W-3 Transmittal of Income and Tax Statements

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.

DO NOT STAPLE
a

33333
b

Kind
of
Payer

Control number

For Official Use Only

䊳

941

Military

CT-1

Hshld.
emp.

c

Total number of Forms W-2

e

Employer identification number (EIN)

d

g

Employer’s address and ZIP code

h

Other EIN used this year

State

Employer’s state ID number

Contact person

943

944

1

Wages, tips, other compensation

2

Federal income tax withheld

Medicare
govt. emp.

Third-party
sick pay

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

Advance EIC payments

10

11

Nonqualified plans

12a Deferred compensation

13

For third-party sick pay use only

12b HIRE exempt wages and tips

14

Income tax withheld by payer of third-party sick pay

16

State wages, tips, etc.

17

State income tax

18

Local wages, tips, etc.

19

Local income tax

Establishment number

f Employer’s name

15

䊳

OMB No. 1545-0008

Telephone number

(
Email address

Dependent care benefits

For Official Use Only

)

Fax number

(

)

Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief,
they are true, correct, and complete.

Signature

Form

䊳

䊳

Title

Date

W-3 Transmittal of Wage and Tax Statements

2010

䊳

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.
Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3.
● File Upload. Upload wage files to SSA that you have created
using payroll or tax software that formats the files according to
SSA’s Specifications for Filing Form W-2 Electronically (EFW2).

Reminder
Separate instructions. See the 2010 Instructions for Forms W-2
and W-3 for information on completing this form.

For more information, go to www.socialsecurity.gov/employer and
select “First Time Filers” or “Returning Filers” under “BEFORE YOU
FILE.”

Purpose of Form
A Form W-3 Transmittal is completed only when paper Copy A of
Form(s) W-2, Wage and Tax Statement, are being filed. Do not file
Form W-3 alone. Do not file Form W-3 for Form(s) W-2 that were
submitted electronically to the Social Security Administration (see
below). All paper forms must comply with IRS standards and be
machine readable. Photocopies are not acceptable. Use a Form
W-3 even if only one paper Form W-2 is being filed. Make sure both
the Form W-3 and Form(s) W-2 show the correct tax year and
Employer Identification Number (EIN). Make a copy of this form and
keep it with Copy D (For Employer) of Form(s) W-2 for your records.

When To File
Mail any paper Forms W-2 under cover of this Form W-3
Transmittal by February 28, 2011. Electronic fill-in forms or uploads
are filed through SSA’s Business Services Online (BSO) Internet site
and will be on time if submitted by March 31, 2011.

Where To File Paper Forms
Send this entire page with the entire Copy A page of Form(s) W-2
to:

Social Security Administration
Data Operations Center
Wilkes-Barre, PA 18769-0001

Electronic Filing
The Social Security Administration (SSA) strongly suggests
employers report Form W-3 and W-2 Copy A electronically instead
of on paper. SSA provides two free options on its Business
Services Online (BSO) website:
● W-2 Online. Use fill-in forms to create, save, print, and submit up
to 20 Forms W-2 to SSA.

Note. If you use “Certified Mail” to file, change the ZIP code to
“18769-0002.” If you use an IRS-approved private delivery service, add
“ATTN: W-2 Process, 1150 E. Mountain Dr.” to the address and change
the ZIP code to “18702-7997.” See Publication 15 (Circular E),
Employer’s Tax Guide, for a list of IRS-approved private delivery services.

For Privacy Act and Paperwork Reduction Act Notice, see the back of Copy D of Form W-2.
Cat. No. 10159Y