes of item 6 of Form SSA-131 is the amount reported in box 1 of Form W-2
plus current year deferrals that are vested (employee and employer portions) less
distributions. Do not consider prior-year deferrals that are vesting in the current
year. If there was a plan failure, the box 1 amount in this calculation should be as if
there were no plan failure. Submit the Form SSA-131 to the nearest SSA office or
give it to the employee.
Example 5—Deferral, immediately vested, and distributions. No vesting of prior
year deferrals.
Regular wages: $200
Defer, vested: $20
Employer match, vested: $10
Distribution: $50
Box 1 = $230 ($200 – $20 + $50)
Boxes 3 and 5 = $210 ($200 + $10)
Box 11 = $0
Example 6—Deferral, delayed vesting, and distributions. No vesting of prior year
deferrals.
Regular wages: $200
Defer, not vested: $20
Distribution: $50
Box 1 = $230 ($200 – $20 + $50)
Boxes 3 and 5 = $180 ($200 – $20)
Box 11 = $50
Example 7—Deferral, immediately vested, and distributions. Prior-year deferrals
and employer matches are now vesting.
Regular wages: $200
Defer, vested: $20
Distribution: $50
Vesting of prior-year deferrals and employer matches: $100 + $15 (earnings on
$100)
Box 1 = $230 ($200 – $20 + $50)
Boxes 3 and 5 = $315 ($200 + $100 + $15)
Box 11 = $0
Example 8—Deferral, delayed vesting, and distributions. Prior-year deferrals and
employer matches are now vesting.
Regular wages: $200
Defer, not vested: $20
Distribution: $50
Vesting of prior-year deferrals and employer matches: $100 + $15 (earnings on
$100)
Box 1 = $230 ($200 – $20 + $50)
Boxes 3 and 5 = $295 ($200 – $20 + $100 + $15)
Box 11 = $0
Form SSA-131 = $210 ($230 (box 1) – $50 (distribution) + $30 (vested employee
and employer deferrals))
Form SSA-131 = $200 ($230 (box 1) – $50 (distribution) + $20 (vested deferral))
Form SSA-131 = $180 ($230 (box 1) – $50 (distribution))
See Nonqualified deferred compensation plans.
General Instructions for Forms W-2 and W-3 (2019)
-31-
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The Payroll Source
Nonqualified Deferred Compensation Reporting Example Chart—(Continued)
Example
How to report on Form W-2
Special Rule for Payment of Social Security, Medicare, and Unemployment Taxes
Estimated Method
Under the estimated method, an employer may treat a reasonably estimated
amount as wages paid on the last day of the calendar year (the “first year”). If the
employer underestimates the amount deferred and, thereby, underdeposits social
security, Medicare, or FUTA taxes, it can choose to treat the shortfall as wages
either in the first year or the first quarter of the next year. The shortfall does not
include income credited to the amount deferred after the first year. Conversely, if
the amount deferred is overestimated, the employer can claim a refund or credit. If
the employer chooses to treat the shortfall as wages in the first year, the employer
must issue a Form W-2c. Also, the employer must correct the information on the
Form 941 for the last quarter of the first year. In such a case, the shortfall will not be
treated as a late deposit subject to penalty if it is deposited by the employer's first
regular deposit date following the first quarter of the next year.
If the amount cannot be reasonably ascertained (the employer is unable to
calculate an amount for a year by December 31), the employer can use two
methods. For example, immediately vested employer contributions to NQDC made
late in the year would have no effect on Form W-2, box 1, but they would affect
FICA and FUTA taxes.
Lag Method
Under the lag method, an employer may calculate the end-of-the-year amount on
any date in the first quarter of the next calendar year. The amount deferred will be
treated as wages on that date, and the amount deferred that would otherwise have
been taken into account on the last day of the first year must be increased by
income earned on that amount through the date on which the amount is taken into
account.
Section 409A NQDC Plan Failure
Example 9—Deferral, immediately vested. No distributions. Plan failure.
Plan balance on January 1, 2010: $325, vested
Regular wages: $100
Defer, vested: $50
Employer match, vested: $25
Plan failure in 2010.
Box 12, code Z = $400
• Amount in the plan account on December 31, 2010, not subject to risk of
forfeiture and not included in prior-year income: $400 ($325 + $50 + $25)
• Current-year distribution: $0
• $400 ($0 + $400)
Box 1 = $450 ($100 – $50 + $400)
Boxes 3 and 5 = $125 ($100 + $25)
Box 11 = $0
Form SSA-131 = not required
Section 409A NQDC Plan Failure
Example 10—Deferral, some delayed vesting, and distributions. Plan failure.
Plan balance on January 1, 2010: $250 vested; $75 not vested
Regular wages: $100
Defer, vested: $50
Employer match, not vested: $25
Distribution: $200
Plan failure in 2010.
Vesting of prior-year deferrals and employer matches: $0
Box 12, code Z = $300
• Amount in the plan account on December 31, 2010, not subject to risk of
forfeiture and not included in prior-year income: $100 ($250 + $50 – $200)
• Current-year distribution: $200
• $100 + $200 = $300
Box 1 = $350 ($100 – $50 + $300 (code Z amount, which already includes the
distribution))
Boxes 3 and 5 = $100
Box 11 = $0
Form SSA-131 = $100 ($250 (what box 1 would have been without plan failure) –
$200 (distribution) + $50 (vested deferral))
See Nonqualified deferred compensation plans.
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A-108
General Instructions for Forms W-2 and W-3 (2019)
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Appendix
Index
501(c) non-governmental organizations 23, 28
A
Additional Medicare Tax withheld 2, 10, 12, 17–19
Adoption benefits 7, 17, 20
Agent reporting 7
Agricultural employers 9, 22, 27
Allocated tips 17
American Samoa 6
Archer MSA 7, 16, 20
B
Bitcoin 13
Box 14—Other 22
Business Services Online (BSO) 2–4, 24
C
Calendar year basis 15
Clergy and religious workers 8
Codes for box 12, Form W-2 18, 27, 29
Code AA—Designated Roth contributions under
a section 401(k) plan 20
Code A—Uncollected social security or RRTA tax
on tips 18
Code BB—Designated Roth contributions under
a section 403(b) plan 20
Code B—Uncollected Medicare tax on tips 18
Code C—Taxable cost of group-term life
insurance over $50,000 18
Code DD—Cost of employer-sponsored health
coverage 20
Code D—Elective deferrals under section 401(k)
cash or deferred arrangement (plan) 19
Code EE—Designated Roth contributions under
a governmental section 457(b) plan 20
Code E—Elective deferrals under a section
403(b) salary reduction agreement 19
Code F—Elective deferrals under a section
408(k)(6) salary reduction SEP 19
Code FF—Permitted benefits under a qualified
small employer health reimbursement
arrangement 20
Code G—Elective deferrals and employer
contributions (including nonelective deferrals)
to any governmental or nongovernmental
section 457(b) deferred compensation
plan 19
Code GG—Income from qualified equity grants
under section 83(i) 21
Code H—Elective deferrals under section 501(c)
(18)(D) tax-exempt organization plan 19
Code HH—Aggregate deferrals under section
83(i) elections as of the close of the calendar
year 21
Code J—Nontaxable sick pay 19
Code K—20% excise tax on excess golden
parachute payments 19
Code L—Substantiated employee business
expense reimbursements 19
Code M—Uncollected social security or RRTA
tax on taxable cost of group-term life
insurance over $50,000 (for former
employees). 19
Code N—Uncollected Medicare tax on taxable
cost of group-term life insurance over
$50,000 (for former employees) 19
Code P—Excludable moving expense
reimbursements paid directly to a member of
the U.S. Armed Forces 19
Code Q—Nontaxable combat pay 20
Code R—Employer contributions to an Archer
MSA 20
Code S—Employee salary reduction
contributions under a section 408(p) SIMPLE
plan 20
Code T—Adoption benefits 20
Code V—Income from the exercise of
nonstatutory stock option(s) 20
Code W—Employer contributions to a health
savings account (HSA) 20
Code Y—Deferrals under a section 409A
nonqualified deferred compensation plan 20
Code Z—Income under section 409A on a
nonqualified deferred compensation plan 20
Common errors 4
Commonwealth of the Northern Mariana Islands 6
Control number 15, 22
Corrections 2, 24, 25
Corrections and void Forms W-2 2, 15
Cost of employer-sponsored health coverage 3, 20
D
Deceased employee's wages 8
Deferred compensation 23, 28
Dependent care benefits 17, 23
Designated Roth contributions 8, 16, 20
Disability payments 2
Due date(s) 5
E
Earned income credit (EIC) notice 2
Educational assistance programs 8, 16
E-filing 3, 4, 24
Election workers 8
Elective deferrals 19
Electronic employee statements 2
Employee's name and address 15, 26
Employee's taxes paid by employer 9, 16
Employee business expense reimbursements 9,
16, 19
Employer's name and address 15, 23, 26, 27
Employer identification number (EIN) 15, 23, 26, 28
Employment tax information 4
Establishment number 23, 28
Extensions 5, 6
F
Federal employers in the CNMI 9, 22
Federal income tax withheld 16
Foreign agricultural workers 9
Form 941 or 941-SS 22, 27
Form 944 3, 22, 27
Forms W-2 for U.S. possessions 3
Form W-2 Copy 1 6
Fringe benefits 9, 16
Furnishing Forms W-2 to employees 6
G
General Instructions for Forms W-2 and W-3 5
General instructions for Forms W-2c and W-3c 24
Golden parachute payments 10, 19
Governmental section 457(b) plans 2
Government employers 10, 22, 28
Group-term life insurance 10, 17, 18
Guam 6
H
Health flexible spending arrangement (FSA) 2, 10
Health savings account (HSA) 10, 20
Help 4
Household employers 5, 9, 22, 28
How to complete a form 25
How to complete Form W-2 14
How to complete Form W-3 22
How to get forms and publications 4
I
Income tax withheld 27
Individual taxpayer identification number (ITIN) 6, 15
Information reporting customer service site 4
IRS.gov 4
K
Kind of Employer 22, 28
Kind of Payer 22, 27
L
Lost Form W-2—reissued statement 11
M
Medicaid waiver payments 2
Medicare tax withheld 2, 12, 17
Medicare wages and tips 17
Military differential pay 11
Military employers 18, 22, 27
Military Spouses Residency Relief Act (MSRRA) 3
Moving expenses 11, 20
Multiple Forms W-2 issued to employee 15
N
Nonqualified compensation plans 20
Nonqualified deferred compensation plans 3, 11
Nonqualified Deferred Compensation Reporting
Example Chart 30, 31
Nonqualified plans 17, 23
Nonstatutory stock option(s) 20
Nontaxable combat pay 20
O
Other EIN 23
P
Penalties 13
Civil damages for fraudulent filing of Forms
W-2 14
Exceptions to the penalty 13, 14
Failure to file correct information returns by the
due date 13
Failure to furnish correct payee statements 14
Intentional disregard of filing requirements 14
Intentional disregard of payee statement
requirements 14
Small businesses 14
Privacy Act and Paperwork Reduction Act Notice 28
Q
Qualified equity grants under section 83(i) 11
Qualified small employer health reimbursement
arrangement 20
R
Railroad employers 12, 22, 28
Reconciling Forms W-2, W-3, 941, 941-SS, 943, 944,
CT-1, and Schedule H (Form 1040) 24
Reference Guide for Form W-2 Box 12 Codes 29
Rejected wage reports 1
Repayments, wages received in error 12
Retirement Plan Checkbox Decision Chart 29
Retirement plans 21, 29
S
Scholarship and fellowship grants 12
Severance payments 3
Shipping and mailing Form W-2 6
Sick pay 12, 19, 28
Signing bonuses 17
SIMPLE retirement account 12, 17, 20
Social security number (SSN) 2, 7, 15, 26
Social security tax withheld 17
Social security tips 17
Social security wages 16
Special reporting situations for Form W-2 7
Special situations for Forms W-2c and W-3c 25
Specific instructions for Form W-2 14
Specific instructions for Form W-2c 26
Specific instructions for Form W-3 22
Specific instructions for Form W-3c 27
State and local tax information 22
State or local 501(c) organizations 23, 28
State or local non-501(c) organizations 23, 28
State or territorial ID number 23, 28
Statutory employee 16, 21
Substitute forms 3, 4
Successor/predecessor employers 13
T
Taxpayer identification numbers (TINs) 6, 15
Terminating a business 13
Third-party sick pay 23, 28
Third-party sick pay recap reporting 22
Tier 1 railroad retirement (RRTA) tax 7, 12
Tier 2 railroad retirement (RRTA) tax 7, 12
Tips 16–18
Total number of Forms W-2 23
TTY/TDD equipment 4
-33-
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The Payroll Source
U
U.S. possessions 3, 6
Uncollected taxes on group-term life insurance 19
Uncollected taxes on tips 18
Undeliverable Forms W-2 6, 25
United States Virgin Islands 6
USERRA contributions 13, 18, 22
V
Virtual currency 13
Void Forms W-2 15, 25
W
Wages 16
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A-110
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Waiver from e-filing 3
When to file 5, 25
When to furnish Forms W-2 to employees 6
Where to file 5, 6, 25
Who may sign 5, 25, 28
Who must file 5
Appendix
Form W-4 (2019)
Future developments. For the latest
information about any future developments
related to Form W-4, such as legislation
enacted after it was published, go to
www.irs.gov/FormW4.
Purpose. Complete Form W-4 so that your
employer can withhold the correct federal
income tax from your pay. Consider
completing a new Form W-4 each year and
when your personal or financial situation
changes.
Exemption from withholding. You may
claim exemption from withholding for 2019
if both of the following apply.
• For 2018 you had a right to a refund of all
federal income tax withheld because you
had no tax liability, and
• For 2019 you expect a refund of all
federal income tax withheld because you
expect to have no tax liability.
If you’re exempt, complete only lines 1, 2,
3, 4, and 7 and sign the form to validate it.
Your exemption for 2019 expires February
17, 2020. See Pub. 505, Tax Withholding
and Estimated Tax, to learn more about
whether you qualify for exemption from
withholding.
General Instructions
If you aren’t exempt, follow the rest of
these instructions to determine the number
of withholding allowances you should claim
for withholding for 2019 and any additional
amount of tax to have withheld. For regular
wages, withholding must be based on
allowances you claimed and may not be a
flat amount or percentage of wages.
You can also use the calculator at
www.irs.gov/W4App to determine your
tax withholding more accurately. Consider
Specific Instructions
using this calculator if you have a more
complicated tax situation, such as if you
have a working spouse, more than one job,
or a large amount of nonwage income not
subject to withholding outside of your job.
After your Form W-4 takes effect, you can
also use this calculator to see how the
amount of tax you’re having withheld
compares to your projected total tax for
2019. If you use the calculator, you don’t
need to complete any of the worksheets for
Form W-4.
Note that if you have too much tax
withheld, you will receive a refund when you
file your tax return. If you have too little tax
withheld, you will owe tax when you file your
tax return, and you might owe a penalty.
Filers with multiple jobs or working
spouses. If you have more than one job at
a time, or if you’re married filing jointly and
your spouse is also working, read all of the
instructions including the instructions for
the Two-Earners/Multiple Jobs Worksheet
before beginning.
Nonwage income. If you have a large
amount of nonwage income not subject to
withholding, such as interest or dividends,
consider making estimated tax payments
using Form 1040-ES, Estimated Tax for
Individuals. Otherwise, you might owe
additional tax. Or, you can use the
Deductions, Adjustments, and Additional
Income Worksheet on page 3 or the
calculator at www.irs.gov/W4App to make
sure you have enough tax withheld from
your paycheck. If you have pension or
annuity income, see Pub. 505 or use the
calculator at www.irs.gov/W4App to find
out if you should adjust your withholding
on Form W-4 or W-4P.
Nonresident alien. If you’re a nonresident
alien, see Notice 1392, Supplemental Form
W-4 Instructions for Nonresident Aliens,
before completing this form.
Personal Allowances Worksheet
Complete this worksheet on page 3 first to
determine the number of withholding
allowances to claim.
Line C. Head of household please note:
Generally, you may claim head of household
filing status on your tax return only if you’re
unmarried and pay more than 50% of the
costs of keeping up a home for yourself and
a qualifying individual. See Pub. 501 for
more information about filing status.
Line E. Child tax credit. When you file your
tax return, you may be eligible to claim a
child tax credit for each of your eligible
children. To qualify, the child must be under
age 17 as of December 31, must be your
dependent who lives with you for more than
half the year, and must have a valid social
security number. To learn more about this
credit, see Pub. 972, Child Tax Credit. To
reduce the tax withheld from your pay by
taking this credit into account, follow the
instructions on line E of the worksheet. On
the worksheet you will be asked about your
total income. For this purpose, total income
includes all of your wages and other
income, including income earned by a
spouse if you are filing a joint return.
Line F. Credit for other dependents.
When you file your tax return, you may be
eligible to claim a credit for other
dependents for whom a child tax credit
can’t be claimed, such as a qualifying child
who doesn’t meet the age or social
security number requirement for the child
tax credit, or a qualifying relative. To learn
more about this credit, see Pub. 972. To
reduce the tax withheld from your pay by
taking this credit into account, follow the
instructions on line F of the worksheet. On
the worksheet, you will be asked about
your total income. For this purpose, total
Separate here and give Form W-4 to your employer. Keep the worksheet(s) for your records.
Form
W-4
Department of the Treasury
Internal Revenue Service
1
Employee’s Withholding Allowance Certificate
OMB No. 1545-0074
Whether you’re entitled to claim a certain number of allowances or exemption from withholding is
subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.
▶
Your first name and middle initial
Home address (number and street or rural route)
2019
2 Your social security number
Last name
3
Single
Married
Married, but withhold at higher Single rate.
Note: If married filing separately, check “Married, but withhold at higher Single rate.”
City or town, state, and ZIP code
4 If your last name differs from that shown on your social security card,
check here. You must call 800-772-1213 for a replacement card.
5
6
7
▶
Total number of allowances you’re claiming (from the applicable worksheet on the following pages) . . . .
5
Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . .
6 $
I claim exemption from withholding for 2019, and I certify that I meet both of the following conditions for exemption.
• Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and
• This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.
If you meet both conditions, write “Exempt” here . . . . . . . . . . . . . . . ▶ 7
Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete.
Employee’s signature
(This form is not valid unless you sign it.) ▶
Date ▶
8 Employer’s name and address (Employer: Complete boxes 8 and 10 if sending to IRS and complete
boxes 8, 9, and 10 if sending to State Directory of New Hires.)
For Privacy Act and Paperwork Reduction Act Notice, see page 4.
9 First date of
employment
Cat. No. 10220Q
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10 Employer identification
number (EIN)
Form W-4 (2019)
A-111
The Payroll Source
Page 2
Form W-4 (2019)
income includes all of your wages and
other income, including income earned by
a spouse if you are filing a joint return.
Line G. Other credits. You may be able to
reduce the tax withheld from your
paycheck if you expect to claim other tax
credits, such as tax credits for education
(see Pub. 970). If you do so, your paycheck
will be larger, but the amount of any refund
that you receive when you file your tax
return will be smaller. Follow the
instructions for Worksheet 1-6 in Pub. 505
if you want to reduce your withholding to
take these credits into account. Enter “-0-”
on lines E and F if you use Worksheet 1-6.
Deductions, Adjustments, and
Additional Income Worksheet
Complete this worksheet to determine if
you’re able to reduce the tax withheld from
your paycheck to account for your itemized
deductions and other adjustments to
income, such as IRA contributions. If you
do so, your refund at the end of the year
will be smaller, but your paycheck will be
larger. You’re not required to complete this
worksheet or reduce your withholding if
you don’t wish to do so.
You can also use this worksheet to figure
out how much to increase the tax withheld
from your paycheck if you have a large
amount of nonwage income not subject to
withholding, such as interest or dividends.
Another option is to take these items into
account and make your withholding more
accurate by using the calculator at
www.irs.gov/W4App. If you use the
calculator, you don’t need to complete any
of the worksheets for Form W-4.
Two-Earners/Multiple Jobs
Worksheet
Complete this worksheet if you have more
than one job at a time or are married filing
jointly and have a working spouse. If you
A-112
don’t complete this worksheet, you might
have too little tax withheld. If so, you will
owe tax when you file your tax return and
might be subject to a penalty.
Figure the total number of allowances
you’re entitled to claim and any additional
amount of tax to withhold on all jobs using
worksheets from only one Form W-4. Claim
all allowances on the W-4 that you or your
spouse file for the highest paying job in
your family and claim zero allowances on
Forms W-4 filed for all other jobs. For
example, if you earn $60,000 per year and
your spouse earns $20,000, you should
complete the worksheets to determine
what to enter on lines 5 and 6 of your Form
W-4, and your spouse should enter zero
(“-0-”) on lines 5 and 6 of his or her Form
W-4. See Pub. 505 for details.
Another option is to use the calculator at
www.irs.gov/W4App to make your
withholding more accurate.
Tip: If you have a working spouse and your
incomes are similar, you can check the
“Married, but withhold at higher Single
rate” box instead of using this worksheet. If
you choose this option, then each spouse
should fill out the Personal Allowances
Worksheet and check the “Married, but
withhold at higher Single rate” box on Form
W-4, but only one spouse should claim any
allowances for credits or fill out the
Deductions, Adjustments, and Additional
Income Worksheet.
Instructions for Employer
Employees, do not complete box 8, 9, or
10. Your employer will complete these
boxes if necessary.
New hire reporting. Employers are
required by law to report new employees to
a designated State Directory of New Hires.
Employers may use Form W-4, boxes 8, 9,
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and 10 to comply with the new hire
reporting requirement for a newly hired
employee. A newly hired employee is an
employee who hasn’t previously been
employed by the employer, or who was
previously employed by the employer but
has been separated from such prior
employment for at least 60 consecutive
days. Employers should contact the
appropriate State Directory of New Hires to
find out how to submit a copy of the
completed Form W-4. For information and
links to each designated State Directory of
New Hires (including for U.S. territories), go
to www.acf.hhs.gov/css/employers.
If an employer is sending a copy of Form
W-4 to a designated State Directory of
New Hires to comply with the new hire
reporting requirement for a newly hired
employee, complete boxes 8, 9, and 10 as
follows.
Box 8. Enter the employer’s name and
address. If the employer is sending a copy
of this form to a State Directory of New
Hires, enter the address where child
support agencies should send income
withholding orders.
Box 9. If the employer is sending a copy of
this form to a State Directory of New Hires,
enter the employee’s first date of
employment, which is the date services for
payment were first performed by the
employee. If the employer rehired the
employee after the employee had been
separated from the employer’s service for
at least 60 days, enter the rehire date.
Box 10. Enter the employer’s employer
identification number (EIN).
Appendix
Page 3
Form W-4 (2019)
Personal Allowances Worksheet (Keep for your records.)
A
B
C
D
E
Enter “1” for yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enter “1” if you will file as married filing jointly . . . . . . . . . . . . . . . . . . . . . . .
Enter “1” if you will file as head of household . . . . . . . . . . . . . . . . . . . . . . .
• You’re single, or married filing separately, and have only one job; or
Enter “1” if:
• You’re married filing jointly, have only one job, and your spouse doesn’t work; or
• Your wages from a second job or your spouse’s wages (or the total of both) are $1,500 or less.
Child tax credit. See Pub. 972, Child Tax Credit, for more information.
• If your total income will be less than $71,201 ($103,351 if married filing jointly), enter “4” for each eligible child.
• If your total income will be from $71,201 to $179,050 ($103,351 to $345,850 if married filing jointly), enter “2” for each
eligible child.
{
}
• If your total income will be from $179,051 to $200,000 ($345,851 to $400,000 if married filing jointly), enter “1” for
each eligible child.
• If your total income will be higher than $200,000 ($400,000 if married filing jointly), enter “-0-” . . . . . . .
F
A
B
C
D
E
Credit for other dependents. See Pub. 972, Child Tax Credit, for more information.
• If your total income will be less than $71,201 ($103,351 if married filing jointly), enter “1” for each eligible dependent.
• If your total income will be from $71,201 to $179,050 ($103,351 to $345,850 if married filing jointly), enter “1” for every
two dependents (for example, “-0-” for one dependent, “1” if you have two or three dependents, and “2” if you have
four dependents).
G
H
• If your total income will be higher than $179,050 ($345,850 if married filing jointly), enter “-0-” . . . . . . .
F
Other credits. If you have other credits, see Worksheet 1-6 of Pub. 505 and enter the amount from that worksheet
here. If you use Worksheet 1-6, enter “-0-” on lines E and F . . . . . . . . . . . . . . . . . .
G
Add lines A through G and enter the total here . . . . . . . . . . . . . . . . . . . . . . ▶ H
For accuracy,
complete all
worksheets
that apply.
{
• If you plan to itemize or claim adjustments to income and want to reduce your withholding, or if you
have a large amount of nonwage income not subject to withholding and want to increase your withholding,
see the Deductions, Adjustments, and Additional Income Worksheet below.
• If you have more than one job at a time or are married filing jointly and you and your spouse both
work, and the combined earnings from all jobs exceed $53,000 ($24,450 if married filing jointly), see the
Two-Earners/Multiple Jobs Worksheet on page 4 to avoid having too little tax withheld.
• If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form
W-4 above.
Deductions, Adjustments, and Additional Income Worksheet
Note: Use this worksheet only if you plan to itemize deductions, claim certain adjustments to income, or have a large amount of nonwage
income not subject to withholding.
1
2
3
4
Enter an estimate of your 2019 itemized deductions. These include qualifying home mortgage interest,
charitable contributions, state and local taxes (up to $10,000), and medical expenses in excess of 10% of
your income. See Pub. 505 for details . . . . . . . . . . . . . . . . . . . . . .
$24,400 if you’re married filing jointly or qualifying widow(er)
$18,350 if you’re head of household
Enter:
. . . . . . . . . . .
$12,200 if you’re single or married filing separately
Subtract line 2 from line 1. If zero or less, enter “-0-” . . . . . . . . . . . . . . . . .
Enter an estimate of your 2019 adjustments to income, qualified business income deduction, and any
additional standard deduction for age or blindness (see Pub. 505 for information about these items) . .
{
}
5
6
7
8
Add lines 3 and 4 and enter the total . . . . . . . . . . . . . . . . . . . . . .
Enter an estimate of your 2019 nonwage income not subject to withholding (such as dividends or interest) .
Subtract line 6 from line 5. If zero, enter “-0-”. If less than zero, enter the amount in parentheses
. . .
Divide the amount on line 7 by $4,200 and enter the result here. If a negative amount, enter in parentheses.
Drop any fraction
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
10
Enter the number from the Personal Allowances Worksheet, line H, above . . . . . . . . . .
Add lines 8 and 9 and enter the total here. If zero or less, enter “-0-”. If you plan to use the Two-Earners/
Multiple Jobs Worksheet, also enter this total on line 1 of that worksheet on page 4. Otherwise, stop here
and enter this total on Form W-4, line 5, page 1 . . . . . . . . . . . . . . . . . . .
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
1 $
2 $
3 $
4
5
6
7
$
$
$
$
8
9
10
A-113
The Payroll Source
Page 4
Form W-4 (2019)
Two-Earners/Multiple Jobs Worksheet
Note: Use this worksheet only if the instructions under line H from the Personal Allowances Worksheet direct you here.
1
Enter the number from the Personal Allowances Worksheet, line H, page 3 (or, if you used the
Deductions, Adjustments, and Additional Income Worksheet on page 3, the number from line 10 of that
worksheet)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if you’re
married filing jointly and wages from the highest paying job are $75,000 or less and the combined wages for
you and your spouse are $107,000 or less, don’t enter more than “3” . . . . . . . . . . . . .
2
3
If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter “-0-”)
and on Form W-4, line 5, page 1. Do not use the rest of this worksheet . . . . . . . . . . . .
3
Note: If line 1 is less than line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4 through 9 below to
figure the additional withholding amount necessary to avoid a year-end tax bill.
4
5
6
7
8
Enter the number from line 2 of this worksheet . . . . . . . . . . .
4
Enter the number from line 1 of this worksheet . . . . . . . . . . .
5
Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . .
Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . . .
Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed .
9
Divide line 8 by the number of pay periods remaining in 2019. For example, divide by 18 if you’re paid every
2 weeks and you complete this form on a date in late April when there are 18 pay periods remaining in
2019. Enter the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld
from each paycheck
. . . . . . . . . . . . . . . . . . . . . . . . . . .
Table 1
Married Filing Jointly
A-114
.
.
.
6
7 $
8 $
9 $
Table 2
All Others
Married Filing Jointly
If wages from LOWEST
paying job are—
Enter on
line 2 above
If wages from LOWEST
paying job are—
Enter on
line 2 above
If wages from HIGHEST
paying job are—
$0 - $5,000
5,001 9,500
9,501 - 19,500
19,501 - 35,000
35,001 - 40,000
40,001 - 46,000
46,001 - 55,000
55,001 - 60,000
60,001 - 70,000
70,001 - 75,000
75,001 - 85,000
85,001 - 95,000
95,001 - 125,000
125,001 - 155,000
155,001 - 165,000
165,001 - 175,000
175,001 - 180,000
180,001 - 195,000
195,001 - 205,000
205,001 and over
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
$0 - $7,000
7,001 - 13,000
13,001 - 27,500
27,501 - 32,000
32,001 - 40,000
40,001 - 60,000
60,001 - 75,000
75,001 - 85,000
85,001 - 95,000
95,001 - 100,000
100,001 - 110,000
110,001 - 115,000
115,001 - 125,000
125,001 - 135,000
135,001 - 145,000
145,001 - 160,000
160,001 - 180,000
180,001 and over
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
$0 - $24,900
24,901 - 84,450
84,451 - 173,900
173,901 - 326,950
326,951 - 413,700
413,701 - 617,850
617,851 and over
Privacy Act and Paperwork Reduction
Act Notice. We ask for the information on
this form to carry out the Internal Revenue
laws of the United States. Internal Revenue
Code sections 3402(f)(2) and 6109 and
their regulations require you to provide this
information; your employer uses it to
determine your federal income tax
withholding. Failure to provide a properly
completed form will result in your being
treated as a single person who claims no
withholding allowances; providing
fraudulent information may subject you to
penalties. Routine uses of this information
include giving it to the Department of
Justice for civil and criminal litigation; to
.
.
.
Enter on
line 7 above
cities, states, the District of Columbia, and
U.S. commonwealths and possessions for
use in administering their tax laws; and to
the Department of Health and Human
Services for use in the National Directory of
New Hires. 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.
You aren’t required to provide the
information requested on a form that’s
subject to the Paperwork Reduction Act
unless the form displays a valid OMB
control number. Books or records relating
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
All Others
$420
500
910
1,000
1,330
1,450
1,540
If wages from HIGHEST
paying job are—
$0 - $7,200
7,201 - 36,975
36,976 - 81,700
81,701 - 158,225
158,226 - 201,600
201,601 - 507,800
507,801 and over
Enter on
line 7 above
$420
500
910
1,000
1,330
1,450
1,540
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 Code section
6103.
The average time and expenses required
to complete and file this form will vary
depending on individual circumstances.
For estimated averages, see the
instructions for your income tax return.
If you have suggestions for making this
form simpler, we would be happy to hear
from you. See the instructions for your
income tax return.
Appendix
Form
W-4P
Withholding Certificate for
Pension or Annuity Payments
Department of the Treasury
Internal Revenue Service
Future developments. For the latest information about any
future developments related to Form W‐4P, such as legislation
enacted after it was published, go to www.irs.gov/FormW4P.
Purpose. Form W‐4P is for U.S. citizens, resident aliens, or their
estates who are recipients of pensions, annuities (including
commercial annuities), and certain other deferred
compensation. Use Form W‐4P to tell payers the correct
amount of federal income tax to withhold from your payment(s).
You also may use Form W‐4P to choose (a) not to have any
federal income tax withheld from the payment (except for
eligible rollover distributions or for payments to U.S. citizens to
be delivered outside the United States or its possessions) or
(b) to have an additional amount of tax withheld.
Your options depend on whether the payment is periodic,
nonperiodic, or an eligible rollover distribution, as explained on
pages 2 and 3. Your previously filed Form W‐4P will remain in
effect if you don’t file a Form W‐4P for 2019.
General Instructions
Section references are to the Internal Revenue Code.
Follow these instructions to determine the number of
withholding allowances you should claim for pension or annuity
payment withholding for 2019 and any additional amount of tax
to have withheld. Complete the worksheet(s) using the taxable
amount of the payments.
If you don’t want any federal income tax withheld (see
Purpose, earlier), you can skip the worksheets and go directly to
the Form W‐4P below.
Sign this form. Form W‐4P is not valid unless you sign it.
You can also use the calculator at www.irs.gov/W4App to
determine your tax withholding more accurately. Consider using
this calculator if you have a more complicated tax situation, such
as if you have more than one pension or annuity, a working
spouse, or a large amount of income outside of your pensions.
After your Form W‐4P takes effect, you can also use this calculator
to see how the amount of tax you’re having withheld compares to
your projected total tax for 2019. If you use the calculator, you
don’t need to complete any of the worksheets for Form W‐4P.
Note that if you have too much tax withheld, you will receive a
refund when you file your tax return. If you have too little tax
OMB No. 1545-0074
2019
withheld, you will owe tax when you file your tax return, and you
might owe a penalty.
Filers with multiple pensions or more than one income. If
you have more than one source of income subject to
withholding (such as more than one pension or a pension and a
job, or you’re married filing jointly and your spouse is working),
read all of the instructions, including the instructions for the
Multiple Pensions/More‐Than‐One‐Income Worksheet, before
beginning.
Other income. If you have a large amount of income from other
sources not subject to withholding (such as interest, dividends,
or capital gains), consider making estimated tax payments using
Form 1040‐ES, Estimated Tax for Individuals. Otherwise, you
might owe additional tax. See Pub. 505, Tax Withholding and
Estimated Tax, for more information. Get Form 1040‐ES and
Pub. 505 at www.irs.gov/FormsPubs. Or, you can use the
Deductions, Adjustments, and Additional Income Worksheet on
page 5 or the calculator at www.irs.gov/W4App to make sure
you have enough tax withheld from your payments. If you have
income from wages, see Pub. 505 or use the calculator at
www.irs.gov/W4App to find out if you should adjust your
withholding on Form W‐4 or Form W‐4P.
Note: Social security and railroad retirement payments may be
includible in income. See Form W‐4V, Voluntary Withholding
Request, for information on voluntary withholding from these
payments.
Withholding From Pensions and Annuities
Generally, federal income tax withholding applies to the taxable
part of payments made from pension, profit-sharing, stock
bonus, annuity, and certain deferred compensation plans; from
individual retirement arrangements (IRAs); and from commercial
annuities. The method and rate of withholding depend on (a) the
kind of payment you receive; (b) whether the payments are to be
delivered outside the United States or its possessions; and
(c) whether the recipient is a nonresident alien individual, a
nonresident alien beneficiary, or a foreign estate. Qualified
distributions from a Roth IRA are nontaxable and, therefore, not
subject to withholding. See page 3 for special withholding rules
that apply to payments to be delivered outside the United
States and payments to foreign persons.
Separate here and give Form W-4P to the payer of your pension or annuity. Keep the worksheet(s) for your records.
Form
W-4P
Department of the Treasury
Internal Revenue Service
Withholding Certificate for
Pension or Annuity Payments
▶
For Privacy Act and Paperwork Reduction Act Notice, see page 6.
Your first name and middle initial
OMB No. 1545-0074
2019
Your social security number
Last name
Claim or identification number
(if any) of your pension or
annuity contract
Home address (number and street or rural route)
City or town, state, and ZIP code
Complete the following applicable lines.
1 Check here if you do not want any federal income tax withheld from your pension or annuity. (Don’t complete line 2 or 3.) ▶
2 Total number of allowances and marital status you’re claiming for withholding from each periodic pension or
annuity payment. (You also may designate an additional dollar amount on line 3.) . . . . . . . . . . . ▶
(Enter number
Marital status:
Single
Married
Married, but withhold at higher Single rate.
of allowances.)
3 Additional amount, if any, you want withheld from each pension or annuity payment. (Note: For periodic payments,
. . . . ▶ $
you can’t enter an amount here without entering the number (including zero) of allowances on line 2.)
Your signature ▶
Date ▶
Cat. No. 10225T
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Form W-4P (2019)
A-115
The Payroll Source
Page 2
Form W-4P (2019)
Because your tax situation may change from year to year, you
may want to refigure your withholding each year. You can
change the amount to be withheld by using lines 2 and 3 of
Form W-4P.
Choosing not to have income tax withheld. You (or in the
event of death, your beneficiary or estate) can choose not to
have federal income tax withheld from your payments by using
line 1 of Form W-4P. For an estate, the election to have no
income tax withheld may be made by the executor or personal
representative of the decedent. Enter the estate’s employer
identification number (EIN) in the area reserved for “Your social
security number” on Form W-4P.
You may not make this choice for eligible rollover
distributions. See Eligible rollover distribution—20% withholding
below.
Caution: There are penalties for not paying enough federal
income tax during the year, either through withholding or
estimated tax payments. New retirees, especially, should see
Pub. 505. It explains your estimated tax requirements and
describes penalties in detail. You may be able to avoid quarterly
estimated tax payments by having enough tax withheld from
your pension or annuity using Form W-4P.
Periodic payments. Withholding from periodic payments of a
pension or annuity is figured in the same manner as withholding
from wages. Periodic payments are made in installments at
regular intervals over a period of more than 1 year. They may be
paid annually, quarterly, monthly, etc.
If you want federal income tax to be withheld, you must
designate the number of withholding allowances on line 2 of
Form W-4P and indicate your marital status by checking the
appropriate box. You can’t designate a specific dollar amount to
be withheld. However, you can designate an additional amount
to be withheld on line 3.
If you don’t want any federal income tax withheld from your
periodic payments, check the box on line 1 of Form W-4P and
submit the form to your payer. However, see Payments to
Foreign Persons and Payments To Be Delivered Outside the
United States on page 3.
Caution: If you don’t submit Form W-4P to your payer, the
payer must withhold on periodic payments as if you’re married
claiming three withholding allowances. Generally, this means
that tax will be withheld if the taxable amount of your pension or
annuity is at least $2,033 a month.
If you submit a Form W-4P that doesn’t contain your correct
social security number (SSN), the payer must withhold as if
A-116
you’re single claiming zero withholding allowances even if you
checked the box on line 1 to have no federal income tax
withheld.
There are some kinds of periodic payments for which you
can’t use Form W-4P because they’re already defined as wages
subject to federal income tax withholding. These payments
include retirement pay for service in the U.S. Armed Forces and
payments from certain nonqualified deferred compensation
plans and tax-exempt organizations’ deferred compensation
plans described in section 457. Your payer should be able to tell
you whether Form W-4P applies.
For periodic payments, your Form W-4P stays in effect until
you change or revoke it. Your payer must notify you each year
of your right to choose not to have federal income tax withheld
(if permitted) or to change your choice.
Nonperiodic payments—10% withholding. Your payer must
withhold at a flat 10% rate from the taxable amount of
nonperiodic payments (but see Eligible rollover distribution—
20% withholding below) unless you choose not to have federal
income tax withheld. Distributions from an IRA that are payable
on demand are treated as nonperiodic payments. You can
choose not to have federal income tax withheld from a
nonperiodic payment (if permitted) by submitting Form W-4P
(containing your correct SSN) to your payer and checking the
box on line 1. However, see Payments to Foreign Persons and
Payments To Be Delivered Outside the United States on page 3.
Generally, your choice not to have federal income tax withheld
will apply to any later payment from the same plan. You can’t
use line 2 for nonperiodic payments. But you may use line 3 to
specify an additional amount that you want withheld.
Caution: If you submit a Form W-4P that doesn’t contain your
correct SSN, the payer can’t honor your request not to have
income tax withheld and must withhold 10% of the payment for
federal income tax.
Eligible rollover distribution—20% withholding. Distributions
you receive from qualified pension or annuity plans (for
example, 401(k) plans and section 457(b) plans maintained by a
governmental employer) or tax-sheltered annuities that are
eligible to be rolled over to an IRA or qualified plan are subject
to a flat 20% federal withholding rate on the taxable amount of
the distribution. The 20% withholding rate is required, and you
can’t choose not to have income tax withheld from eligible
rollover distributions. Don’t give Form W-4P to your payer
unless you want an additional amount withheld. In that case,
complete line 3 of Form W-4P and submit the form to your
payer.
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Appendix
Page 3
Form W-4P (2019)
Note: The payer won’t withhold federal income tax if the entire
distribution is transferred by the plan administrator in a direct
rollover to a traditional IRA or another eligible retirement plan (if
allowed by the plan), such as a 401(k) plan, qualified pension
plan, governmental section 457(b) plan, section 403(b) contract,
or tax-sheltered annuity.
Distributions that are (a) required by federal law, (b) one of a
specified series of equal payments, or (c) qualifying “hardship”
distributions are not “eligible rollover distributions” and aren’t
subject to the mandatory 20% federal income tax withholding.
See Pub. 505 for details. See also Nonperiodic payments—10%
withholding on page 2.
Tax relief for victims of terrorist attacks. For tax years ending
after September 10, 2001, disability payments for injuries
incurred as a direct result of a terrorist attack directed against the
United States (or its allies), whether outside or within the United
States, aren’t included in income. You may check the box on line
1 of Form W-4P and submit the form to your payer to have no
federal income tax withheld from these disability payments.
However, you must include in your income any amounts that you
received or you would’ve received in retirement had you not
become disabled as a result of a terrorist attack. See Pub. 3920,
Tax Relief for Victims of Terrorist Attacks, for more details.
Changing Your “No Withholding” Choice
Periodic payments. If you previously chose not to have federal
income tax withheld and you now want withholding, complete
another Form W-4P and submit it to your payer. If you want
federal income tax withheld at the 2019 default rate (married
with three allowances), write “Revoked” next to the checkbox
on line 1 of the form. If you want tax withheld at any different
rate, complete line 2 on the form.
Nonperiodic payments. If you previously chose not to have
federal income tax withheld and you now want withholding,
write “Revoked” next to the checkbox on line 1 and submit
Form W-4P to your payer.
Payments to Foreign Persons and Payments
To Be Delivered Outside the United States
Unless you’re a nonresident alien, withholding (in the manner
described above) is required on any periodic or nonperiodic
payments that are to be delivered to you outside the United States
or its possessions. Don’t check the box on line 1 of Form W-4P.
See Pub. 505 for details.
In the absence of a tax treaty exemption, nonresident aliens,
nonresident alien beneficiaries, and foreign estates generally are
subject to a 30% federal withholding tax under section 1441 on
the taxable portion of a periodic or nonperiodic pension or
annuity payment that is from U.S. sources. However, most tax
treaties provide that private pensions and annuities are exempt
from withholding and tax. Also, payments from certain pension
plans are exempt from withholding even if no tax treaty applies.
See Pub. 515, Withholding of Tax on Nonresident Aliens and
Foreign Entities, and Pub. 519, U.S. Tax Guide for Aliens, for
details. A foreign person should submit Form W-8BEN,
Certificate of Foreign Status of Beneficial Owner for United
States Tax Withholding and Reporting, to the payer before
receiving any payments. The Form W-8BEN must contain the
foreign person’s taxpayer identification number (TIN).
Statement of Federal Income Tax Withheld
From Your Pension or Annuity
By January 31 of next year, your payer will furnish a statement
to you on Form 1099-R, Distributions From Pensions, Annuities,
Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts,
etc., showing the total amount of your pension or annuity
payments and the total federal income tax withheld during the
year. If you’re a foreign person who has provided your payer
with Form W-8BEN, your payer instead will furnish a statement
to you on Form 1042-S, Foreign Person’s U.S. Source Income
Subject to Withholding, by March 16 of next year.
Specific Instructions
Personal Allowances Worksheet
Complete this worksheet on page 4 first to determine the
number of withholding allowances to claim.
Line C. Head of household please note: Generally, you can
claim head of household filing status on your tax return only if
you’re unmarried and pay more than 50% of the costs of
keeping up a home for yourself and a qualifying individual. See
Pub. 501 for more information about filing status.
Line E. Child tax credit. When you file your tax return, you may
be eligible to claim a child tax credit for each of your eligible
children. To qualify, the child must be under age 17 as of
December 31, must be your dependent who lives with you for
more than half the year, and must have a valid social security
number. To learn more about this credit, see Pub. 972, Child
Tax Credit. To reduce the tax withheld from your payments by
taking this credit into account, follow the instructions on line E
of the worksheet. On the worksheet you will be asked about
your total income. For this purpose, total income includes all of
your pensions, wages, and other income, including income
earned by a spouse, if you are filing a joint return.
Line F. Credit for other dependents. When you file your tax
return, you may be eligible to claim a credit for other
dependents for whom a child tax credit cannot be claimed, such
as a qualifying child who does not meet the age or social
security number requirement for the child tax credit, or a
qualifying relative. To learn more about this credit, see Pub. 972.
To reduce the tax withheld from your payments by taking this
credit into account, follow the instructions on line F of the
worksheet. On the worksheet, you will be asked about your total
income. For this purpose, total income includes all of your
pensions, wages, and other income, including income earned by
a spouse, if you are filing a joint return.
Line G. Other credits. You may be able to reduce the tax
withheld from your payments if you expect to claim other tax
credits, such as tax credits for education (see Pub. 970). If you
do so, your payments will be larger, but the amount of any
refund that you receive when you file your tax return will be
smaller. Follow the instructions for Worksheet 1‐6 in Pub. 505 if
you want to reduce your withholding to take these credits into
account. Enter “-0-” on lines E and F if you use Worksheet 1-6.
Deductions, Adjustments, and Additional
Income Worksheet
Complete this worksheet to determine if you’re able to reduce
the tax withheld from your pension or annuity payments to
account for your itemized deductions and other adjustments to
income, such as IRA contributions. If you do so, your refund at
the end of the year will be smaller, but your payments will be
larger. You’re not required to complete this worksheet or reduce
your withholding if you don’t wish to do so.
You can also use this worksheet to figure out how much to
increase the tax withheld from your payments if you have a large
amount of other income not subject to withholding, such as
interest, dividends, or capital gains.
Another option is to take these items into account and make
your withholding more accurate by using the calculator at
www.irs.gov/W4App. If you use the calculator, you don’t need
to complete any of the worksheets for Form W‐4P.
Multiple Pensions/More‐Than‐One‐Income
Worksheet
Complete this worksheet if you receive more than one pension,
if you have a pension and a job, or if you’re married filing jointly
and have a working spouse or a spouse who receives a
pension. If you don’t complete this worksheet, you might have
too little tax withheld. If so, you will owe tax when you file your
tax return and may be subject to a penalty.
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
A-117
The Payroll Source
Form W-4P (2019)
Page
Figure the total number of allowances you’re entitled to claim
and any additional amount of tax to withhold on all pensions
using worksheets from only one Form W‐4P. Claim all
allowances on the Form W‐4P that you or your spouse file for the
highest paying pension in your family and claim zero allowances
on Forms W‐4P filed for all other pensions. For example, if you
receive $60,000 from your pension per year and your spouse
receives $20,000 from a pension, you should complete the
worksheets to determine what to enter on lines 2 and 3 of your
Form W‐4P, and your spouse should enter zero (“‐0‐”) on lines 2
and 3 of his or her Form W‐4P. See Pub. 505 for details.
Another option is to use the calculator at www.irs.gov/W4App
to figure your withholding more precisely.
Personal Allowances Worksheet (Keep for your records.)
A Enter “1” for yourself . . . . . . . . . . . . . . . . . . . . . . . . .
B Enter “1” if you will file as married filing jointly . . . . . . . . . . . . . . . .
C Enter “1” if you will file as head of household . . . . . . . . . . . . . . . . .
• You’re single, or married filing separately, and have only one pension; or
• You’re married filing jointly, have only one pension, and your spouse has
no income subject to withholding; or
D Enter “1” if:
• Your income from a second pension or a job or your spouse’s pension or
wages (or the total of all) are $1,500 or less.
{
}
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
A
B
C
.
.
.
.
.
D
E Child tax credit. See Pub. 972, Child Tax Credit, for more information.
• If your total income will be less than $71,201 ($103,351 if married filing jointly), enter “4” for each eligible child.
• If your total income will be from $71,201 to $179,050 ($103,351 to $345,850 if married filing jointly), enter “2”
for each eligible child.
• If your total income will be from $179,051 to $200,000 ($345,851 to $400,000 if married filing jointly), enter “1”
for each eligible child.
• If your total income will be higher than $200,000 ($400,000 if married filing jointly), enter “-0-” . . . . . .
F Credit for other dependents. See Pub. 972, Child Tax Credit, for more information.
• If your total income will be less than $71,201 ($103,351 if married filing jointly), enter “1” for each eligible
dependent.
• If your total income will be from $71,201 to $179,050 ($103,351 to $345,850 if married filing jointly), enter “1”
for every two dependents (for example, “-0-” for one dependent, “1” if you have two or three dependents, and
“2” if you have four dependents).
• If your total income will be higher than $179,050 ($345,850 if married filing jointly), enter “-0-” . . . . . .
G Other credits. If you have other credits, see Worksheet 1-6 of Pub. 505 and enter the amount from that
worksheet here. If you use Worksheet 1-6, enter “-0-” on lines E and F . . . . . . . . . . . . . .
H Add lines A through G and enter the total here . . . . . . . . . . . . . . . . . . . . . ▶
For accuracy,
complete all
worksheets
that apply.
A-118
{
4
• If you plan to itemize or claim adjustments to income and want to reduce your withholding,
or if you have a large amount of other income not subject to withholding and want to increase
your withholding, see the Deductions, Adjustments, and Additional Income Worksheet, later.
• If you have more than one source of income subject to withholding or are married filing
jointly and you and your spouse both have income subject to withholding and your
combined income from all sources exceeds $53,000 ($24,450 if married filing jointly), see the
Multiple Pensions/More-Than-One-Income Worksheet on page 5 to avoid having too little
tax withheld.
• If neither of the above situations applies, stop here and enter the number from line H on line
2 of Form W-4P above.
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
E
F
G
H
Appendix
Page 5
Form W-4P (2019)
Deductions, Adjustments, and Additional Income Worksheet
Note: Use this worksheet only if you plan to itemize deductions, claim certain adjustments to income, or have a large amount of
other income not subject to withholding.
1 Enter an estimate of your 2019 itemized deductions. These include qualifying home mortgage interest,
charitable contributions, state and local taxes (up to $10,000), and medical expenses in excess of 10%
of your income. See Pub. 505 for details . . . . . . . . . . . . . . . . . . . . .
$24,400 if you’re married filing jointly or qualifying widow(er)
. . . . . . . . . .
2 Enter:
$18,350 if you’re head of household
$12,200 if you’re single or married filing separately
3 Subtract line 2 from line 1. If zero or less, enter “-0-” . . . . . . . . . . . . . . . . .
4 Enter an estimate of your 2019 adjustments to income, qualified business income deduction, and any
additional standard deduction for age or blindness (see Pub. 505 for information about these items) .
5 Add lines 3 and 4 and enter the total . . . . . . . . . . . . . . . . . . . . . .
6 Enter an estimate of your 2019 other income not subject to withholding (such as dividends, interest, or capital gains)
7 Subtract line 6 from line 5. If zero, enter “-0-”. If less than zero, enter the amount in parentheses . .
8 Divide the amount on line 7 by $4,200 and enter the result here. If a negative amount, enter in
parentheses. Drop any fraction . . . . . . . . . . . . . . . . . . . . . . . .
9 Enter the number from the Personal Allowances Worksheet, line H, page 4 . . . . . . . . .
10 Add lines 8 and 9 and enter the total here. If zero or less, enter “-0-”. If you plan to use the Multiple
Pensions/More-Than-One-Income Worksheet, also enter this total on line 1 below. Otherwise, stop
here and enter this total on Form W-4P, line 2, page 1 . . . . . . . . . . . . . . . .
{
}
1 $
2 $
3 $
4
5
6
7
$
$
$
$
8
9
10
Multiple Pensions/More-Than-One-Income Worksheet
Note: Use this worksheet only if the instructions under line H from the Personal Allowances Worksheet direct you here. This
applies if you (and your spouse if married filing jointly) have more than one source of income subject to withholding (such as more
than one pension, or a pension and a job, or you have a pension and your spouse works).
1 Enter the number from the Personal Allowances Worksheet, line H, page 4 (or from line 10 above if
you used the Deductions, Adjustments, and Additional Income Worksheet) . . . . . . . .
2 Find the number in Table 1 below that applies to the LOWEST paying pension or job and enter it here.
However, if you’re married filing jointly and the amount from the highest paying pension or job is $75,000 or
less and the combined amounts for you and your spouse are $107,000 or less, do not enter more than “3”
1
2
3 If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter
“-0-”) and on Form W-4P, line 2, page 1. Do not use the rest of this worksheet . . . . . . . .
3
Note: If line 1 is less than line 2, enter “-0-” on Form W-4P, line 2, page 1. Complete lines 4 through 9 below to figure the additional
withholding amount necessary to avoid a year-end tax bill.
4 Enter the number from line 2 of this worksheet . . . . . . . . . . .
4
5 Enter the number from line 1 of this worksheet . . . . . . . . . . .
5
6 Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7 Find the amount in Table 2 below that applies to the HIGHEST paying pension or job and enter it here
7 $
8 Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed . .
8 $
9 Divide line 8 by the number of payments remaining in 2019. For example, divide by 8 if you’re paid
every month and you complete this form in April 2019. Enter the result here and on Form W-4P, line 3,
9 $
page 1. This is the additional amount to be withheld from each payment
. . . . . . . . . .
Table 1
Married Filing Jointly
Table 2
All Others
Married Filing Jointly
If wages from LOWEST
paying job or pension are—
Enter on
line 2 above
If wages from LOWEST
paying job or pension are—
Enter on
line 2 above
If wages from HIGHEST
paying job or pension are—
$0 - $5,000
5,001 9,500
9,501 - 19,500
19,501 - 35,000
35,001 - 40,000
40,001 - 46,000
46,001 - 55,000
55,001 - 60,000
60,001 - 70,000
70,001 - 75,000
75,001 - 85,000
85,001 - 95,000
95,001 - 125,000
125,001 - 155,000
155,001 - 165,000
165,001 - 175,000
175,001 - 180,000
180,001 - 195,000
195,001 - 205,000
205,001 and over
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
$0 - $7,000
7,001 - 13,000
13,001 - 27,500
27,501 - 32,000
32,001 - 40,000
40,001 - 60,000
60,001 - 75,000
75,001 - 85,000
85,001 - 95,000
95,001 - 100,000
100,001 - 110,000
110,001 - 115,000
115,001 - 125,000
125,001 - 135,000
135,001 - 145,000
145,001 - 160,000
160,001 - 180,000
180,001 and over
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
$0 - $24,900
24,901 - 84,450
84,451 - 173,900
173,901 - 326,950
326,951 - 413,700
413,701 - 617,850
617,851 and over
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Enter on
line 7 above
$420
500
910
1,000
1,330
1,450
1,540
All Others
If wages from HIGHEST
paying job or pension are—
$0 - $7,200
7,201 - 36,975
36,976 - 81,700
81,701 - 158,225
158,226 - 201,600
201,601 - 507,800
507,801 and over
Enter on
line 7 above
$420
500
910
1,000
1,330
1,450
1,540
A-119
The Payroll Source
Page 6
Form W-4P (2019)
Privacy Act and Paperwork Reduction Act
Notice
We ask for the information on this form to carry out the Internal
Revenue laws of the United States. You’re required to provide
this information only if you want to (a) request federal income
tax withholding from periodic pension or annuity payments
based on your withholding allowances and marital status;
(b) request additional federal income tax withholding from your
pension or annuity; (c) choose not to have federal income tax
withheld, when permitted; or (d) change or revoke a previous
Form W-4P. To do any of the aforementioned, you’re required
by sections 3405(e) and 6109 and their regulations to provide
the information requested on this form. Failure to provide this
information may result in inaccurate withholding on your
payment(s). Providing false or fraudulent information may
subject you to penalties.
Routine uses of this information include giving it to the
Department of Justice for civil and criminal litigation, and to
cities, states, the District of Columbia, and U.S. commonwealths
A-120
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.
You’re 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.
The average time and expenses required to complete and file
this form will vary depending on individual circumstances. For
estimated averages, see the instructions for your income tax
return.
If you have suggestions for making this form simpler, we
would be happy to hear from you. See the instructions for your
income tax return.
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Appendix
Form
W-4S
Request for Federal Income Tax
Withholding From Sick Pay
Department of the Treasury
Internal Revenue Service
Type or print your first name and middle initial
▶
▶
OMB No. 1545-0074
2019
Give this form to the third-party payer of your sick pay.
Go to www.irs.gov/FormW4S for the latest information.
Last name
Your social security number
Home address (number and street or rural route)
City or town, state, and ZIP code
Claim or identification number (if any) . . . . . . . . . . . . . . . . . . . . . . .
I request federal income tax withholding from my sick pay payments. I want the following amount to be
withheld from each payment. (See Worksheet below.) . . . . . . . . . . . . . . . . .
Employee’s signature ▶
$
Date ▶
Separate here and give the top part of this form to the payer. Keep the lower part for your records.
Worksheet (Keep for your records. Do not send to the Internal Revenue Service.)
1 Enter amount of adjusted gross income that you expect in 2019
.
.
.
.
.
.
.
.
.
.
.
.
2 If you plan to itemize deductions on Schedule A (Form 1040), enter the estimated total of your
deductions. See Pub. 505 for details. If you don’t plan to itemize deductions, enter the standard
deduction. (See the instructions on page 2 for the standard deduction amount, including additional
standard deductions for age and blindness.) Note: There is no deduction for personal exemptions
for 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . .
4 Tax. Figure your tax on line 3 by using the 2019 Tax Rate Schedule X, Y-1, Y-2, or Z on page 2. Do
not use any tax tables, worksheets, or schedules in the 2018 Form 1040 instructions . . . . .
5 Credits (child tax and higher education credits, credit for child and dependent care expenses, etc.) .
6 Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . .
7 Estimated federal income tax withheld or to be withheld from other sources (including amounts
withheld due to a prior Form W-4S) during 2019 or paid or to be paid with 2019 estimated tax
payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Subtract line 7 from line 6 . . . . . . . . . . . . . . . . . . . . . . . . .
9 Enter the number of sick pay payments you expect to receive this year to which this Form W-4S will
apply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 Divide line 8 by line 9. Round to the nearest dollar. This is the amount that should be withheld from
each sick pay payment. Be sure it meets the requirements for the amount that should be withheld,
as explained under Amount to be withheld below. If it does, enter this amount on Form W-4S above
General Instructions
Purpose of form. Give this form to the third-party payer of your sick
pay, such as an insurance company, if you want federal income tax
withheld from the payments. You aren’t required to have federal
income tax withheld from sick pay paid by a third party. However, if
you choose to request such withholding, Internal Revenue Code
sections 3402(o) and 6109 and their regulations require you to
provide the information requested on this form. Don’t use this form if
your employer (or its agent) makes the payments because employers
are already required to withhold federal income tax from sick pay.
Note: If you receive sick pay under a collective bargaining
agreement, see your union representative or employer.
Definition. Sick pay is a payment that you receive:
• Under a plan to which your employer is a party, and
• In place of wages for any period when you’re temporarily absent
from work because of your sickness or injury.
Amount to be withheld. Enter on this form the amount that you
want withheld from each payment. The amount that you enter:
• Must be in whole dollars (for example, $35, not $34.50).
• Must be at least $4 per day, $20 per week, or $88 per month
based on your payroll period.
For Paperwork Reduction Act Notice, see page 2.
1
2
3
4
5
6
7
8
9
10
• Must not reduce the net amount of each sick pay payment that
you receive to less than $10.
For payments larger or smaller than a regular full payment of sick
pay, the amount withheld will be in the same proportion as your
regular withholding from sick pay. For example, if your regular full
payment of $100 a week normally has $25 (25%) withheld, then $20
(25%) will be withheld from a partial payment of $80.
Caution: You may be subject to a penalty if your tax payments
during the year aren’t at least 90% of the tax shown on your tax
return. For exceptions and details, see Pub. 505, Tax Withholding
and Estimated Tax. You may pay tax during the year through
withholding or estimated tax payments or both. To avoid a penalty,
make sure that you have enough tax withheld or make estimated
tax payments using Form 1040-ES, Estimated Tax for Individuals.
You may estimate your federal income tax liability by using the
worksheet above.
Sign this form. Form W-4S is not valid unless you sign it.
Statement of income tax withheld. After the end of the year, you’ll
receive a Form W-2, Wage and Tax Statement, reporting the taxable
sick pay paid and federal income tax withheld during the year.
These amounts are reported to the Internal Revenue Service.
(continued on back)
Cat. No. 10226E
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Form W-4S (2019)
A-121
The Payroll Source
Page 2
Form W-4S (2019)
Changing your withholding. Form W-4S remains in effect until you
change or revoke it. You may do this by giving a new Form W-4S or
a written notice to the payer of your sick pay. To revoke your
previous Form W-4S, complete a new Form W-4S and write
“Revoked” in the money amount box, sign it, and give it to the payer.
Specific Instructions for Worksheet
You may use the worksheet on page 1 to estimate the amount of
federal income tax that you want withheld from each sick pay
payment. Use your tax return for last year and the worksheet as a
basis for estimating your tax, tax credits, and withholding for this year.
You may not want to use Form W-4S if you already have your
total tax covered by estimated tax payments or other withholding.
If you expect to file a joint return, be sure to include the income,
deductions, credits, and payments of both yourself and your spouse
in figuring the amount you want withheld.
Caution: If any of the amounts on the worksheet change after you
give Form W-4S to the payer, you should use a new Form W-4S to
request a change in the amount withheld.
Line 2—Deductions
Itemized deductions. Itemized deductions include qualifying home
mortgage interest, charitable contributions, state and local taxes (up
to $10,000), and medical expenses in excess of 10% of your
adjusted gross income. See Pub. 505 for details.
Standard deduction. For 2019, the standard deduction amounts are:
Standard
Filing Status
Deduction
Married filing jointly or qualifying widow(er) . . . . . $24,400*
Head of household . . . . . . . . . . . . $18,350*
Single or Married filing separately . . . . . . . . $12,200*
* If you’re age 65 or older or blind, add to the standard deduction
amount the additional amount that applies to you as shown in the next
paragraph. If you can be claimed as a dependent on another person’s
return, see Limited standard deduction for dependents, later.
Additional standard deduction for the elderly or blind. An
additional standard deduction of $1,300 is allowed for a married
individual (filing jointly or separately) or qualifying widow(er) who is
65 or older or blind, $2,600 if 65 or older and blind. If both spouses
are 65 or older or blind, an additional $2,600 is allowed on a joint
return ($2,600 on a separate return if your spouse is your
dependent). If both spouses are 65 or older and blind, an additional
$5,200 is allowed on a joint return ($5,200 on a separate return if
your spouse is your dependent). An additional $1,650 is allowed for
an unmarried individual (single or head of household) who is 65 or
older or blind, $3,300 if 65 or older and blind. See Pub. 505,
Worksheet 2-4.
Limited standard deduction for dependents. If you are a
dependent of another person, your standard deduction is the greater
of (a) $1,100 or (b) your earned income plus $350 (up to the regular
standard deduction for your filing status). If you’re 65 or older or
blind, see Pub. 505 for additional amounts that you may claim.
Certain individuals not eligible for standard deduction. For the
following individuals, the standard deduction is zero.
• A married individual filing a separate return if either spouse
itemizes deductions.
• A nonresident alien individual.
• An individual filing a return for a period of less than 12 months
because of a change in his or her annual accounting period.
Line 5—Credits
Include on this line any tax credits that you’re entitled to claim, such
as the child tax and higher education credits, credit for child and
dependent care expenses, earned income credit, or credit for the
elderly or the disabled. See Pub. 505, Table 1-2, for credits.
Line 7—Tax Withholding and Estimated Tax
Enter the federal income tax that you expect will be withheld this
year on income other than sick pay and any payments made or to
be made with 2019 estimated tax payments. Include any federal
income tax already withheld or to be withheld from wages and
pensions.
2019 Tax Rate Schedules
Schedule X—Single
If line 3 is:
Over—
$0
9,700
39,475
84,200
160,725
204,100
510,300
But not
over—
$9,700
39,475
84,200
160,725
204,100
510,300
and greater
Schedule Z—Head of household
The tax is:
$0 + 10%
970.00 + 12%
4,543.00 + 22%
14,382.50 + 24%
32,748.50 + 32%
46,628.50 + 35%
153,798.50 + 37%
of the
amount
over—
If line 3 is:
Over—
$0
9,700
39,475
84,200
160,725
204,100
510,300
$0
13,850
52,850
84,200
160,700
204,100
510,300
But not
over—
$13,850
52,850
84,200
160,700
204,100
510,300
and greater
The tax is:
$0 + 10%
1,385 + 12%
6,065 + 22%
12,962 + 24%
31,322 + 32%
45,210 + 35%
152,380 + 37%
of the
amount
over—
$0
13,850
52,850
84,200
160,700
204,100
510,300
Schedule Y-1—Married filing jointly or Qualifying widow(er)
Schedule Y-2—Married filing separately
If line 3 is:
If line 3 is:
Over—
$0
19,400
78,950
168,400
321,450
408,200
612,350
But not
over—
$19,400
78,950
168,400
321,450
408,200
612,350
and greater
The tax is:
$0 + 10%
1,940 + 12%
9,086 + 22%
28,765 + 24%
65,497 + 32%
93,257 + 35%
164,709.50 + 37%
of the
amount
over—
$0
19,400
78,950
168,400
321,450
408,200
612,350
Paperwork Reduction Act Notice. We ask for the information on
this form to carry out the Internal Revenue laws of the United
States.
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
A-122
Over—
$0
9,700
39,475
84,200
160,725
204,100
306,175
But not
over—
$9,700
39,475
84,200
160,725
204,100
306,175
and greater
The tax is:
$0 + 10%
970.00 + 12%
4,543.00 + 22%
14,382.50 + 24%
32,748.50 + 32%
46,628.50 + 35%
82,354.75 + 37%
of the
amount
over—
$0
9,700
39,475
84,200
160,725
204,100
306,175
law. Generally, tax returns and return information are confidential,
as required by Code section 6103.
The average time and expenses required to complete and file this
form will vary depending on individual circumstances. For estimated
averages, see the instructions for your income tax return.
If you have suggestions for making this form simpler, we would
be happy to hear from you. See the instructions for your income tax
return.
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Appendix
Form
W-7
Application for IRS Individual
Taxpayer Identification Number
(Rev. September 2016)
Department of the Treasury
Internal Revenue Service
▶
OMB No. 1545-0074
For use by individuals who are not U.S. citizens or permanent residents.
▶ See separate instructions.
An IRS individual taxpayer identification number (ITIN) is for federal tax purposes only.
Before you begin:
• Don’t submit this form if you have, or are eligible to get, a U.S. social security number (SSN).
• Getting an ITIN doesn’t change your immigration status or your right to work in the United States
and doesn’t make you eligible for the earned income credit.
Application Type (Check one box):
Apply for a New ITIN
Renew an Existing ITIN
Reason you’re submitting Form W-7. Read the instructions for the box you check. Caution: If you check box b, c, d, e, f, or g, you
must file a U.S. federal tax return with Form W-7 unless you meet one of the exceptions (see instructions).
a
b
c
d
e
f
g
h
Name
Nonresident alien required to get an ITIN to claim tax treaty benefit
Nonresident alien filing a U.S. federal tax return
U.S. resident alien (based on days present in the United States) filing a U.S. federal tax return
Dependent of U.S. citizen/resident alien
Enter name and SSN/ITIN of U.S. citizen/resident alien (see instructions) ▶
Spouse of U.S. citizen/resident alien
}
Nonresident alien student, professor, or researcher filing a U.S. federal tax return or claiming an exception
Dependent/spouse of a nonresident alien holding a U.S. visa
Other (see instructions) ▶
and treaty article number ▶
Additional information for a and f: Enter treaty country ▶
1a First name
Middle name
Last name
(see instructions)
Name at birth if
different . .
1b First name
2
Applicant’s
mailing address
Foreign (nonU.S.) address
Other
information
Last name
Street address, apartment number, or rural route number. If you have a P.O. box, see separate instructions.
City or town, state or province, and country. Include ZIP code or postal code where appropriate.
3
(if different from
above)
(see instructions)
Birth
information
Middle name
▶
Street address, apartment number, or rural route number. Don’t use a P.O. box number.
City or town, state or province, and country. Include ZIP code or postal code where appropriate.
4
Date of birth (month / day / year)
6a Country(ies) of citizenship
City and state or province (optional)
Country of birth
Male
Female
6c Type of U.S. visa (if any), number, and expiration date
6b Foreign tax I.D. number (if any)
6d Identification document(s) submitted (see instructions)
USCIS documentation
Other
5
Passport
Driver’s license/State I.D.
Date of entry into the
United States
(MM/DD/YYYY):
Issued by:
No.:
Exp. date:
/
/
6e Have you previously received an ITIN or an Internal Revenue Service Number (IRSN)?
No/Don’t know. Skip line 6f.
Yes. Complete line 6f. If more than one, list on a sheet and attach to this form (see instructions).
—
—
—
6f Enter ITIN and/or IRSN ▶ ITIN
IRSN
/
—
/
and
name under which it was issued ▶
First name
Middle name
6g Name of college/university or company (see instructions)
City and state
Date (month / day / year)
Name of delegate, if applicable (type or print)
/
/
Delegate’s relationship
to applicant
Signature
Date (month / day / year)
/
Name and title (type or print)
For Paperwork Reduction Act Notice, see separate instructions.
Name of company
Parent
Court-appointed guardian
Power of Attorney
Phone
Fax
/
EIN
Office Code
Cat. No. 10229L
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Phone number
▲
Acceptance
Agent’s
Use ONLY
Signature of applicant (if delegate, see instructions)
▲▲
Keep a copy for
your records.
Length of stay
Under penalties of perjury, I (applicant/delegate/acceptance agent) declare that I have examined this application, including accompanying
documentation and statements, and to the best of my knowledge and belief, it is true, correct, and complete. I authorize the IRS to share
information with my acceptance agent in order to perfect this Form W-7, Application for IRS Individual Taxpayer Identification Number.
▲
Sign
Here
Last name
PTIN
Form W-7 (Rev. 9-2016)
A-123
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
The Payroll Source
Instructions for Form W-7
(Rev. November 2018)
Department of the Treasury
Internal Revenue Service
Application for IRS Individual Taxpayer Identification Number
(Use with the September 2016 revision of Form W-7)
Section references are to the Internal Revenue Code unless
otherwise noted.
Contents
Future Developments . . . . . . . . . . . . . . . . .
What’s New . . . . . . . . . . . . . . . . . . . . . . . .
Reminders . . . . . . . . . . . . . . . . . . . . . . . . .
General Instructions . . . . . . . . . . . . . . . . . .
Purpose of Form . . . . . . . . . . . . . . . . . .
Who Is Eligible To Complete This Form .
Additional Information . . . . . . . . . . . . . .
Supporting Documentation Requirements
Additional Documentation Requirements
How To Apply . . . . . . . . . . . . . . . . . . . .
When To Apply . . . . . . . . . . . . . . . . . . .
Where To Apply . . . . . . . . . . . . . . . . . .
Specific Instructions . . . . . . . . . . . . . . . . . .
Application Type . . . . . . . . . . . . . . . . . .
Reason You’re Submitting Form W-7 . . .
Line Instructions . . . . . . . . . . . . . . . . . .
Signature . . . . . . . . . . . . . . . . . . . . . . .
Exceptions Tables . . . . . . . . . . . . . . . . . . .
Future Developments
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For the latest information about developments related to Form
W-7 and its instructions, such as legislation enacted after they
were published, go to IRS.gov/FormW7.
What’s New
Renewal of ITINs for spouses and dependents who reside
outside of the United States. Spouses and dependents
residing outside of the United States who could’ve been claimed
in previous years for the personal exemption and no other
benefit don’t need to renew their ITINs, unless they anticipate
being claimed for a different tax benefit or if they file their own
tax return. For tax years 2018 through 2025, you can’t claim a
personal exemption deduction for yourself, your spouse, or your
dependents.
Expiration and renewal of ITINs. An IRS individual taxpayer
identification number (ITIN) that hasn’t been included on a U.S.
federal tax return at least once in the last 3 consecutive tax years
will expire. In addition, ITINs that were assigned before 2013 will
expire according to an annual schedule based on the middle
digits of the ITIN. The middle digits refer to the fourth and fifth
positions of the ITIN. For example, the middle digits for
9xx-78-xxxx are “78.” Expired ITINs or ITINs that are about to
expire must be renewed in order to avoid delays in processing
your tax return. For more information, see When To Apply, later,
or visit IRS.gov/ITIN.
ITINs not used in the last 3 consecutive tax years. If your
ITIN wasn’t included on a U.S. federal tax return at least once for
tax years 2015, 2016, or 2017, your ITIN will expire on
December 31, 2018. You need to take action to renew it if it'll be
included on a U.S. federal tax return. See Do You Need To
Renew Your ITIN?, later, for more information.
Nov 09, 2018
A-124
ITINs with the middle digits “73,” “74,” “75,” “76,” “77,”
“81,” and “82” will expire. If your ITIN’s middle digits (the
fourth and fifth positions) are “73,” “74,” “75,” “76,” “77,” “81,” or
“82,” your ITIN will remain in effect until December 31, 2018. You
need to take action to renew it if it’ll be included on a U.S. federal
tax return filed in 2019. See Do You Need To Renew Your ITIN?,
later, for more information.
ITINs with the middle digits “70,” “71,” “72,” “78,” “79,”
and “80” have expired. If your ITIN’s middle digits (the fourth
and fifth positions) are “70,” “71,” “72,” “78,” “79,” or “80,” your
ITIN is expired, unless you already submitted a renewal
application and it was approved. You need to take action to
renew it if it’ll be included on a U.S. federal tax return. See Do
You Need To Renew Your ITIN?, later, for more information.
Taxpayers residing outside of the United States can apply
for an ITIN through a certifying acceptance agent.
Taxpayers residing outside of the United States can now apply
for an ITIN using a certifying acceptance agent. See Certifying
Acceptance Agent (CAA) for more information.
Reminders
The passport isn’t a stand-alone document for certain dependents if no date of entry into the United States is
present. A passport that doesn’t have a date of entry won’t be
accepted as a stand-alone identification document for certain
dependents. See Proof of U.S. residency for applicants who are
dependents under Supporting Documentation Requirements,
later, for more information.
Certifying Acceptance Agents (CAA) can verify certain
documentation for dependents. Certifying Acceptance
Agents (CAA) can verify documentation for dependents. This
documentation is limited to passports and birth certificates only.
See Certifying Acceptance Agent (CAA) under Where To Apply,
later, for more information.
General Instructions
Purpose of Form
Use Form W-7 for the following purposes.
• To apply for an ITIN. An ITIN is a nine-digit number issued
by the IRS to individuals who are required for federal tax
purposes to have a U.S. taxpayer identification number but who
don’t have and aren’t eligible to get a social security number
(SSN).
• To renew an ITIN. An ITIN only needs to be renewed if it’ll be
included on a U.S. federal tax return and it’s expiring or has
expired. See How To Apply, later, for more information on how to
renew your ITIN.
If your ITIN is only used on information returns filed with
the IRS by third parties, you don’t have to renew your
CAUTION ITIN, even if the ITIN has expired for purposes of filing a
U.S. federal tax return. However, in the future, if you file an
income tax return, you will need to renew your ITIN at that time.
!
The ITIN is for federal tax purposes only. An ITIN doesn’t
entitle you to social security benefits and doesn’t change your
immigration status or your right to work in the United States.
Cat. No. 54092G
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
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Appendix
The ITIN can’t be used to claim certain federal tax credits.
Individuals filing tax returns using an ITIN aren’t eligible for the
earned income credit (EIC). Also, a child who has an ITIN can’t
be claimed as a qualifying child for purposes of the EIC. For
more information, see Pub. 596, Earned Income Credit (EIC).
Also, for tax years 2018 through 2025, a child who has an ITIN
can’t be claimed as a qualifying child for purposes of the child
tax credit and the additional child tax credit. For more
information, see Pub. 972, Child Tax Credit. However, you may
be able to claim the new credit for other dependents (ODC) for
your child and other qualifying relatives (excluding your spouse)
who live in the United States if they obtain an ITIN by the due
date of your U.S. federal tax return (including extensions) and
meet certain other requirements. See the instructions for your
U.S. federal tax return for more information.
!
CAUTION
A spouse can be claimed as an exemption only for tax
years prior to 2018.
• An alien individual eligible to be claimed as a dependent on a
U.S. federal tax return but who isn’t eligible to get an SSN. Your
spouse is never considered your dependent. For more
information about whether an alien individual is eligible to be
claimed as a dependent on a U.S. federal tax return, see Pubs.
501 and 519.
!
CAUTION
Dependents can be claimed as exemptions only for tax
years prior to 2018.
• A dependent/spouse of a nonresident alien U.S. visa holder
who isn’t eligible for an SSN. See Pub. 519.
Social security numbers. Don’t complete Form W-7 if you
have an SSN or if you’re eligible to get an SSN. You’re eligible
for an SSN if you’re a U.S. citizen or if you’ve been admitted by
the United States for permanent residence or U.S. employment.
To get an SSN, see Form SS-5, Application for a Social
Security Card. To get Form SS-5 or to find out if you’re eligible to
get an SSN, go to SSA.gov or contact a Social Security
Administration (SSA) office.
If you have an application for an SSN pending, don’t file Form
W-7. Complete Form W-7 only if the SSA notifies you that you’re
ineligible for an SSN.
If the SSA won’t issue you an SSN, you must get a letter of
denial and attach it to your Form W-7. This applies whether
you’re attaching Form W-7 to your U.S. federal tax return or not.
However, students, professors, and researchers, see
information for box f, later.
!
CAUTION
Dependents and spouses can be claimed as
exemptions only for tax years prior to 2018.
Note. The deduction for personal exemptions was suspended
for tax years 2018 through 2025. For tax years beginning after
2017, spouses or dependents residing outside of the United
States aren’t eligible for an ITIN, unless they qualify for an
allowable tax benefit. See Pub. 519 for more information.
2. Persons who must renew their ITIN to file a U.S. federal
tax return. See Renewal of an existing ITIN under How To Apply,
and Do You Need To Renew Your ITIN?, later.
Additional Information
For more information, visit IRS.gov/ITIN.
Publications. See Pubs. 501, 515, 519, and 1915 for more
information.
You can visit IRS.gov/Forms to download these publications
as well as other forms at no cost. Otherwise, you can go to
IRS.gov/OrderForms to order current and prior-year forms and
instructions. Your order will be mailed to you within 10 business
days.
You can also call 800-TAX-FORM (800-829-3676) if you’re in
the United States to order forms and publications. If you have a
foreign address, write to:
Who Is Eligible To Complete This
Form
The following individuals are eligible to complete Form W-7.
1. Any individual who isn’t eligible to get an SSN but who
must furnish a taxpayer identification number for U.S. tax
purposes or to file a U.S. federal tax return must apply for an
ITIN on Form W-7. Examples include the following.
• A nonresident alien individual claiming reduced withholding
under an applicable income tax treaty for which an ITIN is
required (see Regulations section 1.1441-1(e)(4)(vii)(A)). Also
see Pub. 515, Withholding of Tax on Nonresident Aliens and
Foreign Entities.
• A nonresident alien individual not eligible for an SSN who is
required to file a U.S. federal tax return or who is filing a U.S.
federal tax return only to claim a refund.
• A nonresident alien individual not eligible for an SSN who
elects to file a joint U.S. federal tax return with a spouse who is a
U.S. citizen or resident alien. See Pub. 519, U.S. Tax Guide for
Aliens.
• A U.S. resident alien (based on the number of days present in
the United States, known as the “substantial presence” test) who
files a U.S. federal tax return but who isn’t eligible for an SSN.
For information about the substantial presence test, see Pub.
519.
• A nonresident alien student, professor, or researcher who is
required to file a U.S. federal tax return but who isn’t eligible for
an SSN, or who is claiming an exception to the tax return filing
requirement. See Pub. 519.
• An alien spouse claimed as an exemption on a U.S. federal
tax return who isn’t eligible to get an SSN. See Pub. 501,
Exemptions, Standard Deduction, and Filing Information, and
Pub. 519.
Internal Revenue Service
1201 N. Mitsubishi Motorway
Bloomington, IL 61705-6613
Telephone help. If, after reading these instructions and our free
publications, you’re not sure how to complete your application or
have additional questions, call 800-829-1040 if you’re in the
United States. If you’re outside the United States, call
267-941-1000 (not a toll-free number) for assistance.
Supporting Documentation
Requirements
The documentation you provide must meet the following
requirements.
1. You must submit documentation to establish your identity
and your connection to a foreign country (“foreign status”).
Applicants claimed as dependents must also prove U.S.
residency unless the applicant is from Canada or Mexico or the
applicant is a dependent of U.S. military personnel stationed
overseas.
2. You must submit original documents, or certified copies of
these documents from the issuing agency, that support the
information provided on Form W-7. A certified document is one
that the original issuing agency provides and certifies as an
exact copy of the original document and contains an official
-2-
Instructions for Form W-7 (Rev. November 2018)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
A-125
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The Payroll Source
stamped seal from the agency. You may be able to request a
certified copy of documents at an embassy or consulate.
However, services may vary between countries, so it’s
recommended that you contact the appropriate consulate or
embassy for specific information.
dependents. In these cases, applicants will be required to submit
at least one of the following original documents in addition to the
passport to prove U.S. residency.
• If under 6 years of age: A U.S. medical record that lists the
applicant’s name and U.S. address.
• If at least 6 years of age but under 18 years of age: A
U.S. school record that lists the applicant’s name and U.S.
address.
• If 18 years of age or older: U.S. school record, rental
statement from a U.S. property, utility bill for a U.S. property, or
bank statement that lists the applicant’s name and U.S. address.
Original documents you submit will be returned to you at
TIP the mailing address shown on your Form W-7. You don’t
need to provide a return envelope. Applicants are
permitted to include a prepaid Express Mail or courier envelope
for faster return delivery of their documents. The IRS will then
return the documents in the envelope provided by the applicant.
If your original documents aren’t returned within 60 days, you
can call the IRS (see Telephone help, earlier). If you will need
your documents for any purpose within 60 days of submitting
your ITIN application, you may wish to apply in person at an IRS
Taxpayer Assistance Center or a CAA. See Where To Apply,
later.
Note. Applicants claimed as dependents on prior-year returns
must also prove U.S. residency if the passport doesn’t have a
date of entry unless the applicant is from Canada or Mexico or is
a dependent of U.S. military personnel stationed overseas. In
these cases, applicants will be required to submit at least one of
the original documents from the list earlier in addition to the
passport to prove U.S. residency.
If you check box d for a dependent of a U.S. citizen or
resident alien, then you may submit an original valid passport (or
a certified copy from the issuing agency) without any other
documents to prove your “foreign status” or “identity” only if the
passport has a U.S. date of entry. Otherwise, you must submit
one of the additional documents listed earlier with your passport
to prove residency. If you don’t have one of the additional
documents listed above to submit with your passport, you can’t
use your passport as a stand-alone supporting document and
must submit at least two types of documents listed in the
“Supporting Documentation” table that prove residency, identity,
and foreign status, and that meet the photograph requirement
explained above.
3. The documentation you provide must be current (that is,
not expired).
There are 13 acceptable documents, as shown in the table
below. At least one document must contain your photograph,
unless you’re a dependent under age 14 (under age 18 if a
student). You may later be required by the IRS to provide a
certified translation of foreign-language documents.
Supporting Documentation
Can be used to
establish:
Foreign
Identity
status
Passport (the only stand-alone document*)
x
x
U.S. Citizenship and Immigration Services (USCIS)
photo identification
x
x
Visa issued by the U.S. Department of State
x
x
U.S. driver’s license
x
U.S. military identification card
x
Foreign driver’s license
Civil birth certificate. An original birth certificate is required
if the applicant is under age 18 and hasn’t provided a valid
passport. Civil birth certificates are considered current at all
times because they don’t contain an expiration date.
Passports and national identification cards. These
documents will be considered current only if their expiration date
hasn’t passed prior to the date the Form W-7 is submitted.
x
Foreign military identification card
x
x
National identification card (must contain name,
photograph, address, date of birth, and expiration date)
x
x
x
x
U.S. state identification card
Foreign voter’s registration card
Additional Documentation Requirements
Note. Certified copies of a passport from the issuing agency
must include the U.S. visa pages if a visa is required for your
Form W-7 application.
Medical records. Medical records will be accepted for
dependents under 6 years of age. The medical record must
contain the child’s name, date of birth, and verifiable address.
Shot/immunization records will be accepted only if they
document the applicant’s name and chronological dates of the
applicant’s medical history and care. In addition, the medical
record must document the name, address, and phone number of
the doctor, hospital, or clinic where treatment was last
administered. If this information isn’t printed on the medical
record, the medical record must be accompanied by a dated
letter providing the required information on official letterhead
from the federal authority, physician, hospital, or clinic that
administered the latest care of the child. The medical record
must be dated no more than 12 months from the date of the
Form W-7 application. If a date of entry is required for the
applicant, the medical record must be from a U.S. facility.
School records. School records will be accepted only if they
are for a school term ending no more than 12 months from the
date of the Form W-7 application. The school record must
consist of an official report card or transcript issued by the
school or the equivalent of a Ministry of Education. The school
record must also be signed by a school official or ministry
official. The record must be dated and contain the student’s
name, coursework with grades (unless under age 6), date of
x
Civil birth certificate
x**
x
Medical records (valid only for dependents under age 6)
x**
x
School records (valid only for a dependent under age
18, if a student)
x**
x
* Applicants claimed as dependents who need to prove U.S. residency must
provide additional original documentation if the passport doesn’t have a date
of entry into the United States. See Proof of U.S. residency for applicants who
are dependents below.
** May be used to establish foreign status only if documents are foreign.
If you submit an original valid passport or a certified copy from
the issuing agency, you don’t need to submit any other
documents from the table, unless the passport is for a
dependent and it doesn’t include a date of entry.
Proof of U.S. residency for applicants who are
dependents. For tax years beginning after 2017, applicants
claimed as dependents must also prove U.S. residency unless
the applicant is a dependent of U.S. military personnel stationed
overseas. A passport that doesn’t have a date of entry won’t be
accepted as a stand-alone identification document for
Instructions for Form W-7 (Rev. November 2018)
A-126
-3-
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
grading period(s) (unless under age 6), and school name and
address. If a date of entry is required for the applicant, the
school record must be from a U.S. facility.
Certified copies. You can submit copies of original documents
if you do any of the following.
• Have the copies certified by the issuing agency.
• Have the officers at U.S. embassies and consulates overseas
provide certification and authentication services. Contact the
Consular Section, American Citizens Services of the U.S.
Embassy or Consulate in advance to determine the hours of
operation for these services.
How To Apply
Follow the guidelines below if you’re applying for a new ITIN or
renewing an existing ITIN. To determine if you need to renew
your ITIN, see Do You Need To Renew Your ITIN?, later.
Deceased taxpayers. When requesting an ITIN for a deceased
taxpayer, the deceased must meet all of the requirements
established to get an ITIN. Also, you must write “Deceased”
across the top of Form W-7 and include the documentation
shown in the following chart.
Note. Keep a copy of your application for your records.
Applying for an ITIN for the first time. If you’ve never had an
ITIN before and are submitting an application for a new ITIN,
include the following in your application package.
1. Your completed Form W-7.
Note. If you submit a Form W-7, all future ITIN notices and
correspondence that you receive will be in English. If you prefer
to receive them in Spanish, submit Form W-7(SP).
2. Your original tax return(s) for which the ITIN is needed.
Attach Form W-7 to the front of your tax return. If you’re applying
for more than one ITIN for the same tax return (such as for a
spouse or dependent(s)), attach all Forms W-7 to the same tax
return. Leave the area of the SSN blank on the tax return for
each person who is applying for an ITIN. After your Form W-7
has been processed, the IRS will assign an ITIN to the return
and process the return.
3. Original documents, or certified copies of these
documents from the issuing agency, required to support the
information provided on Form W-7. The required supporting
documentation must be consistent with the applicant’s
information provided on Form W-7. For example, the name, date
of birth, and country(ies) of citizenship shown in the
documentation must be the same as on Form W-7, lines 1a, 4,
and 6a. See Supporting Documentation Requirements, earlier,
for a list of the documents that can be submitted along with your
application package.
• Form W-7,
• A U.S. individual income tax return, and
• Documentation substantiating the identity
and foreign status of the deceased.
The court-appointed
executor or administrator
of the deceased’s estate
filing an original tax return
on behalf of the deceased
and foreign status of the deceased*, and
• A court certificate showing your appointment.
• Form W-7,
• A U.S. individual income tax return,
• Documentation substantiating the identity
• Form W-7,
• A U.S. individual income tax return,
• Documentation substantiating the identity
and foreign status of the deceased*,
• Form 1310 (if a refund is due), and
• A copy of the certificate of death.
* If Form W-7 is for a deceased individual under 18 years of age, one of the
documents proving identity, foreign status, and/or U.S. residency must be a
birth certificate, unless a passport with a date of entry into the United States is
submitted.
ITIN not needed for Forms 4868, 1040-ES, or 1040-ES (NR).
If you’re filing an application for an extension of time to file using
Form 4868, or making an estimated tax payment using Form
1040-ES or Form 1040-ES (NR), don’t file Form W-7 with those
forms. Enter “ITIN TO BE REQUESTED” wherever your SSN or
ITIN is requested. An ITIN will be issued only after you file a tax
return and meet all other requirements.
Renewal of an existing ITIN. If your ITIN is expiring or has
expired and the ITIN will be included on a U.S. federal tax return,
follow the guidelines below to submit your renewal application.
Applications for renewal may be filed immediately. If your ITIN
won’t be included on a U.S. federal tax return, you don’t need to
renew your ITIN at this time.
CAUTION
THEN you must include:
The surviving spouse
filing an original or
amended joint return with
your deceased spouse
Neither the surviving
spouse nor the
court-appointed executor
or administrator of the
deceased’s estate
There are exceptions to the requirement to include a
TIP U.S. federal tax return. If you claim one of these
exceptions, you must submit the documentation
required instead of a tax return. See Exceptions Tables, later.
!
IF you’re:
!
CAUTION
If you attached your tax return to your Form W-7, leave
the area of the SSN blank on the tax return for each
person who is applying for an ITIN.
When To Apply
If you don’t renew the expired ITIN and you file a
U.S. federal tax return with the expired ITIN, there
may be a delay in processing your tax return.
First-time ITIN applications. If you’re applying for a new ITIN,
complete and attach Form W-7 to your tax return when you file
the tax return for which the ITIN is needed. If you’re unable to file
your tax return by the due date, you must file an application for
an extension of time to file. Failure to timely file the tax return
with a complete Form W-7 and required documentation may
result in the denial of refundable credits, such as the additional
child tax credit and the American opportunity tax credit, if you
otherwise qualify. Don’t file your tax return without Form W-7.
If you meet one of the exceptions described in Exceptions
Tables at the end of these instructions, you may complete and
submit Form W-7 at any time.
Include the following in your renewal application package.
1. Your completed Form W-7. You must check a box to
indicate the reason you’re completing Form W-7 even if you’re
applying to renew your ITIN.
2. Original documentation, or certified copies of the
documentation from the issuing agency, required to support the
information provided on Form W-7. The required supporting
documentation must be consistent with the applicant’s
information provided on Form W-7. For example, the name, date
of birth, and country(ies) of citizenship shown in the
documentation must be the same as on Form W-7, lines 1a, 4,
and 6a. See Supporting Documentation Requirements, earlier,
for a list of the documents that can be submitted along with your
renewal package.
All family members listed on a tax return may renew their
ITINs at the same time.
You can’t electronically file (e-file) a return using an ITIN
in the calendar year the ITIN is assigned. If you need to
CAUTION file multiple year returns, you can attach them all to your
Form W-7 and submit them to the IRS. Once your ITIN is
assigned, you can e-file returns in the following years. For
example, if you apply for and receive an ITIN in 2019, you may
!
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Instructions for Form W-7 (Rev. November 2018)
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The Payroll Source
not e-file any tax return using that ITIN (including prior-year
returns) until 2020.
documentation from the issuing agency for primary and
secondary applicants and their dependents. For dependents,
TACs can verify passports, national identification cards, and
birth certificates. These documents will be returned to you
immediately. Service at TACs is by appointment only.
Appointments can be scheduled by calling 844-545-5640. See
IRS.gov/W7DocumentVerification for a list of designated TACs
that offer ITIN document authentication service. TACs that don’t
offer ITIN document authentication service will mail the original
documents, Form W-7, and the tax return to the IRS Austin
Service Center for processing.
Renewal ITIN applications. If you’re renewing an existing
ITIN, you may submit your Form W-7 renewal application
(without filing a tax return) immediately. If you don’t renew your
expired ITIN and you file a U.S. federal tax return with the
expired ITIN, there may be a delay in processing your tax return.
Where To Apply
By mail. Mail Form W-7, your tax return (if applicable) or other
documents required by an exception, and the documentation
described under Supporting Documentation Requirements,
earlier, to:
Through an acceptance agent. You can also apply through
one of the two types of acceptance agents authorized by the
IRS.
1. Acceptance Agent (AA).
2. Certifying Acceptance Agent (CAA).
Internal Revenue Service
ITIN Operation
P.O. Box 149342
Austin, TX 78714-9342
!
CAUTION
Acceptance Agent (AA). An Acceptance Agent (AA) can
help you complete and file Form W-7. To get a list of agents, visit
IRS.gov and enter “acceptance agent program” in the search
box. An AA will need to submit original documentation or
certified copies of the documentation from the issuing agency to
the IRS for all applicants.
Certifying Acceptance Agent (CAA). A Certifying
Acceptance Agent (CAA) can verify original documentation and
certified copies of the documentation from the issuing agency for
primary and secondary applicants and their dependents. For
dependents, CAAs can only verify passports and birth
certificates. The CAA will return the documentation immediately
after reviewing its authenticity. Taxpayers residing outside of the
United States can apply for an ITIN through a CAA.
If you mail your application, don’t use the mailing
address in the instructions for your tax return.
By private delivery services. If you use a private delivery
service, submit your Form W-7, your tax return (if applicable) or
other documents required by an exception, and the
documentation described under Supporting Documentation
Requirements, earlier, to:
Internal Revenue Service
ITIN Operation
Mail Stop 6090-AUSC
3651 S. Interregional, Hwy 35
Austin, TX 78741-0000
Processing times. Allow 7 weeks for the IRS to notify you of
your ITIN application status (9 to 11 weeks if you submit the
application during peak processing periods (January 15 through
April 30) or if you’re filing from overseas). If you haven’t received
your ITIN or correspondence at the end of that time, you can call
the IRS to find out the status of your application (see Telephone
help, earlier).
In person. You can apply for your ITIN by visiting designated
IRS Taxpayer Assistance Centers (TACs). They can verify
original documentation and certified copies of the
Instructions for Form W-7 (Rev. November 2018)
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Appendix
Do You Need To Renew Your ITIN?
Follow the steps below to see if you need to renew your ITIN.
Caution: If the ITIN is being renewed for a spouse or dependent who resides
outside of the United States, see Renewal of ITINs for spouses and dependents
who reside outside of the United States under What’s New.
You don’t need to renew your ITIN. Contact the IRS
to provide your previously assigned ITIN and your
SSN. See Additional Information for more information
on how to contact the IRS.
Yes
Do you have an SSN or are you eligible
for an SSN?
No
Is the ITIN only being used on information
returns filed with the IRS by third parties (such
as Form 1099)?
You don’t need to renew your ITIN at this time.
However, in the future, if you need to use the ITIN to
file a U.S. federal tax return (including as a spouse or
dependent), you will need to renew the ITIN at that
time.
Yes
No
Will you file a U.S. federal tax return using the
ITIN (or will the ITIN be used for a spouse or
dependent on a U.S. federal tax return)?
You don’t need to renew your ITIN at this time.
However, in the future, if you will file a U.S. federal
tax return using the ITIN (including for a spouse or
dependent), you will need to renew the ITIN at that
time.
No
Yes
No
Are the middle digits of your ITIN “73,” “74,” “75,”
“76,” “77,” “81,” or “82”?
Are the middle digits of your ITIN “70,” “71,”
“72,” “78,” “79,” or “80”?
No
Yes
Yes
Have you filed a U.S. federal tax return using
the ITIN (or was the ITIN used for a spouse or
dependent) for tax year 2015, 2016, or 2017?
No
You need to renew your ITIN. If you don’t renew your ITIN, there may be delays in
processing any future U.S. federal tax returns that you file. See How To Apply for
more information on what steps you need to take to submit an application for an
ITIN renewal.
-6-
Yes
You don’t need to renew
your ITIN at this time. See
How To Apply or visit
IRS.gov/ITIN for more
information.
Instructions for Form W-7 (Rev. November 2018)
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The Payroll Source
be required or the applicant must be applying from an overseas
APO/FPO address. A copy of the servicemember’s U.S. military
ID is required to be included with the application if the
documents are notarized. If you’re applying for an ITIN under this
category, you must provide the full name and SSN or ITIN of
the U.S. citizen/resident alien. Enter the information in the space
provided and include a date of entry on line 6d, unless the
dependent is a resident of Canada, Mexico, or the military
overseas.
Specific Instructions
If you’re completing this form for someone else, answer the
questions as they apply to that individual.
Application Type
Check the applicable box to indicate if you’re:
1. a first-time applicant applying for a new ITIN, or
2. seeking to renew an ITIN that you already have.
If you check Renew an Existing ITIN, you must answer the
question on line 6e and include your ITIN information on line 6f.
See the instructions for lines 6e and 6f for more information.
Note. If you live abroad and requested an Adoption Taxpayer
Identification Number (ATIN) for a foreign child you adopted or
who has been legally placed in your home pending adoption and
that request was denied, your dependent may be eligible for an
ITIN. When submitting your Form W-7, make sure that you
include a copy of the legal documents verifying your relationship
to the child.
Reason You’re Submitting Form W-7
You must check the box to indicate the reason you’re
completing Form W-7 even if you’re applying to renew your
ITIN. If more than one box applies to you, check the box that
best explains your reason for submitting Form W-7. A selection
must be made in this section.
!
CAUTION
e. Spouse of U.S. citizen/resident alien. This category
includes:
• A resident or nonresident alien spouse who isn’t filing a U.S.
federal tax return (including a joint return) and who isn’t eligible
to get an SSN but who, as a spouse, is claimed as an
exemption; and
• A resident or nonresident alien spouse who isn’t eligible to get
an SSN but who is electing to file a U.S. federal tax return jointly
with a spouse who is a U.S. citizen or resident alien. For more
information about this category, see Pubs. 501 and 519.
Spouses of U.S. military personnel can submit original
documents, certified copies or notarized copies of identification
documents. A copy of the servicemember’s U.S. military ID will
be required or the applicant must be applying from an overseas
APO/FPO address. A copy of the servicemember’s U.S. military
ID is required to be included with the application if the
documents are notarized. If you’re applying for an ITIN under this
category, you must provide the full name and SSN or ITIN of
the U.S. citizen/resident alien. Enter the information in the space
provided.
Note. If you check box a or f, then box h may also be checked.
If applicable, you also must enter the treaty country and treaty
article. For more information on treaties, see Pub. 901, U.S. Tax
Treaties.
a. Nonresident alien required to get an ITIN to claim tax
treaty benefit. Certain nonresident aliens must get an ITIN to
claim certain tax treaty benefits even if they don’t have to file a
U.S. federal tax return. If you check this box to claim the benefits
of a U.S. income tax treaty with a foreign country, also check box
h. On the dotted line next to box h, enter the appropriate
designation for Exception 1 or 2, whichever applies (see
Exception 1 and Exception 2, later). Identify the exception by its
number, alpha subsection, and category under which you’re
applying (for example, enter “Exception 1d-Pension Income” or
“Exception 2d-Gambling Winnings”). Also, enter the name of the
treaty country and treaty article number in the appropriate entry
spaces below box h and attach the documents required under
whichever exception applies. For more details on tax treaties,
see Pub. 901.
b. Nonresident alien filing a U.S. federal tax return. This
category includes:
• A nonresident alien who must file a U.S. federal tax return to
report income effectively or not effectively connected with the
conduct of a trade or business in the United States, and
• A nonresident alien who is filing a U.S. federal tax return only
to get a refund. See Pub. 519.
!
CAUTION
!
CAUTION
c. U.S. resident alien (based on days present in the United
States) filing a U.S. federal tax return. A foreign individual
living or present in the United States for a certain number of days
(known as the “substantial presence” test) who doesn’t have
permission to work from the USCIS, and is ineligible for an SSN,
may still be required to file a U.S. federal tax return. These
individuals must check this box and include a date of entry on
line 6d. For information about the substantial presence test, see
Pub. 519.
d. Dependent of U.S. citizen/resident alien. This is an
individual who can be claimed as a dependent on a U.S. federal
tax return and isn’t eligible to get an SSN. Your spouse is never
considered your dependent. See Pubs. 501 and 519.
Dependents of U.S. military personnel can submit original
documents, certified copies or notarized copies of identification
documents. A copy of the servicemember’s U.S. military ID will
A-130
A spouse can be claimed as an exemption only for tax
years prior to 2018.
f. Nonresident alien student, professor, or researcher filing
a U.S. federal tax return or claiming an exception. This is
an individual who hasn’t abandoned his or her residence in a
foreign country and who is a bona fide student, professor, or
researcher coming temporarily to the United States solely to
attend classes at a recognized institution of education, to teach,
or to perform research. For more information about the U.S. tax
rules that apply to foreign students, professors, or researchers,
see Pub. 519.
If you check this box, you must complete lines 6a, 6c, 6d, and
6g, and provide your passport with a valid U.S. visa. If you’re
present in the United States on a work-related visa (F-1, J-1, or
M-1), but won’t be employed (that is, your presence in the United
States is study related), you can choose to attach a letter from
the Designated School Official (DSO) or Responsible Officer
(RO) instead of applying with the SSA for an SSN. The letter
must clearly state that you won’t be securing employment while
in the United States and your presence here is solely study
related. This letter can be submitted instead of a Social Security
Administration denial letter if you’re filing a tax return with this
Form W-7 or claiming Exception 2 (explained later).
Nonresident alien students and exchange visitors, their
spouses, and dependents under the Student Exchange Visitors
Program (SEVP) claiming Exception 2 (no tax return attached)
If you choose reason b, you must provide a complete
foreign address on line 3.
Instructions for Form W-7 (Rev. November 2018)
Dependents can be claimed as exemptions only for tax
years prior to 2018.
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Appendix
can have their original ID certified by an SEVP-approved
institution, rather than mailing originals to the IRS. These are
individuals admitted to the United States under an F, J, or M visa
who receive taxable scholarships, fellowships, or other grants.
If you check this box to claim an exception under the benefits
of a U.S. income tax treaty with a foreign country, also check box
h. On the dotted line next to box h, enter the appropriate
designation for Exception 2, explained later. Identify the
exception by its number, alpha subsection, and category under
which you’re applying (for example, enter “Exception
2b-Scholarship Income and claiming tax treaty benefits” or
“Exception 2c-Scholarship Income”). Also, enter the name of the
treaty country and the treaty article number in the appropriate
entry spaces below box h (if applicable) and attach the
documents required under Exception 2.
1. You’re claiming the benefits of a U.S. income tax treaty
with a foreign country and you receive any of the following.
a. Wages, salary, compensation, and honoraria payments;
b. Scholarships, fellowships, and grants; and/or
c. Gambling income; or
2. You’re receiving taxable scholarship, fellowship, or grant
income, but not claiming the benefits of an income tax treaty.
See Exceptions Tables, later, for more details on Exception 2.
Information returns applicable to Exception 2 may include Form
1042-S.
Exception 3. Mortgage interest—third-party reporting.
This exception may apply if you have a home mortgage loan on
real property you own in the United States that’s subject to
third-party reporting of mortgage interest. See Exceptions
Tables, later, for more details on Exception 3. Information
returns applicable to Exception 3 may include Form 1098,
Mortgage Interest Statement.
Exception 4. Dispositions by a foreign person of U.S.
real property interest—third-party withholding. This
exception may apply if you’re a party to a disposition of a U.S.
real property interest by a foreign person, which is generally
subject to withholding by the transferee or buyer (withholding
agent). This exception may also apply if you have a notice of
non-recognition under Regulations section 1.1445-2(d)(2). See
Exceptions Tables, later, for more details on Exception 4.
Information returns applicable to Exception 4 may include the
following.
• Form 8288, U.S. Withholding Tax Return for Dispositions by
Foreign Persons of U.S. Real Property Interests.
• Form 8288-A, Statement of Withholding on Dispositions by
Foreign Persons of U.S. Real Property Interests.
• Form 8288-B, Application for Withholding Certificate for
Dispositions by Foreign Persons of U.S. Real Property Interests.
Exception 5. Treasury Decision (TD) 9363. This exception
may apply if you have an IRS reporting requirement as a
non-U.S. representative of a foreign corporation who needs to
obtain an ITIN for the purpose of meeting their e-filing
requirement under TD 9363 and are submitting Form W-7 with
Form 13350, Registration for e-services. See Exceptions Tables,
later, for more details on Exception 5.
If you’re applying for an ITIN under this exception, enter
“Exception 5, T.D. 9363” on the dotted line next to box h.
g. Dependent/spouse of a nonresident alien holding a U.S.
visa. This is an individual who can be claimed as a dependent
or a spouse on a U.S. federal tax return, who is unable, or not
eligible, to get an SSN, and who has entered the United States
with a nonresident alien who holds a U.S. visa. If you apply for
an ITIN under this category, remember to attach a copy of your
visa to your Form W-7 and include a date of entry on line 6d.
!
CAUTION
Dependents and spouses can be claimed as
exemptions only for tax years prior to 2018.
h. Other. If the reason for your ITIN request isn’t described in
boxes a through g, check this box. Describe in detail your reason
for requesting an ITIN and attach supporting documents.
Frequently, third parties (such as banks and other financial
institutions) that are subject to information-reporting and
withholding requirements will request an ITIN from you to enable
them to file information returns required by law. If you’re
requesting an ITIN for this reason, you may be able to claim one
of the exceptions described later. Enter on the dotted line next to
box h the exception that applies to you. Identify the exception by
its number, alpha subsection (if applicable), and category under
which you’re applying (for example, enter “Exception
1a-Partnership Income” or “Exception 3-Mortgage Interest”).
Examples of completed Forms W-7 can be found in Pub. 1915.
You won’t need to attach a tax return to your Form W-7.
Exception 1. Passive income—third-party withholding or
tax treaty benefits. This exception may apply if you’re the
recipient of partnership income, interest income, annuity income,
rental income, or other passive income that’s subject to
third-party withholding or covered by tax treaty benefits. See
Exceptions Tables, later, for more details on Exception 1.
Information returns applicable to Exception 1 may include the
following.
• Form 1042-S, Foreign Person’s U.S. Source Income Subject
to Withholding.
• Form 1099-INT, Interest Income.
• Form 1099-MISC, Miscellaneous Income.
• Form 8805, Foreign Partner’s Information Statement of
Section 1446 Withholding Tax.
• Schedule K-1 (Form 1065), Partner’s Share of Income,
Deductions, Credits, etc.
Line Instructions
Enter “N/A” (not applicable) on all sections of each line that don’t
apply to you. Don’t leave any section blank. For example, line 4
should have three separate entries.
Line 1a. Enter your legal name on line 1a as it appears on your
identifying documents. This entry should reflect your name as it’ll
appear on a U.S. federal tax return.
Your ITIN will be established using this name. If you
don’t use this name on the U.S. federal tax return, the
CAUTION processing of the U.S. federal tax return may be
delayed.
!
Line 1b. Enter your name as it appears on your birth certificate
if it’s different from your entry on line 1a.
Applicants receiving compensation for personal services
performed in the United States, or issued a U.S. visa
CAUTION that’s valid for employment, should first apply for an SSN
with the SSA. Unless you’re denied an SSN by the SSA and
attach the denial letter to your Form W-7, you aren’t eligible for
an ITIN.
!
!
CAUTION
Line 2. Enter your complete mailing address on line 2. This is
the address the IRS will use to return your original documents
and send written notification of your ITIN application status.
The IRS won’t use the address you enter to update its
records for other purposes unless you include a U.S. federal tax
return with your Form W-7. If you aren’t including a U.S. federal
tax return with your Form W-7 and you changed your home
mailing address since you filed your last U.S. federal tax return,
If you’re required to file a federal tax return, then you
aren’t eligible for Exception 1.
Exception 2. Other income. This exception may apply if:
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Instructions for Form W-7 (Rev. November 2018)
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The Payroll Source
also file Form 8822, Change of Address, with the IRS at the
address listed in the Form 8822 instructions.
the purpose for which you’re requesting an ITIN (if applicable). If
you’ve never entered the United States, enter “Never entered the
United States” on this line. A passport without an entry date
doesn’t prove U.S. residency and may not be used as a
stand-alone document for certain dependents. See Supporting
Documentation Requirements, earlier.
Note. If the U.S. Postal Service won’t deliver mail to your
physical location, enter the U.S. Postal Service’s post office box
number for your mailing address. Contact your local U.S. Post
Office for more information. Don’t use a post office box owned
and operated by a private firm or company.
Example. You entered the United States on August 1, 2018,
to work for Company X. You want to file a return for the income
you earned in the United States in 2018. You aren’t eligible to
get a social security number. You file Form W-7 with your 2018
return. Enter “08/01/2018” on line 6d of Form W-7.
Line 3. Enter your complete foreign (non-U.S.) address in the
country where you permanently or normally reside, even if it’s
the same as the address on line 2. If you no longer have a
permanent residence due to your relocation to the United States,
enter only the foreign country where you last resided on line 3. If
you’re claiming a benefit under an income tax treaty with the
United States, the income tax treaty country must be the same
as the country listed on line 3.
Line 6e. If you ever received an ITIN and/or an Internal
Revenue Service Number (IRSN), check the “Yes” box and
complete line 6f. If you never had an ITIN or an IRSN, or if you
don’t know your ITIN or IRSN, check the No/Don’t know box.
An IRSN is a nine-digit number issued by the IRS to persons
who file a return or make a payment without providing a TIN. You
would’ve been issued this number if you filed a U.S. federal tax
return and didn’t have an SSN. This IRSN will appear on any
correspondence the IRS sent you concerning that return.
If you’re submitting Form W-7 to renew your ITIN, you must
include your previously assigned ITIN on line 6f to avoid delays
in processing your Form W-7.
Don’t use a post office box or an “in care of” (c/o)
address instead of a street address on line 2 if you’re
CAUTION entering just a “country” name on line 3. If you do, your
application may be rejected.
!
Line 4. Enter your date of birth in the month/day/year (MM/DD/
YYYY) format, where MM = 1 to 12 and DD = 1 to 31. To be
eligible for an ITIN, your birth country must be recognized as a
foreign country by the U.S. Department of State.
Line 6f. If you have both an ITIN and/or an IRSN, list them in the
space(s) provided. Identify your first, middle, and last name
under which the ITIN and/or IRSN was issued. If you were
issued more than one IRSN, attach a separate sheet listing all
the IRSNs you received. On the separate sheet, be sure to write
your name and “Form W-7” at the top.
If you’re submitting Form W-7 to renew your ITIN, the name
under which you applied for your ITIN must be included on
line 6f to avoid delays in processing your Form W-7.
Line 6a. Enter the country or countries (in the case of dual
citizenship) in which you’re a citizen. Enter the complete country
name; don’t abbreviate.
Line 6b. If your country of residence for tax purposes has
issued you a tax identification number, enter that number on
line 6b. For example, if you’re a resident of Canada, enter your
Canadian Social Security number.
Line 6c. Enter only U.S. nonimmigrant visa information. Include
the USCIS classification, number of the U.S. visa, and the
expiration date in month/day/year format. For example, if you
have an F-1/F-2 visa with the number 123456 that has an
expiration date of December 31, 2020, enter “F-1/F-2,” “123456,”
and “12/31/2020” in the entry space. Individuals in possession of
an I-20/I-94 document(s) should attach a copy to their Form
W-7.
Note. If you’re renewing your ITIN and your legal name has
changed since the original assignment of your ITIN, you’ll need
to submit documentation to support your legal name change,
such as your marriage certificate or a court order, which may
include a divorce decree. Attach supporting documentation to
Form W-7.
Line 6g. If you checked reason f, you must enter the name of
the educational institution and the city and state in which it’s
located. You also must enter your length of stay in the United
States.
If you’re temporarily in the United States for business
purposes, you must enter the name of the company with whom
you’re conducting your business and the city and state in which
it’s located. You also must enter your length of stay in the United
States.
Line 6d. Check the box indicating the type of document(s)
you’re submitting to prove your identity and foreign status, and if
required, U.S. residency. You must submit documents as
explained under Supporting Documentation Requirements,
earlier. Enter the name of the state or country or other issuer, the
identification number (if any) appearing on the document(s), the
expiration date, and the date on which you entered the United
States. Dates must be entered in the month/day/year format.
Signature
Note. If you’re submitting a passport, or a certified copy of a
passport from the issuing agency, no other documentation is
required to prove your identity and foreign status. Ensure any
visa information shown on the passport is entered on line 6c and
the pages of the passport showing the U.S. visa (if a visa is
required for your Form W-7) are included with your Form W-7. A
passport that doesn’t have a date of entry will no longer be
accepted as a stand-alone identification document for
dependents, unless the dependents are from Canada, Mexico,
or dependents of U.S. military personnel stationed overseas.
If you’re submitting more than one document, enter only the
information for the first document on this line. Attach a separate
sheet showing the required information for the additional
document(s). On the separate sheet, be sure to write your name
and “Form W-7” at the top.
!
CAUTION
Generally, the applicant is required to sign Form W-7. The
following are exceptions to this requirement.
Applicant is a dependent under 18 years of age. If the
applicant is a dependent under 18 years of age, his or her parent
or court-appointed guardian can sign if the child can’t sign. The
parent or court-appointed guardian must type or print his or her
name in the space provided and check the appropriate box that
indicates his or her relationship to the applicant. If the individual
is signing as a court-appointed guardian, a copy of the
court-appointment papers showing the legal guardianship must
be attached.
Adults, other than a parent or court-appointed guardian, can
sign Form W-7 only if a Form 2848, Power of Attorney and
The “Date of entry into the United States” must contain
the complete date on which you entered the country for
Instructions for Form W-7 (Rev. November 2018)
A-132
Who Can Sign Form W-7
-9-
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Appendix
Acceptance Agent’s Use ONLY
Declaration of Representative, has been signed by a parent or
court-appointed guardian authorizing the individual to sign for
the applicant.
Complete all fields as appropriate and enter the eight-digit office
code that was issued to you by the ITIN Program Office.
Applicant is a dependent 18 years of age or older. If the
applicant is 18 years of age or older, the applicant can sign or
can appoint his or her parent, a court-appointed guardian, or
another individual to sign. The person signing, if other than the
applicant, must type or print his or her name in the space
provided, check the appropriate box that indicates his or her
relationship to the applicant, and attach Form 2848.
!
CAUTION
Paperwork Reduction Act Notice. We ask for the information
on this form to carry out the Internal Revenue laws of the United
States. You are required to give us the information. We need it to
ensure that you are complying with these laws and to allow us to
figure and collect the right amount of tax.
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 Internal Revenue
Code section 6103.
A spouse can’t sign for his or her spouse, unless the
Power of Attorney box is checked and Form 2848 has
been attached to Form W-7.
Applicant can’t sign their name. If an applicant can’t sign his
or her name, then the applicant must sign his or her mark (for
example, an “X” or a thumbprint) in the presence of a witness.
The witness’s signature is also required and must be identified
as that of a witness.
The average time and expenses required to complete and file
this form will vary depending on individual circumstances. For
the estimated averages, see the instructions for your income tax
return.
Note. All Powers of Attorney (POA) submitted to the IRS must
be in English. Any POAs received in a foreign language will be
considered invalid unless accompanied by a certified English
translation. The POA must clearly state the purpose for which it’s
intended under the “Acts authorized” section. For more
information, go to IRS.gov.
If you have suggestions for making this form simpler, we
would be happy to hear from you. See the instructions for your
income tax return.
-10-
Instructions for Form W-7 (Rev. November 2018)
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A-133
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The Payroll Source
Exceptions Tables
Exception #1
Note. Federal tax withholding and/or information reporting must take place within the current tax year.
Third-Party
Withholding on
Passive Income
Persons who are eligible to claim Exception 1 include:
Documentation you must submit if you’re eligible to claim
Exception 1:
1(a) Individuals who are partners of a U.S. or foreign partnership
that invests in the United States and that owns assets that
generate income subject to IRS information-reporting and federal
tax withholding requirements; or
1(a) A copy of the portion of the partnership or LLC agreement
displaying the partnership’s employer identification number and
showing that you’re a partner in the partnership that’s conducting
business in the United States.
1(b) Individuals who have opened an interest-bearing bank
deposit account that generates income that’s effectively
connected with their U.S. trade or business and is subject to IRS
information reporting and/or federal tax withholding; or
1(b) A signed letter from the bank on its official letterhead,
displaying your name and stating that you’ve opened a business
account that’s subject to IRS information reporting and/or federal
tax withholding on the interest generated during the current tax year.
1(c) Individuals who are “resident aliens” for tax purposes and
have opened an interest-bearing bank deposit account that
generates income subject to IRS information reporting and/or
federal tax withholding; or
1(c) A signed letter from the bank on its official letterhead,
displaying your name and stating that you’ve opened an individual
deposit account that’s subject to IRS information reporting and/or
federal tax withholding on the interest generated during the current
tax year.
1(d) Individuals who are receiving distributions during the current
tax year of income such as pensions, annuities, rental income,
royalties, dividends, etc., and are required to provide an ITIN to
the withholding agent (for example, an investment company,
insurance company, financial institution, etc.) for the purposes of
tax withholding and/or reporting requirements.
1(d) A signed letter or document from the withholding agent, on
official letterhead, showing your name and verifying that an ITIN is
required to make distributions to you during the current tax year that
are subject to IRS information reporting and/or federal tax
withholding. Self-generated income statements will only be
accepted with a copy of the contract or a letter with a postmarked
envelope addressed from the withholding agent.
Exception #2
Note. Federal tax withholding and/or information reporting must take place within the current tax year.
2(a). Wages,
Salary,
Compensation,
and Honoraria
Payments
Claiming the
benefits of a tax
treaty
Persons who are eligible to claim Exception 2(a) include:
Individuals claiming the benefits of a tax treaty who:
• Are either exempt or subject to a reduced rate of withholding
of tax on their wages, salary, compensation, and honoraria
payments;
•
and
Will be submitting Form 8233 to the payer of the income.
Documentation you must submit if you’re eligible to claim
Exception 2(a):
• A letter of employment from the payer of the income; or
• A copy of the employment contract; or
• A letter requesting your presence for a speaking engagement,
etc.;
along with:
• Evidence (information) on the Form W-7 that you’re entitled to
claim the benefits of a tax treaty, and
• A copy of the completed withholding agent’s portion of Form
8233 attached to Form W-7.
Instructions for Form W-7 (Rev. November 2018)
A-134
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Appendix
Exceptions Tables (continued)
Exception #2 (continued)
Note. Federal tax withholding and/or information reporting must take place within the current tax year.
2(b).
Scholarships,
Fellowships,
and Grants
Claiming the
benefits of a tax
treaty
Persons who are eligible to claim Exception 2(b)
include:
Individuals claiming the benefits of a tax treaty who:
• Are either exempt from or subject to a reduced rate of
tax on their income from scholarships, fellowships, or
grants (that is, foreign students, scholars, professors,
researchers, foreign visitors, or any other individual);
and
• Will be submitting Form W-8BEN to the withholding
Documentation you must submit if you’re eligible to
claim Exception 2(b):
• A letter or official notification from the college or university
awarding the noncompensatory scholarship, fellowship, or
grant; or
• A copy of a contract with a college, university, or
educational institution;
agent.
along with:
Note. Student and Exchange Visitor Program
(SEVP)-approved institutions for nonresident alien
students and exchange visitors and their spouses and
dependents classified under section 101(a)(15)(F), (M), or
(J) of the Immigration and Nationality Act {8 U.S.C. 1101(a)
(15)(F), (M), or (J)}: A certification letter is required for
each Form W-7 application: primary, associated
secondary (spouse), and dependent(s).1
The certification letter from an SEVP-approved institution
serves as a substitute for submission of original supporting
identification documents with Form W-7. The certification
letter must:
• Be on original, official college, university, or institution
letterhead with a verifiable address;
• Provide the applicant’s full name and Student
Exchange Visitor’s Information System (SEVIS) number;
• Certify the applicant’s registration in SEVIS;
• Certify that the student presented an unexpired
passport, visa, or other identification documents for review
(Exception: a U.S. visa isn’t required if the foreign address
is in Canada or Mexico);
• List the identification documents provided to verify
identity and foreign status;
• Be signed and dated by a SEVIS official: Principal
Designated School Official (PDSO), Designated School
Official (DSO), Responsible Officer (RO), or Alternate
Responsible Officer (ARO) of a certified school exchange
program with a verifiable contact telephone number;
• Attach copies of documents used to verify the
applicant’s identity and foreign status from the approved
list of documents presented in the Form W-7 instructions
(passport must include a copy of the valid visa issued by
the U.S. Department of State). A U.S. visa isn’t required if
the foreign address is in Canada or Mexico;
• Attach a copy of Form DS-2019, Certificate of Eligibility
for Exchange Visitor (J-1) Status and/or a copy of Form
I-20, Certificate of Eligibility for Nonimmigrant Student
Status;
• Form W-7 must include the treaty country and article
number that supports claiming a tax treaty benefit; and
• Include a letter from the DSO or RO stating that the
applicant won’t be securing employment in the United
States or receiving any type of income from personal
services.
1
-12-
• A copy of your passport showing the valid visa issued by
the U.S. Department of State,
• Evidence (information) on the Form W-7 that you’re
entitled to claim the benefits of a tax treaty,
• A copy of the Form W-8BEN that was submitted to the
withholding agent, and
• A letter from the Social Security Administration2 stating
that you’re ineligible to receive a social security number
(SSN).
If you’re a student on an F-1, J-1, or M-1 visa who won’t be
working while studying in the United States, you won’t have
to apply for an SSN. You will be permitted to provide a letter
from the Designated School Official (DSO) or Responsible
Officer (RO) stating that you won’t be securing employment
in the United States or receiving any type of income from
personal services.
2
Instructions for Form W-7 (Rev. November 2018)
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A-135
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The Payroll Source
Exceptions Tables (continued)
Exception #2 (continued)
Note. Federal tax withholding and/or information reporting must take place within the current tax year.
2(c).
Scholarships,
Fellowships,
and Grants
Persons who are eligible to claim Exception 2(c)
include:
Documentation you must submit if you’re eligible to
claim Exception 2(c):
Individuals (that is, foreign students, scholars, professors,
researchers, or any other individuals) receiving
noncompensatory income from scholarships, fellowships,
or grants that’s subject to IRS information-reporting and/or
withholding requirements during the current year.
• A letter or official notification from the educational
institution (that is, college or university) awarding the
noncompensatory scholarship, fellowship, or grant; or
• A copy of a contract with a college, university, or
educational institution;
along with:
• A copy of your passport showing the valid visa issued by
the U.S. Department of State (a U.S. visa isn’t required if the
foreign address is in Canada or Mexico);
• A letter from the DSO or RO stating that you’re receiving
noncompensatory income from scholarships, fellowships, or
grants that’s subject to IRS information-reporting and/or
federal tax withholding requirements during the current year
(this letter must be attached to your Form W-7 or your
application for an ITIN will be denied); and
• A letter from the Social Security Administration3 stating
that you’re ineligible to receive a social security number
(SSN).
Not claiming
benefits of a tax
treaty
If you’re a student on an F-1, J-1, or M-1 visa who won’t be
working while studying in the United States, you won’t have
to apply for an SSN. You will be permitted to provide a letter
from the DSO or RO stating that you won’t be securing
employment in the United States or receiving any type of
income from personal services.
3
Exception #2 (continued)
Note. Federal tax withholding and/or information reporting must take place within the current tax year.
2(d). Gambling
Income
Claiming the
benefits of a tax
treaty
Persons who are eligible to claim Exception 2(d) include:
Nonresident aliens visiting the United States who:
• Have gambling winnings,
• Are claiming the benefits of a tax treaty for an exempt or
reduced rate of federal tax withholding on that income, and
• Will be utilizing the services of a gaming official as an IRS ITIN
Acceptance Agent.
Instructions for Form W-7 (Rev. November 2018)
A-136
Documentation you must submit if you’re eligible to claim
Exception 2(d):
Your Form W-7, which must be submitted through the services of
an appropriate gaming official serving as an IRS ITIN Acceptance
Agent to apply for an ITIN under Exception 2(d).
Note. If you don’t secure the services of a gaming official, you may
still file Form 1040NR at the end of the tax year with a Form W-7,
attaching a copy of Form 1042-S displaying the amount of tax
withheld. Your Form 1040NR also should display the tax treaty
article number and country under which you’re claiming the treaty
benefits.
-13-
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Appendix
Exceptions Tables (continued)
Exception #3
Note. Federal tax withholding and/or information reporting must take place within the current tax year.
Third-Party
Reporting of
Mortgage Interest
Persons who are eligible to claim Exception 3 include:
Individuals with a home mortgage loan on real property located in
the United States.
Documentation you must submit if you’re eligible to claim
Exception 3:
• Documentation showing evidence of a home mortgage loan.
This includes a copy of the contract of sale or similar
documentation showing evidence of a home mortgage loan on real
property located in the United States.
Exception #4
Note. Federal tax withholding and/or information reporting must take place within the current tax year.
Third-Party
Withholding—
Disposition by a
Foreign Person
of U.S. Real
Property Interest
Persons who are eligible to claim Exception 4 include:
An individual who is a party to the disposition of U.S. real property
interest by a foreign person (buyer or other transferee such as a
withholding agent) or notice of non-recognition1 under Regulations
section 1.1445-2(d)(2) from the transferor.
Documentation you must submit if you’re eligible to claim
Exception 4:
• A completed Form 8288, Form 8288-A, or Form 8288-B; and
• A copy of the real estate sales contract, Settlement Statement
(HUD-1), or Closing Disclosure.
• In the case of notice of non-recognition1, document(s) that
evidence a transaction for which a notice of non-recognition is
applicable.
Note. For the seller of the property, copies of the sales contract,
Settlement Statement (HUD-1), or Closing Disclosure, and copies
of Forms 8288 and 8288-A submitted by the buyer need to be
attached to Form W-7.
1
For notices of non-recognition, the document must show the date
of the transaction, the parties involved, and the type of transfer that
took place. For example, for transfers involving real estate, valid
documents include the deed, Direction to Convey form, or a
document that identifies the replacement property in a like-kind
exchange. For transfers involving stock, an example of a valid
document is the document that facilitates the transaction.
Exception #5
Note. Federal tax withholding and/or information reporting must take place within the current tax year.
Reporting
Obligations
under TD 9363
Persons who are eligible to claim Exception 5 include:
A non-U.S. representative of a foreign corporation who needs to
obtain an ITIN for the purpose of meeting their e-filing
requirements.
-14-
Documentation you must submit if you’re eligible to claim
Exception 5:
• Along with your Form W-7, include Form 13350; and
• A letter from your employer on corporate letterhead stating that
you have been designated as the person responsible for ensuring
compliance with IRS information-reporting requirements.
Instructions for Form W-7 (Rev. November 2018)
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A-137
The Payroll Source
Form
W-8BEN
Certificate of Foreign Status of Beneficial Owner for United
States Tax Withholding and Reporting (Individuals)
(Rev. July 2017)
OMB No. 1545-1621
▶ For use by individuals. Entities must use Form W-8BEN-E.
Go to www.irs.gov/FormW8BEN for instructions and the latest information.
▶ Give this form to the withholding agent or payer. Do not send to the IRS.
▶
Department of the Treasury
Internal Revenue Service
Do NOT use this form if:
• You are NOT an individual
Instead, use Form:
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
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.
.
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.
.
.
.
.
.
. W-8BEN-E
.
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.
.
.
.
.
.
.
.
.
.
.
.
.
• You are a beneficial owner claiming that income is effectively connected with the conduct of trade or business within the U.S.
(other than personal services) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
.
.
• You are a beneficial owner who is receiving compensation for personal services performed in the United States .
.
.
.
.
.
.
• You are a person acting as an intermediary
.
.
.
.
.
.
• You are a U.S. citizen or other U.S. person, including a resident alien individual
.
.
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.
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.
. W-9
. W-8ECI
8233 or W-4
.
. W-8IMY
Note: If you are resident in a FATCA partner jurisdiction (i.e., a Model 1 IGA jurisdiction with reciprocity), certain tax account information may be
provided to your jurisdiction of residence.
Part I
Identification of Beneficial Owner (see instructions)
1
Name of individual who is the beneficial owner
2
3
Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
Country of citizenship
City or town, state or province. Include postal code where appropriate.
4
Country
Mailing address (if different from above)
City or town, state or province. Include postal code where appropriate.
5
U.S. taxpayer identification number (SSN or ITIN), if required (see instructions)
7
Reference number(s) (see instructions)
Part II
9
10
8
Country
6
Foreign tax identifying number (see instructions)
Date of birth (MM-DD-YYYY) (see instructions)
Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions)
I certify that the beneficial owner is a resident of
within the meaning of the income tax
treaty between the United States and that country.
Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article and paragraph
of the treaty identified on line 9 above to claim a
% rate of withholding on (specify type of income):
.
Explain the additional conditions in the Article and paragraph the beneficial owner meets to be eligible for the rate of withholding:
Part III
Certification
Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further
certify under penalties of perjury that:
•
I am the individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the income to which this form relates or
am using this form to document myself for chapter 4 purposes,
•
The person named on line 1 of this form is not a U.S. person,
•
The income to which this form relates is:
(a) not effectively connected with the conduct of a trade or business in the United States,
(b) effectively connected but is not subject to tax under an applicable income tax treaty, or
(c) the partner’s share of a partnership's effectively connected income,
•
The person named on line 1 of this form is a resident of the treaty country listed on line 9 of the form (if any) within the meaning of the income tax treaty between
the United States and that country, and
•
For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or
any withholding agent that can disburse or make payments of the income of which I am the beneficial owner. I agree that I will submit a new form within 30 days
if any certification made on this form becomes incorrect.
▲
Sign Here
Signature of beneficial owner (or individual authorized to sign for beneficial owner)
Print name of signer
For Paperwork Reduction Act Notice, see separate instructions.
A-138
Date (MM-DD-YYYY)
Capacity in which acting (if form is not signed by beneficial owner)
Cat. No. 25047Z
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Form
W-8BEN
(Rev. 7-2017)
Page 1 of 7
12:48 - 11-Jul-2017
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Appendix
Instructions for
Form W-8BEN
Department of the Treasury
Internal Revenue Service
(Rev. July 2017)
Certificate of Foreign Status of Beneficial Owner for
United States Tax Withholding and Reporting (Individuals)
Section references are to the Internal Revenue Code
unless otherwise noted.
Future Developments
For the latest information about developments related to
Form W-8BEN and its instructions, such as legislation
enacted after they were published, go to IRS.gov/
FormW8BEN.
What's New
Minor updates are made to Form W-8BEN to conform with
Form W-8BEN-E. A note on reciprocal exchange is added
before Part I; Part II, line 10, is updated to match Form
W-8BEN-E; and the first bullet in Part III is revised for
clarity. These instructions have been updated to reflect
temporary and final regulations under chapters 3 and 4
published in January 2017. These instructions include
additional information on when a foreign TIN and date of
birth are required to be included on Form W-8BEN. In
addition, these instructions include information about the
use of electronic signatures.
More information. For more information on FATCA, go
to IRS.gov/FATCA.
General Instructions
For definitions of terms used throughout these
instructions, see Definitions, later.
Purpose of Form
Establishing status for chapter 3 purposes. Foreign
persons are subject to U.S. tax at a 30% rate on income
they receive from U.S. sources that consists of:
Interest (including certain original issue discount (OID));
Dividends;
Rents;
Royalties;
Premiums;
Annuities;
Compensation for, or in expectation of, services
performed;
Substitute payments in a securities lending transaction;
or
Other fixed or determinable annual or periodical gains,
profits, or income.
This tax is imposed on the gross amount paid and is
generally collected by withholding under section 1441. A
payment is considered to have been made whether it is
made directly to the beneficial owner or to another person,
such as an intermediary, agent, or partnership, for the
benefit of the beneficial owner.
Jul 11, 2017
In addition, section 1446 requires a partnership
conducting a trade or business in the United States to
withhold tax on a foreign partner's distributive share of the
partnership's effectively connected taxable income.
Generally, a foreign person that is a partner in a
partnership that submits a Form W-8BEN for purposes of
section 1441 or 1442 will satisfy the documentation
requirements under section 1446 as well. However, in
some cases the documentation requirements of sections
1441 and 1442 do not match the documentation
requirements of section 1446. See Regulations sections
1.1446-1 through 1.1446-6.
Note. The owner of a disregarded entity (including an
individual), rather than the disregarded entity itself, must
submit the appropriate Form W-8BEN for purposes of
section 1446.
If you receive certain types of income, you must
provide Form W-8BEN to:
Establish that you are not a U.S. person;
Claim that you are the beneficial owner of the income
for which Form W-8BEN is being provided or a foreign
partner in a partnership subject to section 1446; and
If applicable, claim a reduced rate of, or exemption
from, withholding as a resident of a foreign country with
which the United States has an income tax treaty and who
is eligible for treaty benefits.
You may also be required to submit Form W-8BEN to
claim an exception from domestic information reporting
and backup withholding (at the backup withholding rate
under section 3406) for certain types of income that are
not subject to foreign-person withholding at a rate of 30%
under section 1441. Such income includes:
Broker proceeds;
Short-term (183 days or less) OID;
Bank deposit interest;
Foreign source interest, dividends, rents, or royalties;
and
Proceeds from a wager placed by a nonresident alien
individual in the games of blackjack, baccarat, craps,
roulette, or big-6 wheel.
A withholding agent or payer of the income may rely on
a properly completed Form W-8BEN to treat a payment
associated with the Form W-8BEN as a payment to a
foreign person who beneficially owns the amounts paid. If
applicable, the withholding agent may rely on the Form
W-8BEN to apply a reduced rate of, or exemption from,
withholding at source.
Provide Form W-8BEN to the withholding agent or
payer before income is paid or credited to you. Failure to
provide a Form W-8BEN when requested may lead to
withholding at the foreign-person withholding rate of 30%
or the backup withholding rate under section 3406.
Cat. No. 25576H
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A-139
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The Payroll Source
person who is requesting it from you. Generally, this will
be the person from whom you receive the payment, who
credits your account, or a partnership that allocates
income to you. An FFI may also request this form from you
to document your account as other than a U.S. account.
Give Form W-8BEN to the person requesting it before the
payment is made to you, credited to your account, or
allocated. If you do not provide this form, the withholding
agent may have to withhold at the 30% rate (under
chapters 3 and 4), backup withholding rate, or the rate
applicable under section 1446. If you receive more than
one type of income from a single withholding agent for
which you claim different benefits, the withholding agent
may, at its option, require you to submit a Form W-8BEN
for each different type of income. Generally, a separate
Form W-8BEN must be given to each withholding agent.
Establishing status for chapter 4 purposes. A foreign
financial institution (FFI) may rely on a properly completed
Form W-8BEN to establish your chapter 4 status as a
foreign person. The Form W-8BEN should be provided to
the FFI when requested. Failure to do so could result in
30% withholding on income paid or credited to you as a
recalcitrant account holder from sources within the United
States. See the definition of amounts subject to
withholding, later.
Additional information. For additional information and
instructions for the withholding agent, see the Instructions
for the Requester of Forms W-8BEN, W-8BEN-E,
W-8ECI, W-8EXP, and W-8IMY.
Who Must Provide Form W-8BEN
You must give Form W-8BEN to the withholding agent or
payer if you are a nonresident alien who is the beneficial
owner of an amount subject to withholding, or if you are an
account holder of an FFI documenting yourself as a
nonresident alien. If you are the single owner of a
disregarded entity, you are considered the beneficial
owner of income received by the disregarded entity.
Submit Form W-8BEN when requested by the withholding
agent, payer, or FFI whether or not you are claiming a
reduced rate of, or exemption from, withholding.
Note. If you own the income or account jointly with one or
more other persons, the income or account will be treated
by the withholding agent as owned by a foreign person
that is a beneficial owner of a payment only if Forms
W-8BEN or W-8BEN-E are provided by all of the owners.
If the withholding agent or financial institution receives a
Form W-9 from any of the joint owners, however, the
payment must be treated as made to a U.S. person and
the account treated as a U.S. account.
You should also provide Form W-8BEN to a payment
settlement entity (PSE) requesting this form if you are a
foreign individual receiving payments subject to reporting
under section 6050W (payment card transactions and
third-party network transactions) as a participating payee.
However, if the payments are income which is effectively
connected to the conduct of a U.S. trade or business, you
should instead provide the PSE with a Form W-8ECI.
Expiration of Form W-8BEN. Generally, a Form
W-8BEN will remain in effect for purposes of establishing
foreign status for a period starting on the date the form is
signed and ending on the last day of the third succeeding
calendar year, unless a change in circumstances makes
any information on the form incorrect. For example, a
Form W-8BEN signed on September 30, 2015, remains
valid through December 31, 2018.
However, under certain conditions a Form W-8BEN will
remain in effect indefinitely until a change of
circumstances occurs. To determine the period of validity
for Form W-8BEN for purposes of chapter 4, see
Regulations section 1.1471-3(c)(6)(ii). To determine the
period of validity for Form W-8BEN for purposes of
chapter 3, see Regulations section 1.1441-1(e)(4)(ii).
Do not use Form W-8BEN if you are described
below.
You are a foreign entity documenting your foreign
status, documenting your chapter 4 status, or claiming
treaty benefits. Instead, use Form W-8BEN-E.
You are a U.S. citizen (even if you reside outside the
United States) or other U.S. person (including a resident
alien individual). Instead, use Form W-9 to document your
status as a U.S. person.
You are acting as a foreign intermediary (that is, acting
not for your own account, but for the account of others as
an agent, nominee, or custodian). Instead, provide Form
W-8IMY.
You are a nonresident alien individual who claims
exemption from withholding on compensation for
independent or dependent personal services performed in
the United States. Instead, provide Form 8233 or Form
W-4.
You are receiving income that is effectively connected
with the conduct of a trade or business in the United
States, unless it is allocable to you through a partnership.
Instead, provide Form W-8ECI. If any of the income for
which you have provided a Form W-8BEN becomes
effectively connected, this is a change in circumstances
and Form W-8BEN is no longer valid with respect to such
income. You must file Form W-8ECI. See Change in
circumstances, later.
Change in circumstances. If a change in circumstances
makes any information on the Form W-8BEN you have
submitted incorrect, you must notify the withholding agent,
payer, or FFI with which you hold an account within 30
days of the change in circumstances and you must file a
new Form W-8BEN or other appropriate form.
If you use Form W-8BEN to certify that you are a
foreign person, a change of address to an address in the
United States is a change in circumstances. Generally, a
change of address within the same foreign country or to
another foreign country is not a change in circumstances.
However, if you use Form W-8BEN to claim treaty
benefits, a move to the United States or outside the
country where you have been claiming treaty benefits is a
change in circumstances. In that case, you must notify the
withholding agent, payer, or FFI within 30 days of the
move.
If you become a U.S. citizen or resident alien after you
submit Form W-8BEN, you are no longer subject to the
30% withholding rate under section 1441 or the
withholding tax on a foreign partner's share of effectively
Giving Form W-8BEN to the withholding agent. Do
not send Form W-8BEN to the IRS. Instead, give it to the
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Appendix
Foreign partnerships, foreign simple trusts, and foreign
grantor trusts are not the beneficial owners of income paid
to the partnership or trust. The beneficial owners of
income paid to a foreign partnership are generally the
partners in the partnership, provided that the partner is not
itself a partnership, foreign simple or grantor trust,
nominee, or other agent. The beneficial owners of income
paid to a foreign simple trust (that is, a foreign trust that is
described in section 651(a)) are generally the
beneficiaries of the trust, if the beneficiary is not a foreign
partnership, foreign simple or grantor trust, nominee, or
other agent. The beneficial owners of a foreign grantor
trust (that is, a foreign trust to the extent that all or a
portion of the income of the trust is treated as owned by
the grantor or another person under sections 671 through
679) are the persons treated as the owners of the trust.
The beneficial owners of income paid to a foreign complex
trust (that is, a foreign trust that is not a foreign simple
trust or foreign grantor trust) is the trust itself.
For purposes of section 1446, the same beneficial
owner rules apply, except that under section 1446 a
foreign simple trust rather than the beneficiary provides
the form to the partnership.
The beneficial owner of income paid to a foreign estate
is the estate itself.
Note. A payment to a U.S. partnership, U.S. trust, or
U.S. estate is treated as a payment to a U.S. payee that is
not subject to 30% withholding under chapter 3 or 4. A
U.S. partnership, trust, or estate should provide the
withholding agent with a Form W-9. For purposes of
section 1446, a U.S. grantor trust or disregarded entity
shall not provide the withholding agent a Form W-9 in its
own right. Rather, the grantor or other owner shall provide
the withholding agent the appropriate form.
connected income under section 1446. To the extent you
have an account with an FFI, your account may be subject
to reporting by the FFI under chapter 4. You must notify
the withholding agent, payer, or FFI within 30 days of
becoming a U.S. citizen or resident alien. You may be
required to provide a Form W-9. For more information,
see Form W-9 and its instructions.
You may be a U.S. resident for tax purposes
depending on the number of days you are
CAUTION physically present in the United States over a
3-year period. See Pub. 519, available at IRS.gov/
Pub519. If you satisfy the substantial presence test, you
must notify the withholding agent, payer, or financial
institution with which you have an account within 30 days
and provide a Form W-9.
!
Definitions
Account holder. An account holder is generally the
person listed or identified as the holder or owner of a
financial account. For example, if a partnership is listed as
the holder or owner of a financial account, then the
partnership is the account holder, rather than the partners
of the partnership (subject to some exceptions). However,
an account that is held by a single-member disregarded
entity is treated as held by the entity's single owner.
Amounts subject to withholding. Generally, an amount
subject to chapter 3 withholding is an amount from
sources within the United States that is fixed or
determinable annual or periodical (FDAP) income. FDAP
income is all income included in gross income, including
interest (as well as OID), dividends, rents, royalties, and
compensation. FDAP income does not include most gains
from the sale of property (including market discount and
option premiums), as well as other specific items of
income described in Regulations section 1.1441-2 (such
as interest on bank deposits and short-term OID).
For purposes of section 1446, the amount subject to
withholding is the foreign partner’s share of the
partnership’s effectively connected taxable income.
Generally, an amount subject to chapter 4 withholding
is an amount of U.S. source FDAP income that is also a
withholdable payment as defined in Regulations section
1.1473-1(a). The exemptions from withholding provided
for under chapter 3 are not applicable when determining
whether withholding applies under chapter 4. For specific
exceptions applicable to the definition of a withholdable
payment, see Regulations section 1.1473-1(a)(4)
(exempting, for example, certain nonfinancial payments).
Chapter 3. Chapter 3 means chapter 3 of the Internal
Revenue Code (Withholding of Tax on Nonresident Aliens
and Foreign Corporations). Chapter 3 contains sections
1441 through 1464.
Chapter 4. Chapter 4 means chapter 4 of the Internal
Revenue Code (Taxes to Enforce Reporting on Certain
Foreign Accounts). Chapter 4 contains sections 1471
through 1474.
Deemed-compliant FFI. Under section 1471(b)(2),
certain FFIs are deemed to comply with the regulations
under chapter 4 without the need to enter into an FFI
agreement with the IRS. However, certain
deemed-compliant FFIs are required to register with the
IRS and obtain a Global Intermediary Identification
Number (GIIN). These FFIs are referred to as registered
deemed-compliant FFIs. See Regulations section
1.1471-5(f).
Beneficial owner. For payments other than those for
which a reduced rate of, or exemption from, withholding is
claimed under an income tax treaty, the beneficial owner
of income is generally the person who is required under
U.S. tax principles to include the payment in gross income
on a tax return. A person is not a beneficial owner of
income, however, to the extent that person is receiving the
income as a nominee, agent, or custodian, or to the extent
the person is a conduit whose participation in a
transaction is disregarded. In the case of amounts paid
that do not constitute income, beneficial ownership is
determined as if the payment were income.
Instructions for Form W-8BEN (Rev. 7-2017)
Disregarded entity. A business entity that has a single
owner and is not a corporation under Regulations section
301.7701-2(b) is disregarded as an entity separate from
its owner. A disregarded entity does not submit this Form
W-8BEN to a partnership for purposes of section 1446 or
to an FFI for purposes of chapter 4. Instead, the owner of
such entity provides appropriate documentation. See
Regulations section 1.1446-1 and section 1.1471-3(a)(3)
(v), respectively.
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Certain entities that are disregarded for U.S. tax
purposes may be recognized for purposes of claiming
treaty benefits under an applicable tax treaty (see the
definition of hybrid entity below). A hybrid entity claiming
treaty benefits is required to complete Form W-8BEN-E.
See Form W-8BEN-E and its instructions.
implement FATCA through reporting by FFIs directly to
the IRS in accordance with the requirements of an FFI
agreement, supplemented by the exchange of information
between such foreign government or agency and the IRS.
An FFI in a Model 2 IGA jurisdiction that has entered into
an FFI agreement with respect to a branch is a
participating FFI, but may be referred to as a reporting
Model 2 FFI.
Financial account. A financial account includes:
A depository account maintained by a financial
institution;
A custodial account maintained by a financial
institution;
Equity or debt interests (other than interests regularly
traded on an established securities market) in investment
entities and certain holding companies, treasury centers,
or financial institutions as defined in Regulations section
1.1471-5(e);
Cash value insurance contracts; and
Annuity contracts.
For purposes of chapter 4, exceptions are provided for
accounts such as certain tax-favored savings accounts;
term life insurance contracts; accounts held by estates;
escrow accounts; and annuity contracts. These
exceptions are subject to certain conditions. See
Regulations section 1.1471-5(b)(2). Accounts may also
be excluded from the definition of financial account under
an applicable IGA.
Nonresident alien individual. Any individual who is not
a citizen or resident alien of the United States is a
nonresident alien individual. An alien individual meeting
either the “green card test” or the “substantial presence
test” for the calendar year is a resident alien. Any person
not meeting either test is a nonresident alien individual.
Additionally, an alien individual who is treated as a
nonresident alien pursuant to Regulations section
301.7701(b)-7 for purposes figuring the individual's U.S.
tax liability, or an alien individual who is a bona fide
resident of Puerto Rico, Guam, the Commonwealth of the
Northern Mariana Islands, the U.S. Virgin Islands, or
American Samoa is a nonresident alien individual. See
Pub. 519 for more information on resident and
nonresident alien status.
Even though a nonresident alien individual
married to a U.S. citizen or resident alien may
CAUTION choose to be treated as a resident alien for certain
purposes (for example, filing a joint income tax return),
such individual is still treated as a nonresident alien for
chapter 3 withholding tax purposes on all income except
wages. For purposes of chapter 4, a nonresident alien
individual who holds a joint account with a U.S. person will
be considered a holder of a U.S. account for chapter 4
purposes.
!
Financial institution. A financial institution generally
means an entity that is a depository institution, custodial
institution, investment entity, or an insurance company (or
holding company of an insurance company) that issues
cash value insurance or annuity contracts.
Foreign financial institution (FFI). An FFI generally
means a foreign entity that is a financial institution.
Foreign person. A foreign person includes a
nonresident alien individual and certain foreign entities
that are not U.S. persons (entities should complete Form
W-8BEN-E rather than this Form W-8BEN).
Participating FFI. A participating FFI is an FFI that has
agreed to comply with the terms of an FFI agreement with
respect to all branches of the FFI, other than a branch that
is a reporting Model 1 FFI or a U.S. branch. The term
“participating FFI” also includes a reporting Model 2 FFI
and a qualified intermediary (QI) branch of a U.S. financial
institution, unless such branch is a reporting Model 1 FFI.
Hybrid entity. A hybrid entity is any person (other than
an individual) that is treated as fiscally transparent for
purposes of its status under the Code but is not treated as
fiscally transparent by a country with which the United
States has an income tax treaty. Hybrid status is relevant
for claiming treaty benefits.
Participating payee. A participating payee means any
person that accepts a payment card as payment or
accepts payment from a third-party settlement
organization in settlement of a third-party network
transaction.
Intergovernmental agreement (IGA). An IGA means a
Model 1 IGA or a Model 2 IGA. For a list of jurisdictions
treated as having in effect a Model 1 or Model 2 IGA, see
the list of jurisdictions at www.treasury.gov/resourcecenter/tax-policy/treaties/Pages/FATCA-Archive.aspx.
A Model 1 IGA means an agreement between the
United States or the Treasury Department and a foreign
government or one or more agencies to implement
FATCA through reporting by FFIs to such foreign
government or agency, followed by automatic exchange
of the reported information with the IRS. An FFI in a Model
1 IGA jurisdiction that performs account reporting to the
jurisdiction’s government is referred to as a reporting
Model 1 FFI.
A Model 2 IGA means an agreement or arrangement
between the United States or the Treasury Department
and a foreign government or one or more agencies to
Payment settlement entity (PSE). A PSE is a
merchant acquiring entity or third-party settlement
organization. Under section 6050W, a PSE is generally
required to report payments made in settlement of
payment card transactions or third-party network
transactions. However, a PSE is not required to report
payments made to a beneficial owner that is documented
as foreign with an applicable Form W-8.
Recalcitrant account holder. A recalcitrant account
holder includes an individual who fails to comply with the
requests of an FFI for documentation and information for
determining the U.S. or foreign status of the individual’s
account, including furnishing this Form W-8BEN when
requested.
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Appendix
U.S. person. A U.S. person is defined in section 7701(a)
(30) and includes an individual who is a citizen or resident
of the United States. For purposes of chapter 4, a U.S.
person is defined in Regulations section 1.1471-1(b)
(141).
Line 5. If you have a social security number (SSN), enter
it here. To apply for an SSN, get Form SS-5 from a Social
Security Administration (SSA) office or online at
www.ssa.gov/forms/ss-5.pdf. If you are in the United
States, you can call the SSA at 1-800-772-1213.
Complete Form SS-5 and return it to the SSA.
If you do not have an SSN and are not eligible to get
one, you can get an individual taxpayer identification
number (ITIN). To apply for an ITIN, file Form W-7 with the
IRS. It usually takes 4–6 weeks to get an ITIN. To claim
certain treaty benefits, you must complete line 5 by
submitting an SSN or ITIN, or line 6 by providing a foreign
tax identification number (foreign TIN).
Withholding agent. Any person, U.S. or foreign, that has
control, receipt, custody, disposal, or payment of U.S.
source FDAP income subject to chapter 3 or 4 withholding
is a withholding agent. The withholding agent may be an
individual, corporation, partnership, trust, association, or
any other entity, including (but not limited to) any foreign
intermediary, foreign partnership, and U.S. branches of
certain foreign banks and insurance companies.
For purposes of section 1446, the withholding agent is
the partnership conducting the trade or business in the
United States. For a publicly traded partnership, the
withholding agent may be the partnership, a nominee
holding an interest on behalf of a foreign person, or both.
See Regulations sections 1.1446-1 through 1.1446-6.
!
CAUTION
A partner in a partnership conducting a trade or
business in the United States will likely be allocated
effectively connected taxable income. The partner is
required to file a U.S. federal income tax return and must
have a U.S. taxpayer identification number (TIN).
You must provide an SSN or TIN if you are:
Claiming an exemption from withholding under section
871(f) for certain annuities received under qualified plans,
or
Submitting the form to a partnership that conducts a
trade or business in the United States.
If you are claiming treaty benefits, you are generally
required to provide an ITIN if you do not provide a tax
identifying number issued to you by your jurisdiction of tax
residence on line 6. However, an ITIN is not required to
claim treaty benefits relating to:
Dividends and interest from stocks and debt obligations
that are actively traded;
Dividends from any redeemable security issued by an
investment company registered under the Investment
Company Act of 1940 (mutual fund);
Dividends, interest, or royalties from units of beneficial
interest in a unit investment trust that are (or were upon
issuance) publicly offered and are registered with the SEC
under the Securities Act of 1933; and
Income related to loans of any of the above securities.
Specific Instructions
Part I
Line 1. Enter your name. If you are a foreign individual
who is the single owner of a disregarded entity that is not
claiming treaty benefits as a hybrid entity, with respect to
a payment, you should complete this form with your name
and information. If the account to which a payment is
made or credited is in the name of the disregarded entity,
you should inform the withholding agent of this fact. This
may be done by including the name and account number
of the disregarded entity on line 7 (reference number) of
the form. However, if the disregarded entity is claiming
treaty benefits as a hybrid entity, it should complete Form
W-8BEN-E instead of this Form W-8BEN.
Line 2. Enter your country of citizenship. If you are a dual
citizen, enter the country where you are both a citizen and
a resident at the time you complete this form. If you are
not a resident in any country in which you have
citizenship, enter the country where you were most
recently a resident. However, if you are a U. S. citizen, you
should not complete this form even if you hold citizenship
in another jurisdiction. Instead, provide Form W-9.
Line 6. If you are providing this Form W-8BEN to
document yourself as an account holder with respect to a
financial account (as defined in Regulations section
1.1471-5(b)) that you hold at a U.S. office of a financial
institution (including a U.S. branch of an FFI) and you
receive U.S. source income reportable on Form 1042-S
associated with this form, you must provide the TIN issued
to you by your jurisdiction of tax residence identified on
line 3 unless:
You have not been issued a TIN (including if the
jurisdiction does not issue TINs), or
You are a resident of a U.S. possession.
If you are providing this form to document a financial
account described above but you do not enter a TIN on
line 6, and you are not a resident of a U.S. possession,
you must provide the withholding agent with an
explanation for why you have not been issued a TIN. For
this purpose, an explanation is a statement that you are
Line 3. Your permanent residence address is the
address in the country where you claim to be a resident
for purposes of that country’s income tax. If you are
completing Form W-8BEN to claim a reduced rate of
withholding under an income tax treaty, you must
determine your residency in the manner required by the
treaty. Do not show the address of a financial institution, a
post office box, or an address used solely for mailing
purposes. If you do not have a tax residence in any
country, your permanent residence is where you normally
reside.
If you reside in a country that does not use street
addresses, you may enter a descriptive address on line 3.
The address must accurately indicate your permanent
residence in the manner used in your jurisdiction.
Line 4. Enter your mailing address only if it is different
from the address you show on line 3.
Instructions for Form W-8BEN (Rev. 7-2017)
An ITIN is for tax use only. It does not entitle you
to social security benefits or change your
employment or immigration status under U.S. law.
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Scholarship and fellowship grants, later, for more
information.
This line is generally not applicable to treaty benefits
under an interest or dividends (other than dividends
subject to a preferential rate based on ownership) article
of a treaty.
not legally required to obtain a TIN in your jurisdiction of
tax residence. The explanation may be written on line 6, in
the margins of the form, or on a separate attached
statement associated with the form. If you are writing the
explanation on line 6, you may shorten it to “not legally
required.” Do not write “not applicable.”
In addition, if you are not using this form to document a
financial account described above, you may provide the
TIN issued to you by your jurisdiction of tax residence on
line 6 for purposes of claiming treaty benefits (rather than
providing a U.S. TIN on line 5, if required).
Nonresident alien who becomes a resident alien.
Generally, only a nonresident alien individual can use the
terms of a tax treaty to reduce or eliminate U.S. tax on
certain types of income. However, most tax treaties
contain a provision known as a “saving clause” which
preserves or “saves” the right of each country to tax its
own residents as if no tax treaty existed. Exceptions
specified in the saving clause may permit an exemption
from tax to continue for certain types of income even after
the recipient has otherwise become a U.S. resident alien
for tax purposes. The individual must use Form W-9 to
claim the tax treaty benefit. See the instructions for Form
W-9 for more information. Also see Nonresident alien
student or researcher who becomes a resident alien, later,
for an example.
Line 7. This line may be used by the filer of Form
W-8BEN or by the withholding agent to whom it is
provided to include any referencing information that is
useful to the withholding agent in carrying out its
obligations. For example, withholding agents who are
required to associate the Form W-8BEN with a particular
Form W-8IMY may want to use line 7 for a referencing
number or code that will make the association clear. A
beneficial owner can use line 7 to include the number of
the account for which he or she is providing the form. A
foreign single owner of a disregarded entity can use line 7
to inform the withholding agent that the account to which a
payment is made or credited is in the name of the
disregarded entity (see the instructions for line 1).
Scholarship and fellowship grants. A nonresident
alien student (including a trainee or business apprentice)
or researcher who receives noncompensatory scholarship
or fellowship income can use Form W-8BEN to claim
benefits under a tax treaty that apply to reduce or
eliminate U.S. tax on such income. No Form W-8BEN is
required unless a treaty benefit is being claimed. A
nonresident alien student or researcher who receives
compensatory scholarship or fellowship income must use
Form 8233, instead of Form W-8BEN, to claim any
benefits of a tax treaty that apply to that income. The
student or researcher must use Form W-4 for any part of
such income for which he or she is not claiming a tax
treaty withholding exemption. Do not use Form W-8BEN
for compensatory scholarship or fellowship income. See
Compensation for Dependent Personal Services in the
Instructions for Form 8233.
Line 8. If you are providing this Form W-8BEN to
document yourself as an account holder with respect to a
financial account as described above in line 6 that you
hold with a U.S. office of a financial institution (including a
U.S. branch of an FFI), provide your date of birth. Use the
following format to input your information: MM-DD-YYYY.
For example, if you were born on April 15, 1956, you
would enter 04-15-1956.
Part II
Line 9. If you are claiming treaty benefits as a resident of
a foreign country with which the United States has an
income tax treaty for payments subject to withholding
under chapter 3, identify the country where you claim to
be a resident for income tax treaty purposes. For treaty
purposes, a person is a resident of a treaty country if the
person is a resident of that country under the terms of the
treaty. A list of U.S. tax treaties is available at IRS.gov/
Individuals/International-Taxpayers/Tax-Treaties.
If you are a nonresident alien individual who
TIP received noncompensatory scholarship or
fellowship income and personal services income
(including compensatory scholarship or fellowship
income) from the same withholding agent, you may use
Form 8233 to claim a tax treaty withholding exemption for
part or all of both types of income.
If you are related to the withholding agent within
the meaning of section 267(b) or 707(b) and the
CAUTION aggregate amount subject to withholding received
during the calendar year exceeds $500,000, then you are
generally required to file Form 8833, Treaty-Based Return
Position Disclosure Under Section 6114 or 7701(b),
available at IRS.gov/Form8833. See the Instructions for
Form 8833 for more information on the filing requirements.
!
Completing lines 3 and 9. Most tax treaties that
contain an article exempting scholarship or fellowship
grant income from taxation require that the recipient be a
resident of the other treaty country at the time of, or
immediately prior to, entry into the United States. Thus, a
student or researcher may claim the exemption even if he
or she no longer has a permanent address in the other
treaty country after entry into the United States. If this is
the case, you can provide a U.S. address on line 3 and
still be eligible for the exemption if all other conditions
required by the tax treaty are met. You must also identify
on line 9 the tax treaty country of which you were a
resident at the time of, or immediately prior to, your entry
into the United States.
Completing line 10. You must complete line 10 if you
are a student or researcher claiming an exemption from
Line 10. Line 10 must be used only if you are claiming
treaty benefits that require that you meet conditions not
covered by the representations you make on line 9 and
Part III. For example, persons claiming treaty benefits on
royalties must complete this line if the treaty contains
different withholding rates for different types of royalties.
However, this line should always be completed by foreign
students and researchers claiming treaty benefits. See
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Appendix
subject to reporting rules and backup withholding unless
Form W-8BEN or a substitute form is filed to notify the
broker or barter exchange that you are an exempt foreign
person.
You are an exempt foreign person for a calendar year
in which:
You are a nonresident alien individual or a foreign
corporation, partnership, estate, or trust;
You are an individual who has not been, and does not
plan to be, present in the United States for a total of 183
days or more during the calendar year; and
You are neither engaged, nor plan to be engaged
during the year, in a U.S. trade or business that has
effectively connected gains from transactions with a
broker or barter exchange.
taxation on your noncompensatory scholarship or
fellowship grant income under a tax treaty.
Nonresident alien student or researcher who
becomes a resident alien. You must use Form W-9 to
claim an exception to a saving clause. See Nonresident
alien who becomes a resident alien, earlier, for a general
explanation of saving clauses and exceptions to them.
Example. Article 20 of the United States-China
income tax treaty allows an exemption from tax for
scholarship income received by a Chinese student
temporarily present in the United States. Under U.S. law,
this student will become a resident alien for tax purposes
if his or her stay in the United States exceeds 5 calendar
years. However, paragraph 2 of the first protocol to the
United States-China treaty (dated April 30, 1984) allows
the provisions of Article 20 to continue to apply even after
the Chinese student becomes a resident alien of the
United States. A Chinese student who qualifies for this
exception (under paragraph 2 of the first protocol) and is
relying on this exception to claim an exemption from tax
on his or her scholarship or fellowship income would
complete Form W-9.
Paperwork Reduction Act Notice. We ask for the
information on this form to carry out the Internal Revenue
laws of the United States. You are required to provide the
information. We need it to ensure that you are complying
with these laws and to allow us to figure and collect the
right amount of tax.
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.
Part III
Form W-8BEN must be signed and dated by the beneficial
owner of the amount subject to withholding or the account
holder of an FFI (or an agent with legal authority to act on
the person’s behalf). If Form W-8BEN is completed by an
agent acting under a duly authorized power of attorney for
the beneficial owner or account holder, the form must be
accompanied by the power of attorney in proper form or a
copy thereof specifically authorizing the agent to
represent the principal in making, executing, and
presenting the form. Form 2848 can be used for this
purpose. The agent, as well as the beneficial owner or
account holder, may incur liability for the penalties
provided for an erroneous, false, or fraudulent form.
A withholding agent may allow you to provide this form
with an electronic signature. The electronic signature must
indicate that the form was electronically signed by a
person authorized to do so (for example, with a time and
date stamp and statement that the form has been
electronically signed). Simply typing your name into the
signature line is not an electronic signature.
The time needed to complete and file this form will vary
depending on individual circumstances. The estimated
burden for business taxpayers filing this form is approved
under OMB control number 1545-0123. The estimated
burden for all other taxpayers who file this form is:
Recordkeeping, 2 hr., 52 min.; Learning about the law
or the form, 2 hr., 05 min.; Preparing the form, 2 hr., 13
min.
If you have comments concerning the accuracy of
these time estimates or suggestions for making this form
simpler, we would be happy to hear from you. You can
send us comments from IRS.gov/FormComments.
You can write to Internal Revenue Service, Tax Forms
and Publications, 1111 Constitution Ave. NW, IR-6526,
Washington, DC 20224. Do not send Form W-8BEN to
this office. Instead, give it to your withholding agent.
If any information on Form W-8BEN becomes
incorrect, you must submit a new form within 30
CAUTION days unless you are no longer an account holder
of the requester that is an FFI and you will not receive a
future payment with respect to the account.
!
Broker transactions or barter exchanges. Income
from transactions with a broker or a barter exchange is
Instructions for Form W-8BEN (Rev. 7-2017)
-7-
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A-145
The Payroll Source
W-9
Form
(Rev. October 2018)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
▶
Give Form to the
requester. Do not
send to the IRS.
Go to www.irs.gov/FormW9 for instructions and the latest information.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
Print or type.
See Specific Instructions on page 3.
2 Business name/disregarded entity name, if different from above
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
following seven boxes.
Individual/sole proprietor or
single-member LLC
C Corporation
S Corporation
Partnership
Trust/estate
Exempt payee code (if any)
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ▶
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
code (if any)
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
(Applies to accounts maintained outside the U.S.)
Other (see instructions) ▶
5 Address (number, street, and apt. or suite no.) See instructions.
Requester’s name and address (optional)
6 City, state, and ZIP code
7 List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later.
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter.
Part II
Social security number
–
–
or
Employer identification number
–
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign
Here
Signature of
U.S. person ▶
Date ▶
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X
A-146
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Form W-9 (Rev. 10-2018)
Appendix
Page 2
Form W-9 (Rev. 10-2018)
By signing the filled-out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee. If applicable, you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners' share of
effectively connected income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating
that you are exempt from the FATCA reporting, is correct. See What is
FATCA reporting, later, for further information.
Note: If you are a U.S. person and a requester gives you a form other
than Form W-9 to request your TIN, you must use the requester’s form if
it is substantially similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien;
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States;
• An estate (other than a foreign estate); or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United States are generally required to pay a withholding
tax under section 1446 on any foreign partners’ share of effectively
connected taxable income from such business. Further, in certain cases
where a Form W-9 has not been received, the rules under section 1446
require a partnership to presume that a partner is a foreign person, and
pay the section 1446 withholding tax. Therefore, if you are a U.S. person
that is a partner in a partnership conducting a trade or business in the
United States, provide Form W-9 to the partnership to establish your
U.S. status and avoid section 1446 withholding on your share of
partnership income.
In the cases below, the following person must give Form W-9 to the
partnership for purposes of establishing its U.S. status and avoiding
withholding on its allocable share of net income from the partnership
conducting a trade or business in the United States.
• In the case of a disregarded entity with a U.S. owner, the U.S. owner
of the disregarded entity and not the entity;
• In the case of a grantor trust with a U.S. grantor or other U.S. owner,
generally, the U.S. grantor or other U.S. owner of the grantor trust and
not the trust; and
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust
(other than a grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a
foreign bank that has elected to be treated as a U.S. person, do not use
Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see
Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign
Entities).
Nonresident alien who becomes a resident alien. Generally, only a
nonresident alien individual may use the terms of a tax treaty to reduce
or eliminate U.S. tax on certain types of income. However, most tax
treaties contain a provision known as a “saving clause.” Exceptions
specified in the saving clause may permit an exemption from tax to
continue for certain types of income even after the payee has otherwise
become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an exemption
from U.S. tax on certain types of income, you must attach a statement
to Form W-9 that specifies the following five items.
1. The treaty country. Generally, this must be the same treaty under
which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the
saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption
from tax.
5. Sufficient facts to justify the exemption from tax under the terms of
the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows an
exemption from tax for scholarship income received by a Chinese
student temporarily present in the United States. Under U.S. law, this
student will become a resident alien for tax purposes if his or her stay in
the United States exceeds 5 calendar years. However, paragraph 2 of
the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows
the provisions of Article 20 to continue to apply even after the Chinese
student becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2 of the first
protocol) and is relying on this exception to claim an exemption from tax
on his or her scholarship or fellowship income would attach to Form
W-9 a statement that includes the information described above to
support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the
appropriate completed Form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certain payments to you
must under certain conditions withhold and pay to the IRS 24% of such
payments. This is called “backup withholding.” Payments that may be
subject to backup withholding include interest, tax-exempt interest,
dividends, broker and barter exchange transactions, rents, royalties,
nonemployee pay, payments made in settlement of payment card and
third party network transactions, and certain payments from fishing boat
operators. Real estate transactions are not subject to backup
withholding.
You will not be subject to backup withholding on payments you
receive if you give the requester your correct TIN, make the proper
certifications, and report all your taxable interest and dividends on your
tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the instructions for
Part II for details),
3. The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding
because you did not report all your interest and dividends on your tax
return (for reportable interest and dividends only), or
5. You do not certify to the requester that you are not subject to
backup withholding under 4 above (for reportable interest and dividend
accounts opened after 1983 only).
Certain payees and payments are exempt from backup withholding.
See Exempt payee code, later, and the separate Instructions for the
Requester of Form W-9 for more information.
Also see Special rules for partnerships, earlier.
What is FATCA Reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a
participating foreign financial institution to report all United States
account holders that are specified United States persons. Certain
payees are exempt from FATCA reporting. See Exemption from FATCA
reporting code, later, and the Instructions for the Requester of Form
W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you
claimed to be an exempt payee if you are no longer an exempt payee
and anticipate receiving reportable payments in the future from this
person. For example, you may need to provide updated information if
you are a C corporation that elects to be an S corporation, or if you no
longer are tax exempt. In addition, you must furnish a new Form W-9 if
the name or TIN changes for the account; for example, if the grantor of a
grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $50 for each such failure
unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you
make a false statement with no reasonable basis that results in no
backup withholding, you are subject to a $500 penalty.
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A-147
The Payroll Source
Page 3
Form W-9 (Rev. 10-2018)
Criminal penalty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal penalties
including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of
federal law, the requester may be subject to civil and criminal penalties.
Specific Instructions
Line 1
You must enter one of the following on this line; do not leave this line
blank. The name should match the name on your tax return.
If this Form W-9 is for a joint account (other than an account
maintained by a foreign financial institution (FFI)), list first, and then
circle, the name of the person or entity whose number you entered in
Part I of Form W-9. If you are providing Form W-9 to an FFI to document
a joint account, each holder of the account that is a U.S. person must
provide a Form W-9.
a. Individual. Generally, enter the name shown on your tax return. If
you have changed your last name without informing the Social Security
Administration (SSA) of the name change, enter your first name, the last
name as shown on your social security card, and your new last name.
Note: ITIN applicant: Enter your individual name as it was entered on
your Form W-7 application, line 1a. This should also be the same as the
name you entered on the Form 1040/1040A/1040EZ you filed with your
application.
b. Sole proprietor or single-member LLC. Enter your individual
name as shown on your 1040/1040A/1040EZ on line 1. You may enter
your business, trade, or “doing business as” (DBA) name on line 2.
c. Partnership, LLC that is not a single-member LLC, C
corporation, or S corporation. Enter the entity's name as shown on the
entity's tax return on line 1 and any business, trade, or DBA name on
line 2.
d. Other entities. Enter your name as shown on required U.S. federal
tax documents on line 1. This name should match the name shown on the
charter or other legal document creating the entity. You may enter any
business, trade, or DBA name on line 2.
e. Disregarded entity. For U.S. federal tax purposes, an entity that is
disregarded as an entity separate from its owner is treated as a
“disregarded entity.” See Regulations section 301.7701-2(c)(2)(iii). Enter
the owner's name on line 1. The name of the entity entered on line 1
should never be a disregarded entity. The name on line 1 should be the
name shown on the income tax return on which the income should be
reported. For example, if a foreign LLC that is treated as a disregarded
entity for U.S. federal tax purposes has a single owner that is a U.S.
person, the U.S. owner's name is required to be provided on line 1. If
the direct owner of the entity is also a disregarded entity, enter the first
owner that is not disregarded for federal tax purposes. Enter the
disregarded entity's name on line 2, “Business name/disregarded entity
name.” If the owner of the disregarded entity is a foreign person, the
owner must complete an appropriate Form W-8 instead of a Form W-9.
This is the case even if the foreign person has a U.S. TIN.
Line 2
If you have a business name, trade name, DBA name, or disregarded
entity name, you may enter it on line 2.
Line 3
Check the appropriate box on line 3 for the U.S. federal tax
classification of the person whose name is entered on line 1. Check only
one box on line 3.
A-148
IF the entity/person on line 1 is
a(n) . . .
THEN check the box for . . .
• Corporation
Corporation
• Individual
Individual/sole proprietor or singlemember LLC
• Sole proprietorship, or
• Single-member limited liability
company (LLC) owned by an
individual and disregarded for U.S.
federal tax purposes.
• LLC treated as a partnership for
U.S. federal tax purposes,
• LLC that has filed Form 8832 or
2553 to be taxed as a corporation,
or
• LLC that is disregarded as an
entity separate from its owner but
the owner is another LLC that is
not disregarded for U.S. federal tax
purposes.
Limited liability company and enter
the appropriate tax classification.
(P= Partnership; C= C corporation;
or S= S corporation)
• Partnership
• Trust/estate
Partnership
Trust/estate
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting,
enter in the appropriate space on line 4 any code(s) that may apply to
you.
Exempt payee code.
• Generally, individuals (including sole proprietors) are not exempt from
backup withholding.
• Except as provided below, corporations are exempt from backup
withholding for certain payments, including interest and dividends.
• Corporations are not exempt from backup withholding for payments
made in settlement of payment card or third party network transactions.
• Corporations are not exempt from backup withholding with respect to
attorneys’ fees or gross proceeds paid to attorneys, and corporations
that provide medical or health care services are not exempt with respect
to payments reportable on Form 1099-MISC.
The following codes identify payees that are exempt from backup
withholding. Enter the appropriate code in the space in line 4.
1—An organization exempt from tax under section 501(a), any IRA, or
a custodial account under section 403(b)(7) if the account satisfies the
requirements of section 401(f)(2)
2—The United States or any of its agencies or instrumentalities
3—A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
4—A foreign government or any of its political subdivisions, agencies,
or instrumentalities
5—A corporation
6—A dealer in securities or commodities required to register in the
United States, the District of Columbia, or a U.S. commonwealth or
possession
7—A futures commission merchant registered with the Commodity
Futures Trading Commission
8—A real estate investment trust
9—An entity registered at all times during the tax year under the
Investment Company Act of 1940
10—A common trust fund operated by a bank under section 584(a)
11—A financial institution
12—A middleman known in the investment community as a nominee or
custodian
13—A trust exempt from tax under section 664 or described in section
4947
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
Appendix
Page 4
Form W-9 (Rev. 10-2018)
The following chart shows types of payments that may be exempt
from backup withholding. The chart applies to the exempt payees listed
above, 1 through 13.
IF the payment is for . . .
THEN the payment is exempt
for . . .
Interest and dividend payments
All exempt payees except
for 7
Broker transactions
Exempt payees 1 through 4 and 6
through 11 and all C corporations.
S corporations must not enter an
exempt payee code because they
are exempt only for sales of
noncovered securities acquired
prior to 2012.
Barter exchange transactions and
patronage dividends
Exempt payees 1 through 4
Payments over $600 required to be Generally, exempt payees
reported and direct sales over
1 through 52
$5,0001
Payments made in settlement of
Exempt payees 1 through 4
payment card or third party network
transactions
1
2
See Form 1099-MISC, Miscellaneous Income, and its instructions.
However, the following payments made to a corporation and
reportable on Form 1099-MISC are not exempt from backup
withholding: medical and health care payments, attorneys’ fees, gross
proceeds paid to an attorney reportable under section 6045(f), and
payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify
payees that are exempt from reporting under FATCA. These codes
apply to persons submitting this form for accounts maintained outside
of the United States by certain foreign financial institutions. Therefore, if
you are only submitting this form for an account you hold in the United
States, you may leave this field blank. Consult with the person
requesting this form if you are uncertain if the financial institution is
subject to these requirements. A requester may indicate that a code is
not required by providing you with a Form W-9 with “Not Applicable” (or
any similar indication) written or printed on the line for a FATCA
exemption code.
A—An organization exempt from tax under section 501(a) or any
individual retirement plan as defined in section 7701(a)(37)
B—The United States or any of its agencies or instrumentalities
C—A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
D—A corporation the stock of which is regularly traded on one or
more established securities markets, as described in Regulations
section 1.1472-1(c)(1)(i)
E—A corporation that is a member of the same expanded affiliated
group as a corporation described in Regulations section 1.1472-1(c)(1)(i)
F—A dealer in securities, commodities, or derivative financial
instruments (including notional principal contracts, futures, forwards,
and options) that is registered as such under the laws of the United
States or any state
G—A real estate investment trust
H—A regulated investment company as defined in section 851 or an
entity registered at all times during the tax year under the Investment
Company Act of 1940
I—A common trust fund as defined in section 584(a)
J—A bank as defined in section 581
K—A broker
L—A trust exempt from tax under section 664 or described in section
4947(a)(1)
M—A tax exempt trust under a section 403(b) plan or section 457(g)
plan
Note: You may wish to consult with the financial institution requesting
this form to determine whether the FATCA code and/or exempt payee
code should be completed.
Line 5
Enter your address (number, street, and apartment or suite number).
This is where the requester of this Form W-9 will mail your information
returns. If this address differs from the one the requester already has on
file, write NEW at the top. If a new address is provided, there is still a
chance the old address will be used until the payor changes your
address in their records.
Line 6
Enter your city, state, and ZIP code.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and
you do not have and are not eligible to get an SSN, your TIN is your IRS
individual taxpayer identification number (ITIN). Enter it in the social
security number box. If you do not have an ITIN, see How to get a TIN
below.
If you are a sole proprietor and you have an EIN, you may enter either
your SSN or EIN.
If you are a single-member LLC that is disregarded as an entity
separate from its owner, enter the owner’s SSN (or EIN, if the owner has
one). Do not enter the disregarded entity’s EIN. If the LLC is classified as
a corporation or partnership, enter the entity’s EIN.
Note: See What Name and Number To Give the Requester, later, for
further clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately.
To apply for an SSN, get Form SS-5, Application for a Social Security
Card, from your local SSA office or get this form online at
www.SSA.gov. You may also get this form by calling 1-800-772-1213.
Use Form W-7, Application for IRS Individual Taxpayer Identification
Number, to apply for an ITIN, or Form SS-4, Application for Employer
Identification Number, to apply for an EIN. You can apply for an EIN
online by accessing the IRS website at www.irs.gov/Businesses and
clicking on Employer Identification Number (EIN) under Starting a
Business. Go to www.irs.gov/Forms to view, download, or print Form
W-7 and/or Form SS-4. Or, you can go to www.irs.gov/OrderForms to
place an order and have Form W-7 and/or SS-4 mailed to you within 10
business days.
If you are asked to complete Form W-9 but do not have a TIN, apply
for a TIN and write “Applied For” in the space for the TIN, sign and date
the form, and give it to the requester. For interest and dividend
payments, and certain payments made with respect to readily tradable
instruments, generally you will have 60 days to get a TIN and give it to
the requester before you are subject to backup withholding on
payments. The 60-day rule does not apply to other types of payments.
You will be subject to backup withholding on all such payments until
you provide your TIN to the requester.
Note: Entering “Applied For” means that you have already applied for a
TIN or that you intend to apply for one soon.
Caution: A disregarded U.S. entity that has a foreign owner must use
the appropriate Form W-8.
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or
resident alien, sign Form W-9. You may be requested to sign by the
withholding agent even if item 1, 4, or 5 below indicates otherwise.
For a joint account, only the person whose TIN is shown in Part I
should sign (when required). In the case of a disregarded entity, the
person identified on line 1 must sign. Exempt payees, see Exempt payee
code, earlier.
Signature requirements. Complete the certification as indicated in
items 1 through 5 below.
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Form W-9 (Rev. 10-2018)
1. Interest, dividend, and barter exchange accounts opened
before 1984 and broker accounts considered active during 1983.
You must give your correct TIN, but you do not have to sign the
certification.
2. Interest, dividend, broker, and barter exchange accounts
opened after 1983 and broker accounts considered inactive during
1983. You must sign the certification or backup withholding will apply. If
you are subject to backup withholding and you are merely providing
your correct TIN to the requester, you must cross out item 2 in the
certification before signing the form.
3. Real estate transactions. You must sign the certification. You may
cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not
have to sign the certification unless you have been notified that you
have previously given an incorrect TIN. “Other payments” include
payments made in the course of the requester’s trade or business for
rents, royalties, goods (other than bills for merchandise), medical and
health care services (including payments to corporations), payments to
a nonemployee for services, payments made in settlement of payment
card and third party network transactions, payments to certain fishing
boat crew members and fishermen, and gross proceeds paid to
attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of
secured property, cancellation of debt, qualified tuition program
payments (under section 529), ABLE accounts (under section 529A),
IRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your correct
TIN, but you do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account:
Give name and SSN of:
1. Individual
The individual
2. Two or more individuals (joint
account) other than an account
maintained by an FFI
The actual owner of the account or, if
combined funds, the first individual on
3. Two or more U.S. persons
(joint account maintained by an FFI)
Each holder of the account
4. Custodial account of a minor
(Uniform Gift to Minors Act)
5. a. The usual revocable savings trust
(grantor is also trustee)
b. So-called trust account that is not
a legal or valid trust under state law
The minor
6. Sole proprietorship or disregarded
entity owned by an individual
The owner
7. Grantor trust filing under Optional
Form 1099 Filing Method 1 (see
Regulations section 1.671-4(b)(2)(i)
(A))
The grantor*
For this type of account:
1
the account
2
1
The grantor-trustee
1
The actual owner
3
Give name and EIN of:
8. Disregarded entity not owned by an
individual
The owner
9. A valid trust, estate, or pension trust
Legal entity
4
10. Corporation or LLC electing
corporate status on Form 8832 or
Form 2553
The corporation
11. Association, club, religious,
charitable, educational, or other taxexempt organization
The organization
12. Partnership or multi-member LLC
13. A broker or registered nominee
The partnership
The broker or nominee
A-150
For this type of account:
Give name and EIN of:
14. Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
The public entity
15. Grantor trust filing under the Form
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulations section 1.671-4(b)(2)(i)(B))
The trust
1
List first and circle the name of the person whose number you furnish.
If only one person on a joint account has an SSN, that person’s number
must be furnished.
2
Circle the minor’s name and furnish the minor’s SSN.
3
You must show your individual name and you may also enter your
business or DBA name on the “Business name/disregarded entity”
name line. You may use either your SSN or EIN (if you have one), but the
IRS encourages you to use your SSN.
4
List first and circle the name of the trust, estate, or pension trust. (Do
not furnish the TIN of the personal representative or trustee unless the
legal entity itself is not designated in the account title.) Also see Special
rules for partnerships, earlier.
*Note: The grantor also must provide a Form W-9 to trustee of trust.
Note: If no name is circled when more than one name is listed, the
number will be considered to be that of the first name listed.
Secure Your Tax Records From Identity Theft
Identity theft occurs when someone uses your personal information
such as your name, SSN, or other identifying information, without your
permission, to commit fraud or other crimes. An identity thief may use
your SSN to get a job or may file a tax return using your SSN to receive
a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a
notice from the IRS, respond right away to the name and phone number
printed on the IRS notice or letter.
If your tax records are not currently affected by identity theft but you
think you are at risk due to a lost or stolen purse or wallet, questionable
credit card activity or credit report, contact the IRS Identity Theft Hotline
at 1-800-908-4490 or submit Form 14039.
For more information, see Pub. 5027, Identity Theft Information for
Taxpayers.
Victims of identity theft who are experiencing economic harm or a
systemic problem, or are seeking help in resolving tax problems that
have not been resolved through normal channels, may be eligible for
Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD
1-800-829-4059.
Protect yourself from suspicious emails or phishing schemes.
Phishing is the creation and use of email and websites designed to
mimic legitimate business emails and websites. The most common act
is sending an email to a user falsely claiming to be an established
legitimate enterprise in an attempt to scam the user into surrendering
private information that will be used for identity theft.
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Appendix
Page 6
Form W-9 (Rev. 10-2018)
The IRS does not initiate contacts with taxpayers via emails. Also, the
IRS does not request personal detailed information through email or ask
taxpayers for the PIN numbers, passwords, or similar secret access
information for their credit card, bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS,
forward this message to [email protected] You may also report misuse
of the IRS name, logo, or other IRS property to the Treasury Inspector
General for Tax Administration (TIGTA) at 1-800-366-4484. You can
forward suspicious emails to the Federal Trade Commission at
[email protected] or report them at www.ftc.gov/complaint. You can
contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338).
If you have been the victim of identity theft, see www.IdentityTheft.gov
and Pub. 5027.
Visit www.irs.gov/IdentityTheft to learn more about identity theft and
how to reduce your risk.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your
correct TIN to persons (including federal agencies) who are required to
file information returns with the IRS to report interest, dividends, or
certain other income paid to you; mortgage interest you paid; the
acquisition or abandonment of secured property; the cancellation of
debt; or contributions you made to an IRA, Archer MSA, or HSA. The
person collecting this form uses the information on the form to file
information returns with the IRS, reporting the above information.
Routine uses of this information include giving it to the Department of
Justice for civil and criminal litigation and to cities, states, the District of
Columbia, and U.S. commonwealths and possessions for use in
administering their laws. The information also may be disclosed to other
countries under a treaty, to federal and state agencies to enforce civil
and criminal laws, or to federal law enforcement and intelligence
agencies to combat terrorism. You must provide your TIN whether or
not you are required to file a tax return. Under section 3406, payers
must generally withhold a percentage of taxable interest, dividend, and
certain other payments to a payee who does not give a TIN to the payer.
Certain penalties may also apply for providing false or fraudulent
information.
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The Payroll Source
Instructions for the
Requester of Form W-9
Department of the Treasury
Internal Revenue Service
(Rev. October 2018)
Request for Taxpayer Identification Number
and Certification
Section references are to the Internal Revenue Code unless
otherwise noted.
partnership's effectively connected income. For more
information, see Regulations section 1.1446-1.
Future Developments
A participating foreign financial institution (PFFI) should
request Form W-9 from an account holder that is a U.S. person.
If an account is jointly held, the PFFI should request a Form W-9
from each holder that is a U.S. person.
For the latest developments related to Form W-9 and its
instructions, such as legislation enacted after they were
published, go to IRS.gov/FormW9.
What’s New
Backup withholding rate. The backup withholding rate is 24%
for reportable payments.
Advise foreign persons to use the appropriate Form W-8 or
Form 8233, Exemption From Withholding on Compensation for
Independent (and Certain Dependent) Personal Services of a
Nonresident Alien Individual. See Pub. 515, Withholding of Tax
on Nonresident Aliens and Foreign Entities, for more information
and a list of the W-8 forms.
Reminders
Electronic Submission of Forms W-9
Backup withholding liability. If you do not collect backup
withholding from affected payees as required, you may become
liable for any uncollected amount.
Payee's agent. A payee's agent can be an investment advisor
(corporation, partnership, or individual) or an introducing broker.
An investment advisor must be registered with the Securities
and Exchange Commission (SEC) under the Investment
Advisers Act of 1940. The introducing broker is a broker-dealer
that is regulated by the SEC and the National Association of
Securities Dealers, Inc., and that is not a payer. Except for a
broker who acts as a payee's agent for “readily tradable
instruments,” the advisor or broker must show in writing to the
payer that the payee authorized the advisor or broker to transmit
the Form W-9 to the payer.
FATCA and backup withholding exemptions. FATCA
requires a participating foreign financial institution to report all
U.S. account holders that are specified U.S. persons. Form W-9
has an Exemptions box on the front of the form that includes
entry for the Exempt payee code (if any) and Exemption from
FATCA Reporting Code (if any). The references for the
appropriate codes are in the Exemptions section of Form W-9,
and in the Payees Exempt From Backup Withholding and
Payees and Account Holders Exempt From FATCA Reporting
sections of these instructions.
The Certification section in Part II of Form W-9 includes
certification relating to FATCA reporting.
TIN matching e-services. The IRS website offers TIN
Matching e-services for certain payers to validate name and TIN
combinations. See Taxpayer Identification Number (TIN)
Matching, later.
How Do I Know When To Use
Form W-9?
Use Form W-9 to request the taxpayer identification number
(TIN) of a U.S. person (including a resident alien) and to request
certain certifications and claims for exemption. (See Purpose of
Form on Form W-9.) Withholding agents may require signed
Forms W-9 from U.S. exempt recipients to overcome a
presumption of foreign status. For federal tax purposes, a U.S.
person includes but is not limited to:
• An individual who is a U.S. citizen or U.S. resident alien;
• A partnership, corporation, company, or association created
or organized in the United States or under the laws of the United
States;
• Any estate (other than a foreign estate); or
• A domestic trust (as defined in Regulations section
301.7701-7).
A partnership may require a signed Form W-9 from its U.S.
partners to overcome a presumption of foreign status and to
avoid withholding on the partner's allocable share of the
Sep 25, 2018
A-152
Requesters may establish a system for payees and payees'
agents to submit Forms W-9 electronically, including by fax. A
requester is anyone required to file an information return. A
payee is anyone required to provide a taxpayer identification
number (TIN) to the requester.
Electronic system. Generally, the electronic system must:
• Ensure the information received is the information sent, and
document all occasions of user access that result in the
submission;
• Make reasonably certain that the person accessing the
system and submitting the form is the person identified on Form
W-9, the investment advisor, or the introducing broker;
• Provide the same information as the paper Form W-9;
• Be able to supply a hard copy of the electronic Form W-9 if
the Internal Revenue Service requests it; and
• Require as the final entry in the submission an electronic
signature by the payee whose name is on Form W-9 that
authenticates and verifies the submission. The electronic
signature must be under penalties of perjury and the perjury
statement must contain the language of the paper Form W-9.
For Forms W-9 that are not required to be signed, the
TIP electronic system need not provide for an electronic
signature or a perjury statement.
For more details, see the following.
• Announcement 98-27, which is on page 30 of Internal
Revenue Bulletin 1998-15 at IRS.gov/pub/irs-irbs/irb98-15.pdf.
• Announcement 2001-91, which is on page 221 of Internal
Revenue Bulletin 2001-36 at IRS.gov/pub/irs-irbs/irb01-36.pdf.
Cat. No. 20479P
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Appendix
Individual Taxpayer Identification
Number (ITIN)
“The Internal Revenue Service does not require your consent
to any provision of this document other than the certifications
required to avoid backup withholding.”
Form W-9 (or an acceptable substitute) is used by persons
required to file information returns with the IRS to get the payee's
(or other person's) correct name and TIN. For individuals, the
TIN is generally a social security number (SSN).
If you use a substitute form, you are required to provide the
Form W-9 instructions to the payee only if he or she requests
them. However, if the IRS has notified the payee that backup
withholding applies, then you must instruct the payee to strike
out the language in the certification that relates to
underreporting. This instruction can be given orally or in writing.
See item 2 of the Certification on Form W-9. You can replace
“defined below” with “defined in the instructions” in item 3 of the
Certification on Form W-9 when the instructions will not be
provided to the payee except upon request. For more
information, see Rev. Proc. 83-89,1983-2 C.B. 613; amplified by
Rev. Proc. 96-26, which is on page 22 of Internal Revenue
Bulletin 1996-8 at IRS.gov/pub/irs-irbs/irb96-08.pdf.
However, in some cases, individuals who become U.S.
resident aliens for federal tax purposes are not eligible to obtain
an SSN. This includes certain resident aliens who must receive
information returns but who cannot obtain an SSN.
These individuals must apply for an ITIN on Form W-7,
Application for IRS Individual Taxpayer Identification Number,
unless they have an application pending for an SSN. Individuals
who have an ITIN must provide it on Form W-9.
TIN Applied For
Note. ITINs that haven’t been included on a U.S. federal tax
return at least once in the last 3 consecutive tax years will expire.
Expired ITINs must be renewed in order to avoid delays in
processing the ITIN holder’s tax return. If the IRS deactivates the
ITIN because it has expired, the ITIN may still be used on Form
W-9. However, the ITIN holder will have to apply to renew the
deactivated ITIN if there is a need to file a tax return. For more
information, see the Instructions for Form W-7.
For interest and dividend payments and certain payments with
respect to readily tradable instruments, the payee may return a
properly completed, signed Form W-9 to you with “Applied For”
written in Part I. This is an “awaiting-TIN” certificate. The payee
has 60 calendar days, from the date you receive this certificate,
to provide a TIN. If you do not receive the payee's TIN at that
time, you must begin backup withholding on payments.
Substitute Form W-9
Reserve rule. You must backup withhold on any reportable
payments made during the 60-day period if a payee withdraws
more than $500 at one time, unless the payee reserves an
amount equal to the current year's backup withholding rate on all
reportable payments made to the account.
You may develop and use your own Form W-9 (a substitute
Form W-9) if its content is substantially similar to the official IRS
Form W-9 and it satisfies certain certification requirements.
You may incorporate a substitute Form W-9 into other
business forms you customarily use, such as account signature
cards. However, the certifications on the substitute Form W-9
must clearly state (as shown on the official Form W-9) that under
penalties of perjury:
1. The payee's TIN is correct,
2. The payee is not subject to backup withholding due to
failure to report interest and dividend income,
3. The payee is a U.S. person, and
4. The FATCA code entered on this form (if any) indicating
that the payee is exempt from FATCA reporting is correct.
Alternative rule. You also may elect to backup withhold during
this 60-day period, after a 7-day grace period, under one of the
two alternative rules discussed below.
Option 1. Backup withhold on any reportable payments if the
payee makes a withdrawal from the account after the close of 7
business days after you receive the awaiting-TIN certificate.
Treat as reportable payments all cash withdrawals in an amount
up to the reportable payments made from the day after you
receive the awaiting-TIN certificate to the day of withdrawal.
Option 2. Backup withhold on any reportable payments
made to the payee's account, regardless of whether the payee
makes any withdrawals, beginning no later than 7 business days
after you receive the awaiting-TIN certificate.
You may provide certification instructions on a substitute
Form W-9 in a manner similar to the official form. If you are not
collecting a FATCA exemption code by omitting that field from
the substitute Form W-9 (see Payees and Account Holders
Exempt From FATCA Reporting, later), you may notify the payee
that item 4 does not apply.
The 60-day exemption from backup withholding does
not apply to any payment other than interest, dividends,
CAUTION and certain payments relating to readily tradable
instruments. Any other reportable payment, such as
nonemployee compensation, is subject to backup withholding
immediately, even if the payee has applied for and is awaiting a
TIN.
!
You may not:
1. Use a substitute Form W-9 that requires the payee, by
signing, to agree to provisions unrelated to the required
certifications, or
2. Imply that a payee may be subject to backup withholding
unless the payee agrees to provisions on the substitute form that
are unrelated to the required certifications.
Even if the payee gives you an awaiting-TIN certificate, you must
backup withhold on reportable interest and dividend payments if
the payee does not certify, under penalties of perjury, that the
payee is not subject to backup withholding.
If you do not collect backup withholding from affected payees as
required, you may become liable for any uncollected amount.
A substitute Form W-9 that contains a separate signature line
just for the certifications satisfies the requirement that the
certifications be clearly stated.
Payees Exempt From Backup
Withholding
If a single signature line is used for the required certifications
and other provisions, the certifications must be highlighted,
boxed, printed in bold-face type, or presented in some other
manner that causes the language to stand out from all other
information contained on the substitute form. Additionally, the
following statement must be presented to stand out in the same
manner as described above and must appear immediately
above the single signature line:
The following payees are exempt from backup withholding with
respect to the payments below, and should enter the
corresponding exempt payee code on Form W-9. You may rely
on the payee’s claim of exemption unless you have actual
knowledge that the exempt payee code and/or classification
selected are not valid, or if they are inconsistent with each other.
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Instr. for Req. of Form W-9 (Rev. 10-2018)
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The Payroll Source
Payments Exempt From Backup
Withholding
In that case, you may rely on the Form W-9 for purposes of
obtaining the payee’s TIN, but you must treat the payee as
non-exempt. If the payee failed to enter an exempt payee code,
but the classification selected indicates that the payee is
exempt, you may accept the classification and treat the payee as
exempt unless you have actual knowledge that the classification
is not valid.
Payments that are not subject to information reporting also are
not subject to backup withholding. For details, see sections
6041, 6041A, 6042, 6044, 6045, 6049, 6050A, 6050N, and
6050W and their regulations. The following payments generally
are exempt from backup withholding.
If the payee is not exempt, you are required to backup
withhold on reportable payments if the payee does not provide a
TIN in the manner required or does not sign the certification, if
required.
1. An organization exempt from tax under
section 501(a), any IRA, or a custodial account under section
403(b)(7) if the account satisfies the requirements of section
401(f)(2);
2. The United States or any of its agencies or
instrumentalities;
3. A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions, agencies, or
instrumentalities;
4. A foreign government or any of its political subdivisions,
agencies, or instrumentalities;
5. A corporation;
6. A dealer in securities or commodities required to register
in the United States, the District of Columbia, or a U.S.
commonwealth or possession;
7. A futures commission merchant registered with the
Commodity Futures Trading Commission;
8. A real estate investment trust;
9. An entity registered at all times during the tax year under
the Investment Company Act of 1940;
10. A common trust fund operated by a bank under
section 584(a);
11. A financial institution;
12. A middleman known in the investment community as a
nominee or custodian; or
13. A trust exempt from tax under section 664 or described in
section 4947.
Dividends and patronage dividends.
• Payments to nonresident aliens subject to withholding under
section 1441.
• Payments to partnerships not engaged in a trade or business
in the United States and that have at least one nonresident alien
partner.
• Payments of patronage dividends not paid in money.
• Payments made by certain foreign organizations.
• Section 404(k) distributions made by an ESOP.
Interest payments.
• Payments of interest on obligations issued by individuals.
However, if you pay $600 or more of interest in the course of
your trade or business to a payee, you must report the payment.
Backup withholding applies to the reportable payment if the
payee has not provided a TIN or has provided an incorrect TIN.
• Payments described in section 6049(b)(5) to nonresident
aliens.
• Payments on tax-free covenant bonds under
section 1451.
• Payments made by certain foreign organizations.
• Mortgage or student loan interest paid to you.
Other types of payment.
• Wages.
• Distributions from a pension, annuity, profit-sharing or stock
bonus plan, any IRA, an owner-employee plan, or other deferred
compensation plan.
• Distributions from a medical or health savings account and
long-term care benefits.
• Certain surrenders of life insurance contracts.
• Distribution from qualified tuition programs or
Coverdell ESAs.
• Gambling winnings if regular gambling winnings withholding is
required under section 3402(q). However, if regular gambling
winnings withholding is not required under section 3402(q),
backup withholding applies if the payee fails to furnish a TIN.
• Real estate transactions reportable under
section 6045(e).
• Cancelled debts reportable under section 6050P.
• Fish purchases for cash reportable under
section 6050R.
The following types of payments are exempt from backup
withholding as indicated for payees listed in 1 through 13 above.
Interest and dividend payments. All listed payees are exempt
except the payee in item 7.
Broker transactions. All payees listed in items 1 through 4 and
6 through 11 are exempt. Also, C corporations are exempt. A
person registered under the Investment Advisers Act of 1940
who regularly acts as a broker also is exempt.
Payees and Account Holders Exempt
From FATCA Reporting
Barter exchange transactions and patronage dividends.
Only payees listed in items 1 through 4 are exempt.
Reporting under chapter 4 (FATCA) with respect to U.S. persons
generally applies only to foreign financial institutions (FFI)
(including a branch of a U.S. financial institution that is treated as
an FFI under an applicable intergovernmental agreement (IGA)).
Thus, for example, a U.S. financial institution maintaining an
account in the United States does not need to collect an
exemption code for FATCA reporting. If you are providing a
Form W-9, you may pre-populate the FATCA exemption code
with "Not Applicable," "N/A," or a similar indication that an
exemption from FATCA reporting does not apply. Any payee that
provides such a form, however, cannot be treated as exempt
from FATCA reporting. For details on the FATCA reporting
requirements, including specific information regarding which
financial institutions are required to report, see sections 1471 to
1474 and related regulations. See Regulations section
1.1471-3(d)(2) for when an FFI may rely on documentary
Payments reportable under sections 6041 and 6041A.
Payees listed in items 1 through 5 generally are exempt.
However, the following payments made to a corporation and
reportable on Form 1099-MISC, Miscellaneous Income, are not
exempt from backup withholding.
• Medical and health care payments.
• Attorneys' fees (also gross proceeds paid to an attorney,
reportable under section 6045(f)).
• Payments for services paid by a federal executive agency.
(See Rev. Rul. 2003-66, which is on page 1115 of Internal
Revenue Bulletin 2003-26 at IRS.gov/pub/irs-irbs/irb03-26.pdf.)
Payments made in settlement of payment card or third party network transactions. Only payees listed in items 1 through
4 are exempt.
Instr. for Req. of Form W-9 (Rev. 10-2018)
A-154
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Appendix
If any one of the joint payees who has not established foreign
status gives you a TIN, use that number for purposes of backup
withholding and information reporting.
evidence to treat a U.S. person as other than a specified U.S.
person and see Regulations section 1.1471-3(f)(3) for when an
FFI may presume a U.S. person as other than a specified U.S.
person.
For more information on foreign payees, see the Instructions
for the Requester of Forms W-8BEN, W-8BEN-E, W-8ECI,
W-8EXP, and W-8IMY.
If you receive a Form W-9 with a FATCA exemption code and
you know or have reason to know the person is a specified U.S.
person, you may not rely on the Form W-9 to treat the person as
exempt from FATCA reporting. However, you may still rely on an
otherwise completed Form W-9 to treat a person as a specified
U.S. person. An exemption from FATCA reporting (or lack
thereof) does not affect backup withholding as described earlier
in these instructions. The following are not specified U.S.
persons and are thus exempt from FATCA reporting.
Names and TINs To Use
for Information Reporting
Show the full name and address as provided on Form W-9 on
the information return filed with the IRS and on the copy
furnished to the payee. If the payee has marked their address
“NEW”, you should update your records. If you made payments
to more than one payee or the account is in more than one
name, enter on the first name line of the information return only
the name of the payee whose TIN is shown on Form W-9. You
may show the names of any other individual payees in the area
below the first name line on the information return. Forms W-9
showing an ITIN must have the name exactly as shown on
line 1a of the Form W-7 application. If you are a PFFI reporting a
U.S. account on Form 8966, FATCA Report, and the account is
jointly held by U.S. persons, file a separate Form 8966 for each
holder.
A. An organization exempt from tax under section 501(a), or
any individual retirement plan as defined in section 7701(a)(37);
B. The United States or any of its agencies or
instrumentalities;
C. A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions, agencies, or
instrumentalities;
D. A corporation the stock of which is regularly traded on one
or more established securities markets, as described in
Regulations 1.1472-1(c)(1)(i);
For more information on the names and TINs to use for
TIP information reporting, see section J of the General
E. A corporation that is a member of the same expanded
affiliated group as a corporation described in Regulations
1.1472-1(c)(1)(i);
Instructions for Certain Information Returns.
Notices From the IRS
F. A dealer in securities, commodities, or derivative financial
instruments (including notional principal contracts, futures,
forwards, and options) that is registered as such under the laws
of the United States or any State;
The IRS will send you a notice if the payee's name and TIN on
the information return you filed do not match the IRS's records.
(See Taxpayer Identification Number (TIN) Matching, next.) If
you receive a backup withholding notice, you may have to send
a “B” notice to the payee to solicit another TIN. Pub. 1281,
Backup Withholding for Missing and Incorrect Name/TIN(s),
contains copies of the two types of “B” notices. If you receive a
penalty notice, you also may have to send a solicitation to the
payee. See Pub. 1586, Reasonable Cause Regulations and
Requirements for Missing and Incorrect Name/TINs.
G. A real estate investment trust;
H. A regulated investment company as defined in section
851 or an entity registered at all times during the tax year under
the Investment Company Act of 1940;
I. A common trust fund as defined in section 584(a);
J. A bank as defined in section 581;
Taxpayer Identification Number (TIN)
Matching
K. A broker;
L. A trust exempt from tax under section 664 or described in
section 4947; or
TIN Matching allows a payer or authorized agent who is required
to file Forms 1099-B, DIV, INT, K, MISC, OID, and/or PATR to
match TIN and name combinations with IRS records before
submitting the forms to the IRS. TIN Matching is one of the
e-services products that is offered and is accessible through the
IRS website. Go to IRS.gov and enter “e-services” in the search
box. It is anticipated that payers who validate the TIN and name
combinations before filing information returns will receive fewer
backup withholding (CP2100) notices and penalty notices.
M. A tax-exempt trust under a section 403(b) plan or section
457(g) plan.
Joint Foreign Payees
If the first payee listed on an account gives you a
Form W-8 or a similar statement signed under penalties of
perjury, backup withholding applies unless:
1. Every joint payee provides the statement regarding
foreign status, or
2. Any one of the joint payees who has not established
foreign status gives you a TIN.
Additional Information
For more information on backup withholding, see Pub. 1281.
-4-
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Instr. for Req. of Form W-9 (Rev. 10-2018)
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A-156
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Appendix
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Appendix
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Appendix
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Appendix
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A-164
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Appendix
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Appendix
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A-170
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Appendix
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Appendix
Form
673
(Rev. December 2007)
Department of the Treasury
Internal Revenue Service
Statement for Claiming Exemption From Withholding
on Foreign Earned Income Eligible for the Exclusion(s)
Provided by Section 911
OMB No. 1545-0074
The following statement, when completed and furnished by a citizen of the United States to his or her employer, permits the
employer to exclude from income tax withholding all or a part of the wages paid for services performed outside the United
States.
Name (please print or type)
Part I
Social security number
Qualification Information for Foreign Earned Income Exclusion
I expect to qualify for the foreign earned income exclusion under either the bona fide residence or physical presence test for
calendar year
or other tax year beginning
and ending
.
Please check applicable box:
Bona Fide Residence Test
I am a citizen of the United States. I have been a bona fide resident of and my tax home has been located in
(foreign country or countries) for an uninterrupted
period which includes an entire tax year that began on
, 20
.
(date)
I expect to remain a bona fide resident and retain my tax home in a foreign country (or countries) until the end of the tax
year for which this statement is made. Or, if not that period, from the date of this statement until
, 20
.
(date within tax year)
I have not submitted a statement to the authorities of any foreign country named above that I am not a resident of that
country. Or, if I made such a statement, the authorities of that country thereafter made a determination to the effect that I
am a resident of that country.
Based on the facts in my case, I have good reason to believe that for this period of foreign residence I will satisfy the
tax home and the bona fide foreign resident requirements prescribed by section 911(d)(1)(A) of the Internal Revenue Code
and qualify for the exclusion Code section 911(a) allows.
Physical Presence Test
I am a citizen of the United States. Except for occasional absences that will not disqualify me for the benefit of section
911(a) of the Internal Revenue Code, I expect to be present in and maintain my tax home in
(foreign country or countries) for a 12-month
period that includes the entire tax year
. Or, if not the entire year, for the part of the tax year beginning
on
, 20
, and ending on
, 20
.
Based on the facts in my case, I have good reason to believe that for this period of presence in a foreign country or
countries, I will satisfy the tax home and the 330 full-day requirements within a 12-month period under section 911(d)(1)(B).
Part II
1
2
3
4
5
6
7
8
9
Estimated Housing Cost Amount for Foreign Housing Exclusion (see instructions)
Rent
Utilities (other than telephone charges)
Real and personal property insurance
Occupancy tax not deductible under section 164
Nonrefundable fees paid for securing a leasehold
Household repairs
Estimated qualified housing expenses. Add lines 1 through 6
Estimated base housing amount for qualifying period
Subtract line 8 from line 7. This is your estimated housing cost amount
Part III
1
2
3
4
5
6
7
8
9
Certification
Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge
and belief it is true, correct, and complete. I further certify under penalties of perjury that:
● The estimated housing cost amount entered in Part II, plus the amount reported on any other statements outstanding with
other employers, is not more than my total estimated housing cost amount.
● If I become disqualified for the exclusions, I will immediately notify my employer and advise what part, if any, of the period
for which I am qualified.
I understand that any exemption from income tax withholding permitted by reason of furnishing this statement is not a
determination by the Internal Revenue Service that any amount paid to me for any services performed during the tax year is
excludable from gross income under the provisions of Code section 911(a).
Your Signature
For Paperwork Reduction Act Notice, see back of form.
Date
Cat. No. 10183Y
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Form
673
(Rev. 12-2007)
A-173
The Payroll Source
Form 673 (Rev. 12-2007)
Instructions
Information for Employee
File Form 673 with your U.S. employer to claim an exemption
from U.S. income tax withholding on wages earned abroad
to the extent of the foreign earned income exclusion and
foreign housing exclusion. Your employer will then withhold
the correct amount of federal income tax from your pay.
Even though you may qualify for the foreign earned income
exclusion, you must file Form 2555, Foreign Earned Income,
or Form 2555-EZ, Foreign Earned Income Exclusion, with
your Form 1040, U.S. Individual Income Tax Return, to claim
your exclusion. You must file Form 2555 to claim the foreign
housing exclusion.
Estimated housing cost amount. The amount of qualified
housing expenses eligible for the housing exclusion is limited
depending on the location of your foreign tax home. See
Pub. 54, Tax Guide for U.S. Citizens and Resident Aliens
Abroad, and the Instructions for Form 2555 for more details.
Information for Employer
Once you have received Form 673 completed by the
employee, you may discontinue withholding of U.S. income
tax on those wages that qualify for the exclusion(s). If for any
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2
reason you believe the employee will not qualify for the
exclusion(s), you should disregard Form 673.
Note. If you have questions about the exclusion(s), see
Pub. 54.
Paperwork Reduction Act Notice
We ask for the information on this form to carry out the
Internal Revenue laws of the United States. If you want to
claim an exemption from withholding, you are required to
give this form (or similar statement) to your employer.
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
Code section 6103.
The average time and expenses required to complete and
file this form will vary depending on individual circumstances.
For the estimated averages, see the instructions for your
income tax return.
If you have suggestions for making this form simpler, we
would be happy to hear from you. See the instructions for
your income tax return.
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Appendix
Form
843
Claim for Refund and Request for Abatement
OMB No. 1545-0024
(Rev. August 2011)
Department of the Treasury
Internal Revenue Service
▶
See separate instructions.
Use Form 843 if your claim or request involves:
(a) a refund of one of the taxes (other than income taxes or an employer’s claim for FICA tax, RRTA tax, or income tax
withholding) or a fee, shown on line 3,
(b) an abatement of FUTA tax or certain excise taxes, or
(c) a refund or abatement of interest, penalties, or additions to tax for one of the reasons shown on line 5a.
Do not use Form 843 if your claim or request involves:
(a) an overpayment of income taxes or an employer’s claim for FICA tax, RRTA tax, or income tax withholding (use the
appropriate amended tax return),
(b)
(c)
a refund of excise taxes based on the nontaxable use or sale of fuels, or
an overpayment of excise taxes reported on Form(s) 11-C, 720, 730, or 2290.
Name(s)
Your social security number
Address (number, street, and room or suite no.)
Spouse’s social security number
City or town, state, and ZIP code
Employer identification number (EIN)
Name and address shown on return if different from above
Daytime telephone number
1
3
4
5a
Period. Prepare a separate Form 843 for each tax period or fee year.
2 Amount to be refunded or abated:
From
to
$
Type of tax or fee. Indicate the type of tax or fee to be refunded or abated or to which the interest, penalty, or addition to tax
is related.
Employment
Estate
Gift
Excise
Income
Fee
Type of penalty. If the claim or request involves a penalty, enter the Internal Revenue Code section on which the penalty is
based (see instructions). IRC section:
Interest, penalties, and additions to tax. Check the box that indicates your reason for the request for refund or abatement. (If
none apply, go to line 6.)
Interest was assessed as a result of IRS errors or delays.
A penalty or addition to tax was the result of erroneous written advice from the IRS.
Reasonable cause or other reason allowed under the law (other than erroneous written advice) can be shown for not
assessing a penalty or addition to tax.
b Date(s) of payment(s) ▶
6
7
Original return. Indicate the type of fee or return, if any, filed to which the tax, interest, penalty, or addition to tax relates.
706
709
940
941
943
945
990-PF
1040
1120
4720
Other (specify) ▶
Explanation. Explain why you believe this claim or request should be allowed and show the computation of the amount shown
on line 2. If you need more space, attach additional sheets.
Signature. If you are filing Form 843 to request a refund or abatement relating to a joint return, both you and your spouse must sign the claim.
Claims filed by corporations must be signed by a corporate officer authorized to sign, and the officer’s title must be shown.
Under penalties of perjury, I declare that I have examined this claim, including accompanying schedules and statements, and, to the best of my knowledge and belief, it is
true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Signature (Title, if applicable. Claims by corporations must be signed by an officer.)
Date
Signature (spouse, if joint return)
Paid
Preparer
Use Only
Date
Print/Type preparer’s name
Firm’s name
Preparer's signature
▶
Firm's address ▶
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Date
Check
if
self-employed
PTIN
Firm's EIN ▶
Phone no.
Cat. No. 10180R
Form 843 (Rev. 8-2011)
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The Payroll Source
Note: Instructions for Form 843 (Rev. December 2013) begins on the
next page.
Effective August 28, 2014, if you are filing Form 843 in response to Letter 5067C
(Annual Fee on Health Insurance Providers Final fee), note that the following address is
being added to the Where To File table in the Instructions for Form 843 (Rev.
December 2013). The address to mail Form 843 in this case is:
Internal Revenue Service
Mailstop 4921 IPF
1973 Rulon White Blvd.
Ogden, UT 84201
The above address is effective ONLY if you are filing Form 843 in
response to Letter 5067C (Annual Fee on Health Insurance Providers Final Fee).
Please see the modifications to the Where to File Table below.
Where To File
IF you are filing Form 843...
THEN mail the form to...
In response to an IRS notice
regarding a tax or fee related to
certain taxes such as income,
employment, gift, estate, excise,
etc.
The address shown in the notice.
For penalties, or for any other
reason other than an IRS notice
(see above) or Letter 4658 or
5067C (see below)
The service center where you
would be required to a file a
current year tax return for the tax
to which your claim or request
relates. See the instructions for
the return you are filing.
In response to Letter 4658 (Notice Internal Revenue Service
of Branded Prescription Drug Fee) Mail Stop 4921 BPDF
1973 Rulon White Blvd.
Note. To ensure proper
Ogden, UT 84201
processing, write “Branded
Prescription Drug Fee” across the Caution. Use this address only if
top of Form 843.
you are claiming a refund of the
branded prescription drug fee.
In response to Letter 5067C
(Annual Fee on Health Insurance
Providers Final Fee)
Note. To ensure proper
processing, write “Annual Fee on
Health Insurance Providers Final
Fee” across the top of Form 843.
The service center where you filed
your most recent return.
Internal Revenue Service
Mail Stop 4921 IPF
1973 Rulon White Blvd.
Ogden, UT 84201
Caution. Use this address only if
you are claiming a refund of the
health insurance provider fee.
For requests of a net interest rate
of zero
This change will be reflected in the next revision of the Instructions for Form 843.
A-176
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Appendix
Instructions for Form 843
(Rev. December 2013)
Department of the Treasury
Internal Revenue Service
(For use with Form 843 (Rev. August 2011))
Claim for Refund and Request for Abatement
Section references are to the Internal Revenue Code unless
otherwise noted.
A refund of a branded prescription drug fee.
If you received an IRS notice notifying you of a change
to an item on your tax return, or that you owe interest, a
penalty, or addition to tax, follow the instructions on the
notice. You may not have to file Form 843.
TIP
General Instructions
Future Developments
For the latest information about developments related to Form
843 and its instructions, such as legislation enacted after they
were published, go to www.irs.gov/form843.
Purpose of Form
Use Form 843 to claim a refund or request an abatement of
certain taxes, interest, penalties, fees, and additions to tax.
Note. If you are filing Form 843 to claim a refund of the branded
prescription drug fee, please write “Branded Prescription Drug
Fee” across the top of Form 843.
Do not use Form 843 to request a refund of income tax or
Additional Medicare Tax. Employers cannot use Form 843 to
request a refund of Federal Insurance Contributions Act (FICA)
tax, Railroad Retirement Tax Act (RRTA) tax, or income tax
withholding. Also do not use Form 843 to amend a previously
filed income or employment tax return. Do not use Form 843 to
claim a refund of agreement fees, offer-in-compromise fees, or
lien fees.
Note. You cannot use Form 843 to request an abatement of
income, estate, or gift taxes. Employers cannot use Form 843 to
request abatement of FICA tax, RRTA tax, or income tax
withholding.
Use Form 843 to claim or request the following.
A refund of tax, other than a tax for which a different form must
be used. (See Do not use Form 843 when you must use a
different tax form, next.)
An abatement of tax, other than income, estate, or gift tax.
Employers cannot use Form 843 to request an abatement of
FICA tax, RRTA tax, or income tax withholding.
A refund to an employee of excess social security or RRTA
tax withheld by any one employer, but only if your employer will
not adjust the overcollection. See the instructions for line 7.
A refund to an employee of social security or Medicare taxes
that were withheld in error, but only if your employer will not
adjust the overcollection. See the instructions for Line 7. If you
are a nonresident alien, see Pub. 519 for specific instructions.
A refund of excess tier 2 RRTA tax when you had more than
one railroad employer for the year and your total tier 2 RRTA tax
withheld or paid for the year was more than the tier 2 limit. See
the instructions for line 3.
A refund or abatement of interest, penalties, or additions to
tax, caused by certain IRS errors or delays, or certain erroneous
written advice from the IRS.
A refund or abatement of a penalty or addition to tax due to
reasonable cause or other reason (other than erroneous written
advice provided by the IRS) allowed under the law.
A refund of the penalty imposed under section 6715 for
misuse of dyed fuel.
A refund or abatement of tier 1 RRTA tax for an employee
representative.
Dec 30, 2013
Do not use Form 843 when you must use a different tax
form.
Use Form 1040X, Amended U.S. Individual Income Tax
Return, to change any amounts reported on Form 1040, 1040A,
1040EZ, 1040NR, or 1040NR-EZ, to change amounts previously
adjusted by the IRS, or to make certain elections after the
prescribed deadline (see Regulations sections 301.9100-1
through -3).
Use Form 1040X and attach a corrected Form 8959,
Additional Medicare Tax, to correct your liability for Additional
Medicare Tax. If your Medicare wages, RRTA compensation, or
self-employment income is adjusted, you may need to correct
your liability, if any, for Additional Medicare Tax.
Use Form 8379, Injured Spouse Allocation, to claim your
portion of a joint refund used to offset your spouse's past due
obligations.
Individuals, estates, and trusts filing within 1 year after the end
of the year in which a claim of right adjustment under section
1341(b)(1), a net operating loss (NOL), a general business
credit, or net section 1256 contracts loss arose, can use Form
1045, Application for Tentative Refund, to apply for a “quick
refund” resulting from any overpayment of tax due to the claim of
right adjustment or the carryback of the loss or unused credit.
Individuals also can get a refund by filing Form 1040X instead of
Form 1045. An estate or trust can file an amended Form 1041,
U.S. Income Tax Return for Estates and Trusts.
Use Form 940, Employer's Annual Federal Unemployment
(FUTA) Tax Return, to amend a previously filed Form 940. See
the Instructions for Form 940.
Employers must use the tax form that corresponds to the tax
return previously filed to make an adjustment or claim a refund or
abatement of FICA tax, RRTA tax, or income tax withholding.
IF you filed...
CORRECT using...
Form 941 or Form 941-SS
Form 941-X
Form 943
Form 943-X
Form 944 or Form 944-SS
Form 944-X
Form 945
Form 945-X
Form CT-1
Form CT-1 X
Formulario 941-PR
Formulario 941-X (PR)
Formulario 943-PR
Formulario 943-X (PR)
Formulario 944-PR
Formulario 944-X (PR)
Formulario 944 (SP)
Formulario 944-X (SP)
If you filed Schedule H (Form 1040) or Anexo H-PR (Formulario 1040-PR), see Pub.
926, Household Employer's Tax Guide, for how to correct that form.
For more information, see Treasury Decision 9405 at
www.irs.gov/irb/2008-32_IRB/ar13.html.
Use Form 1120X, Amended U.S. Corporation Income Tax
Return, to correct Form 1120 or 1120-A as originally filed, or as
Cat. No. 11200I
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A-177
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The Payroll Source
Where To File
later adjusted by an amended return, a claim for refund, or an
examination, or to make certain elections after the prescribed
deadline (see Regulations sections 301.9100-1 through -3).
Use Form 720X, Amended Quarterly Federal Excise Tax
Return, to make adjustments to liability reported on Forms 720
you have filed for previous quarters. Do not use Form 720X to
make changes to claims made on Schedule C (Form 720),
except for the section 4051(d) tire credit and section 6426 fuel
credits.
Use Form 730, Monthly Tax Return for Wagers, to claim a
credit or refund of wagering tax.
Use Form 4136, Credit for Federal Tax Paid on Fuels, to claim
a credit against your income tax for certain nontaxable uses (or
sales) of fuel during the income tax year. Also, use Form 4136 if
you are a producer claiming a credit for alcohol fuel mixtures or
biodiesel mixtures. However, you can use Form 8849, Claim for
Refund of Excise Taxes, to claim a periodic refund instead of
waiting to claim an annual credit on Form 4136.
Use Form 8849, Claim for Refund of Excise Taxes, to claim a
refund of excise taxes other than those resulting from
adjustments to your reported liabilities. See IRS Pub. 510,
Excise Taxes, for the appropriate forms to use to claim excise
tax refunds.
Corporations (other than S corporations) can use Form 1139,
Corporation Application for Tentative Refund, to apply for a
“quick refund” of taxes from an overpayment of tax due to a
claim of right adjustment under section 1341(b)(1), or the
carryback of an NOL, a net capital loss, or an unused general
business credit.
IF you are filing Form 843...
THEN mail the form to...
In response to an IRS notice
The address shown in the notice.
regarding a tax or fee related to
certain taxes such as income,
employment, gift, estate,
excise, etc.
For penalties, or for any other
reason other than an IRS notice
(see above) or Letter 4658 (see
below)
The service center where you would be
required to a file a current year tax return for
the tax to which your claim or request
relates. See the instructions for the return
you are filing.
In response to Letter 4658
(notice of branded prescription
drug fee)
Internal Revenue Service
Mail Stop 4921 BPDF
1973 N. Rulon White Blvd.
Ogden, UT 84404
Note. To ensure proper
processing, write “Branded
Prescription Drug Fee” across
the top of Form 843.
For requests of a net interest
rate of zero
Caution. Use this address only if you are
claiming a refund of the branded
prescription drug fee.
The service center where you filed your
most recent return.
Penalty for Erroneous Claim for
Refund
If you claim an excessive amount of tax refund or credit relating
to income tax (other than a claim relating to the earned income
credit), you may be liable for a penalty of 20% of the amount
determined to be excessive. An excessive amount is the amount
of the claim for refund or credit that is more than the amount of
claim allowable for the tax year. The penalty may be waived if
you can show that you had a reasonable basis for making the
claim.
Separate Form Required
Generally, you must file a separate Form 843 for each tax period
or fee year or type of tax or fee. There are exceptions for certain
claims. See the instructions for line 5.
Generally, you must file a claim for a credit or refund within 3
years from the date you filed your original return or 2 years from
the date you paid the tax, whichever is later. If you do not file a
claim within this period, you may no longer be entitled to a credit
or refund. See Pub. 556, Examination of Returns, Appeal Rights,
and Claims for Refund, for more information. But note below the
instructions for when to file a request for abatement or refund of
a penalty or an addition to tax as a result of erroneous written
advice.
Paid Tax Return Preparer
A paid tax return preparer who files Form 843 for you must sign
the form and fill in the identifying information at the bottom of the
form. The tax preparer must give you a copy of the completed
Form 843 for your records. Someone who prepares your Form
843 but does not charge you should not sign it.
Who Can File
Specific Instructions
You can file Form 843 or your authorized representative can file
it for you. If your authorized representative files Form 843, the
original or copy of Form 2848, Power of Attorney and
Declaration of Representative, must be attached. You must sign
Form 2848 and authorize the representative to act on your
behalf for the purposes of the request. See the Instructions for
Form 2848 for more information.
Social security number. Enter your social security number
(SSN). If you are filing Form 843 relating to a joint return, enter
the SSNs for both you and your spouse.
Line 1
Enter the tax period for which you are making the claim for
refund or request for abatement. If you are requesting a refund of
a branded prescription drug fee, enter the fee year on the “From”
line.
If you are filing as a legal representative for a decedent
whose return you filed, attach to Form 843 a statement that you
filed the return and you are still acting as the decedent's
representative. If you did not file the decedent's return, attach
certified copies of letters testamentary, letters of administration,
or similar evidence to show your authority. File Form 1310,
Statement of Person Claiming Refund Due a Deceased
Taxpayer, with Form 843 if you are the legal representative of a
decedent.
Line 3
Check the appropriate box to show the type of tax or fee for
which you are claiming a refund or requesting an abatement. If
the claim relates to interest, a penalty, or addition to tax, check
the box to indicate the type of tax to which the claim or request
relates.
!
CAUTION
Do not use Form 843 when another tax form must be
used. See Purpose of Form.
Excess tier 2 RRTA tax. Complete lines 1 and 2. On line 3,
check the box for “Employment” tax. Skip lines 4, 5, and 6. On
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A-178
Instructions for Form 843 (Rev. December 2013)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
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Appendix
On line 7 state:
The type of tax involved,
When you were first notified by the IRS in writing about the
deficiency or payment,
The specific period for which you are requesting abatement of
interest,
The circumstances of your case, and
The reasons why you believe that failure to abate the interest
would result in grossly unfair treatment.
Multiple tax years or types of tax. File only one Form 843 if
the interest assessment resulted from the IRS's error or delay in
performing a single managerial or ministerial act affecting a tax
assessment for multiple tax years or types of tax (for example,
where 2 or more tax years were under examination). Check the
applicable box(es) on line 3 and provide a detailed explanation
on line 7.
line 7, identify the claim as “Excess tier 2 RRTA” and show your
computation of the refund. You must also attach copies of your
Forms W-2 for the year to Form 843. See the worksheet in Pub.
505, Tax Withholding and Estimated Tax, to help you figure the
excess amount.
Branded prescription drug fee. On line 1, enter the fee year
on the “From” line. Complete line 2. On line 3, check the box for
“Fee.” Skip lines 4 and 5. On line 6, check the “Other” box and
enter “BPD Fee” in the space provided. On line 7, identify the
claim as “branded prescription drug fee” and explain why you
are claiming a refund.
Attach a copy of the Form 8947 that provided the basis for the
fee as calculated by the IRS, as well as any additional
information on the amount to be refunded. You must tell us
whether you or anyone else has filed a previous claim for any
amount covered by this claim. Fee claims should not be
combined with any other claims.
Requesting Abatement or Refund of a Penalty or
Addition to Tax as a Result of Written Advice
Note. Interest related to the branded prescription drug fee
cannot be abated.
The IRS can abate or refund any portion of a penalty or addition
to tax caused by erroneous advice furnished to you in writing by
an officer or employee of the IRS acting in his or her official
capacity.
Line 4
If you are requesting a refund or abatement of an assessed
penalty, enter the applicable Internal Revenue Code (IRC)
section. Generally, you can find the IRC section on the Notice of
Assessment you received from the IRS.
The IRS will abate the penalty or addition to tax only if:
1. You reasonably relied on the written advice,
2. The written advice was in response to a specific written
request for advice made by you (or your representative who is
allowed to practice before the IRS), and
3. The penalty or addition to tax did not result from your
failure to provide the IRS with adequate or accurate information.
Line 5
Requesting Abatement or Refund of Interest
Due to IRS Error or Delay
The IRS can abate interest if the interest is caused by IRS errors
or delays.The IRS will abate the interest only if there was an
unreasonable error or delay in performing a managerial or
ministerial act (defined next). The taxpayer cannot have caused
any significant aspect of the error or delay. In addition, the
interest can be abated only if it relates to taxes for which a notice
of deficiency is required. This includes income taxes,
generation-skipping transfer taxes, estate and gift taxes, and
certain excise taxes. Interest related to employment taxes or
other excise taxes cannot be abated. See Pub. 556,
Examination of Returns, Appeal Rights, and Claims for Refund,
for more information.
How To Request an Abatement or Refund of a
Penalty or an Addition to Tax as a Result of
Written Advice
Request an abatement or refund of a penalty or addition to tax
because of erroneous written advice by writing “Request for
Abatement of Penalty or Addition to Tax Under Section 6404(f)”
at the top of Form 843.
Complete lines 1 through 4. Check the second box on line 5a.
On line 5b, enter the date of payment if the penalty or addition to
tax has been paid.
Managerial act. The term “managerial act” means an
administrative act that occurs during the processing of your case
involving the temporary or permanent loss of records or the
exercise of judgment or discretion relating to management of
personnel. A decision regarding the proper application of federal
tax law (or other federal or state law) is not a managerial act.
See Regulations section 301.6404-2 for more information.
You must attach copies of the following information to Form
843.
1. Your written request for advice.
2. The erroneous written advice you relied on that was
furnished to you by the IRS.
3. The report, if any, of tax adjustments identifying the
penalty or addition to tax, and the item(s) relating to the
erroneous advice.
Ministerial act. The term “ministerial act” means a procedural
or mechanical act that does not involve the exercise of judgment
or discretion and that occurs during the processing of your case
after all prerequisites of the act, such as conferences and review
by supervisors, have taken place. A decision regarding the
proper application of federal tax law (or other federal or state
law) is not a ministerial act. See Regulations section 301.6404-2
for more information.
When to file. An abatement of any penalty or addition to tax as
a result of written advice will be allowed only if:
You submit the request for abatement within the period
allowed for collection of the penalty or addition to tax, or
You paid the penalty or addition to tax, within the period
allowed for claiming a credit or refund of such penalty or addition
to tax.
How To Request an Abatement of Interest
Abatement of interest on a tax. Request an abatement of
interest on a tax by writing “Request for Abatement of Interest
Under Section 6404(e)” at the top of Form 843.
Complete lines 1 through 3. Check the first box on line 5a. On
line 5b, show the dates of any payment of interest or tax liability
for the tax period involved.
Instructions for Form 843 (Rev. December 2013)
Line 6
Check the appropriate box to show the type of fee or return, if
any, to which your claim or request relates. Check the box
labeled “1040” to indicate other individual income tax returns
(such as Form 1040A or Form 1040EZ).
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Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
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A-179
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
The Payroll Source
You can use Form 843 to request a refund or an
abatement of interest, penalties, and additions to tax
CAUTION
that relate to your income tax return. However, you
cannot use Form 843 to request a refund or an abatement of
income tax. If you are an employer, you cannot use it to request
abatement of FICA tax, RRTA tax, or income tax withholding.
On line 7, provide all of the following information.
1. The tax periods for which you overpaid and underpaid
your tax liability. A separate Form 843 is not required for each
separate taxable period involved in the request.
2. When you paid the tax if the underpayment is no longer
outstanding.
3. When you received your tax refund if the overpayment is
no longer outstanding.
4. The period(s) that your overpayment and underpayment
overlapped and the overlapping amount. You should provide any
background material (such as copies of examination reports,
notices, or prior interest computations provided by the IRS)
relating to the overpayment and underpayment.
5. A computation, to the extent possible, of the amount of
interest to be credited, refunded, or abated. If you are unable to
provide a computation, provide an explanation of why you are
unable to provide the computation. The computation generally
should be made by applying section 6621(d) to reduce your
underpayment interest payable to the IRS. However, if only the
period of limitation for claiming additional overpayment interest
is open on the date you file Form 843, you should make the
computation by applying section 6621(d) to increase your
overpayment interest payable by the IRS.
6. Section 6621(d) provides for a net interest rate of zero to
the extent of the overlapping underpayment and overpayment of
the same taxpayer. If your claim involves more than one tax
identification number (TIN), explain why the different TINs can
be treated as the same taxpayer.
!
Check the box labeled “Other” if your claim relates to:
Form 944, Employer's Annual Federal Tax Return. Enter “944”
(or “944-SS”) in the space provided.
Form CT-2, Employee Representative's Quarterly Railroad
Tax Return. Enter “CT-2” in the space provided.
The branded prescription drug fee. Enter “BPD Fee” in the
space provided.
Line 7
Explain in detail your reasons for filing this claim and show your
computation for the credit, refund, or abatement. If you attach an
additional sheet(s), include your name and SSN or employer
identification number (EIN) on it. Also attach appropriate
supporting evidence. Include a statement that to the extent of
equivalent amounts of underpayment and overpayment for the
period(s) identified and established, the period(s) has (have)
been used only once in a request to obtain the net interest rate
of zero under section 6621(d).
Refund of excess social security taxes. If you are claiming a
refund of excess social security or RRTA tax withheld by one
employer, you must, if possible, attach a statement from the
employer. The statement should indicate the following.
The amount, if any, the employer has repaid or reimbursed
you for excess taxes withheld.
The amount, if any, of credit or refund claimed by the
employer or authorized by you to be claimed by the employer.
The employer should include in the statement the fact that it is
made in support of your claim for refund of employee tax paid by
the employer to the IRS.
If you cannot obtain a statement from the employer, you
should attach a statement with the same information to the best
of your knowledge and belief and include in the statement an
explanation of why you could not obtain a statement from the
employer. Attach a copy of your Form W-2 to prove the amount
of social security or RRTA taxes withheld.
Privacy Act and Paperwork Reduction Act Notice. We ask
for the information on this form to carry out the Internal Revenue
laws of the United States. Sections 6402 and 6404 state the
conditions under which you may file a claim for refund and
request for abatement of certain taxes, penalties, and interest.
Form 843 may be used to file your claim. Section 6109 requires
that you disclose your taxpayer identification number (TIN).
Routine uses of this information include giving it to the
Department of Justice for civil 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
give this information to Federal and state agencies to enforce
Federal nontax criminal laws and to combat terrorism. You are
not required to claim a refund or request an abatement;
however, if you choose to do so you are required to provide the
information requested on this form. Failure to provide all of the
requested information may delay or prevent processing your
claim or request; providing false or fraudulent information may
subject you to civil or criminal penalties.
Refund of social security and Medicare tax withheld in error. The same supporting evidence described above must be
provided. If you are a nonresident alien, see Pub. 519 for
additional information.
Requesting Net Interest Rate of Zero
on Overlapping Tax Underpayments
and Overpayments
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.
If you have paid or are liable for interest on a tax underpayment
and have received or are due interest on a tax overpayment for
the same period of time, you can request that the IRS compute
the interest using the net interest rate of zero.
How To Request a Net Interest Rate of Zero
The time needed to complete and file this form will vary
depending on individual circumstances. The estimated average
time is:
You can request a net interest rate of zero by writing on top of
Form 843 “Request for Net Interest Rate of Zero under Rev.
Proc. 2000-26.” You must provide documentation to substantiate
that you are the taxpayer entitled to receive the interest due on
the overpayment.
Recordkeeping . . . . . . . . . . . . . . . . . . . . .
Learning about the law or the form . . . . . .
Preparing the form . . . . . . . . . . . . . . . . . .
Copying, assembling, and sending the form
to the IRS . . . . . . . . . . . . . . . . . . . . . . . . .
Leave line 1 blank. You can enter a dollar amount on line 2 or
leave it blank. Complete line 3 to indicate the type of tax. More
than one box can be checked. Do not complete lines 4 and 5.
Complete line 6 to indicate the type of return filed. More than one
box can be checked.
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26 min.
20 min.
28 min.
20 min.
Instructions for Form 843 (Rev. December 2013)
Printed for: 196580, Vicki Gray CPP © 2019 American Payroll Institute, Inc. All Rights reserved.
From: APA Digital Publications (bookshelf.americanpayroll.org)
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Appendix
Do not send the form to this address. Instead, see Where To
File.
If you have comments concerning the accuracy of these time
estimates or suggestions for making this form simpler, we would
be happy to hear from you. You can send us comments from
www.irs.gov/formspubs/. Click on “More Information”and then
“Comment on Tax Forms and Publications”. You can also send
your comments to:
Internal Revenue Service
Tax Forms and Publications
1111 Constitution Ave. NW, IR-6526
Washington, DC 2