W-2VI U.S. Virgin Islands Wage and Tax Statement

Attention:
This form is provided for informational purposes only. Copy A appears in red, similar
to the official IRS form. Do not file copy A downloaded from this website with the
SSA. The official printed version of this IRS form is scannable, but the online version
of it, printed from this website, is not. A penalty of $50 per information return may be
imposed for filing forms that cannot be scanned.
To order official IRS forms, call 1-800-TAX-FORM (1-800-829-3676) or Order
Information Returns and Employer Returns Online, and we’ll mail you the scannable
forms and other products.

You may file Forms W-2 and W-3 electronically on the SSA’s website at
Employer Reporting Instructions & Information. You can create fill-in versions of
Forms W-2 and W-3 for filing with SSA. You may also print out copies for filing
with state or local governments, distribution to your employees, and for your
records.
See IRS Publications 1141, 1167, 1179 and other IRS resources for information
about printing these tax forms.

22222

a Employee’s social security number

Void

For Official Use Only

©

OMB No. 1545-0008

b Employer identification number (EIN)

1 Wages, tips, other compensation

2 VI 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
10

9 Advance EIC payment

d Control number
e Employee’s first name and initial

Last name

Suff. 11 Nonqualified plans
13

Statutory
employee

14 Other

Retirement
plan

12a See the separate instructions
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

Form

W-2VI

U.S. Virgin Islands
Wage and Tax Statement

2010

Copy A For Social Security Administration — Send this entire page with Copy A of
Form W-3SS to the Social Security Administration; photocopies are not acceptable.

Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction Act
Notice, see the separate instructions.
Cat. No. 49977C

Do Not Cut, Fold, or Staple Forms on This Page — Do Not Cut, Fold, or Staple Forms on This Page

22222

a Employee’s social security number

Void

OMB No. 1545-0008

b Employer identification number (EIN)

1 Wages, tips, other compensation

2 VI 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

d Control number

9 Advance EIC payment

e Employee’s first name and initial

Last name

Suff.

12a

11 Nonqualified plans
13

Statutory
employee

14 Other

Retirement
plan

10

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

Form

W-2VI

U.S. Virgin Islands
Wage and Tax Statement

Copy 1—For VI Bureau of Internal Revenue

2010

Department of the Treasury—Internal Revenue Service

a Employee’s social security number
OMB No. 1545-0008
b Employer identification number (EIN)

1 Wages, tips, other compensation

2 VI 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

d Control number

10

9 Advance EIC payment

e Employee’s first name and initial

Last name

Suff.

11 Nonqualified plans
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

Form

W-2VI

U.S. Virgin Islands
Wage and Tax Statement

Copy B—To Be Filed With Employee’s VI Tax Return

2010

Department of the Treasury—Internal Revenue Service
This information is being furnished to the
VI Bureau of Internal Revenue.

Notice to Employee
Refund. Even if you do not have to file a tax return, you
should file to get a refund if box 2 shows VI income tax
withheld or if you can take the earned income credit.
Earned income credit (EIC). You must file a tax return
regardless of your income if any amount is shown in Box 9,
Advance EIC payment. If you qualify, you can get the earned
income credit in advance by giving Form W-5, Earned
Income Credit Advance Payment Certificate, to your
employer. See Pub. 596, Earned Income Credit (EIC), for
details.
Copies B and C; corrections. File Copy B of this form with
your 2010 U.S. Virgin Islands income tax return. Keep Copy
C for your records. If your name, social security number
(SSN), or address is incorrect, correct Copies B and C and
ask your employer to correct your employment record. Be
sure to ask your employer to file Form W-2c, Corrected
Wage and Tax Statement, with the Social Security
Administration (SSA) to correct any name, amount, or SSN
error reported to the SSA.
Estimated tax. If you expect to owe $1,000 or more in tax
for 2011 (including self-employment tax), you may have to
make estimated tax payments to the U.S. Internal Revenue
Service. Use Form 1040-ES, Estimated Tax for Individuals.
Clergy and religious workers. If you are not subject to
social security and Medicare taxes, see Pub. 517, Social
Security and Other Information for Members of the Clergy
and Religious Workers.

Credit for excess social security tax. If one employer paid
you wages during 2010 and more than $6,621.60 in social
security tax was withheld, you may claim a refund of the
excess by filing Form 1040 with the V.I. Bureau of Internal
Revenue, 9601 Estate Thomas, Charlotte Amalie, St.
Thomas, VI 00802.
If you had more than one employer in 2010 and more than
$6,621.60 in social security tax was withheld, you may have
the excess refunded by filing Form 843, Claim for Refund
and Request for Abatement, with the Department of the
Treasury, Internal Revenue Service Center, Austin, TX
73301-0215, USA. If you are required to file Form 1040 with
the United States, you must claim the excess tax as a credit
on Form 1040.
Note. Keep Copy C of Form W-2VI 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. Review the information shown on your
annual (for workers over 25) Social Security Statement.
(Also see the Instructions for Employee on the back of
Copy C.)

a Employee’s social security number
OMB No. 1545-0008
b Employer identification number (EIN)

1 Wages, tips, other compensation

2 VI 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

d Control number

10

9 Advance EIC payment

e Employee’s first name and initial

Last name

Suff.

11 Nonqualified plans
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

Form

W-2VI

U.S. Virgin Islands
Wage and Tax Statement

Copy C—For EMPLOYEE'S RECORDS (See Notice to Employee
on the back of Copy B.)

2010

Department of the Treasury—Internal Revenue Service
This information is being furnished to the
VI Bureau of Internal Revenue.

Instructions for Employee
(Also see Notice to Employee on the back of Copy B.)
Box 9. Enter this amount on the advance earned income credit payments line
of your tax return.
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 any section 457(b) plan that became taxable for social
security and Medicare taxes this year because there is no longer a
substantial risk of forfeiture of your right to the deferred amount.
Box 12. The following list explains the codes shown in box 12. You may
need this information to complete your tax return. Elective deferrals (codes
D, E, F, and S) and designated Roth contributions (codes AA and BB) under
all plans are generally limited to a total of $16,500 ($11,500 if you have only
SIMPLE plans; $19,500 for section 403(b) plans, if you qualify for the 15-year
rule explained in Pub. 571). Deferrals under code G are limited to $16,500.
Deferrals under code H are limited to $7,000.
However, if you were at least age 50 in 2010, your employer may have
allowed an additional deferral of up to $5,500 ($2,500 for section 401(k)(11)
and 408(p) SIMPLE plans). This additional deferral amount is not subject to
the overall limit on elective deferrals. For code G, the limit on elective
deferrals may be higher for the last 3 years before you reach retirement age.
Contact your plan administrator for more information. Amounts in excess of
the overall elective deferral limit must be included in income. See the
“Wages, salaries, tips, etc.” line instructions for your tax return.
A—Uncollected social security tax on tips. Report on U.S. Form 1040 or on
Form 1040-SS if not required to file Form 1040.
B—Uncollected Medicare tax on tips. Report on U.S. Form 1040 or on Form
1040-SS if not required to file Form 1040.
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.
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.
(You may be able to deduct.)
J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5).
M—Uncollected social security tax on taxable cost of group-term life
insurance over $50,000 (former employees only). Report on U.S. Form 1040
or on Form 1040-SS if not required to file Form 1040.
N—Uncollected Medicare tax on taxable cost of group-term life insurance
over $50,000 (former employees only). Report on U.S. Form 1040 or on Form
1040-SS if not required to file Form 1040.
P—Excludable moving expense reimbursements paid directly to employee
(not included in boxes 1, 3, or 5).
Q—Nontaxable combat pay. See your tax return instructions 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 figure taxable and nontaxable amounts.
V—Income from exercise of nonstatutory stock option(s) (included in boxes
1, 3 (up to social security wage base), and 5). See Pub. 525 and instructions
for Schedule D (Form 1040) for reporting requirements.
W—Employer contributions (including amounts the employee elected to
contribute using a section 125 (cafeteria) plan) to your health savings
account (HSA). Report on Form 8889, Health Savings Accounts (HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan.
Z—Income under section 409A on a nonqualified deferred compensation
plan. This amount is also included in box 1. It is subject to an additional 20%
tax plus interest. See “Total Tax” in the instructions for your tax return.
AA—Designated Roth contributions under a section 401(k) plan.
BB—Designated Roth contributions under a section 403(b) plan.
CC (For employer use only)—HIRE exempt wages and tips.
Box 13. If the “Retirement plan” box is checked, special limits may apply to
the amount of traditional IRA contributions that you may deduct.

a Employee’s social security number

Void

OMB No. 1545-0008

b Employer identification number (EIN)

1 Wages, tips, other compensation

2 VI 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

d Control number

10

9 Advance EIC payment

e Employee’s first name and initial

Last name

Suff.

11 Nonqualified plans
13

Statutory
employee

14 Other

Retirement
plan

12a See the separate instructions
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

Form

W-2VI

Copy D—For Employer

U.S. Virgin Islands
Wage and Tax Statement

2010

Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction Act
Notice, see the separate instructions.

Employers, Please Note—
Who must file. File Form W-2VI for each employee to whom
any of the following items applied during 2010.
● You withheld VI income tax or social security and Medicare
taxes.
● You would have withheld VI income tax if the employee
had not claimed more than one withholding allowance.
● You paid any amount for services if you are in a trade or
business. Include the cash value of any payment you made
that was not in cash.
Distribution of copies. By January 31, 2011, furnish Copies
B and C to each person who was your employee during
2010. For anyone who stopped working for you before the
end of 2010, you may furnish Copies B and C any time after
employment ends but no later than January 31, 2011. If the
employee asks for Form W-2VI, furnish the completed
copies within 30 days of the request or within 30 days of the
final wage payment, whichever is later.

You may also file Copy A and Form W-3SS, Transmittal of
Wage and Tax Statements, with the Social Security
Administration (SSA) at the same time.
Note. If you terminate your business, see the rules on
furnishing and filing Forms W-2VI and W-3SS under
Terminating a business in the separate instructions.
When to file. By February 28, 2011, send Copy A of Forms
W-2VI and W-3SS to the SSA. However, if you file
electronically, the due date is March 31, 2011. See the
separate instructions.
Reporting electronically. If you file 250 or more Forms
W-2VI, you must file electronically. For information, visit
SSA’s Employer W-2 Filing Instructions & Information
website at www.socialsecurity.gov/employer or contact your
Employer Services Liaison Officer (ESLO) at
1-212-264-1117.
See the Instructions for Forms W-2AS, W-2GU, W-2VI,
and Form W-3SS for more information on how to complete
Form W-2VI.