W-3SS Transmittal of Wage 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 OR FOLD
33333

For Official Use Only ▶
OMB No. 1545-0008
1 Wages, tips, other compensation

2 Income tax withheld

3 Social security wages

4 Social security tax withheld

5 Medicare wages and tips

6 Medicare tax withheld

e Employer identification number (EIN)

7 Social security tips

8

f Employer’s name

9 Advance EIC payments

Kind
of
Payer

▲

b

a Control number
941-SS

Military

943

Hshld.
emp.

Medicare
govt. emp.

Third-party
sick pay

c Total number of Forms W-2

944-SS

d Establishment number

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
g Employer’s address and ZIP code
h Other EIN used this year

15 Check the appropriate box

▲

Type
of
Form

i Employer’s territorial ID number

W-2AS

Contact person

Telephone number

Email address

Fax number

W-2CM

W-2GU

W-2VI

For Official Use Only

Copy A—For Social Security Administration
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-3SS

Title ▶

Transmittal of Wage and Tax Statements

Date ▶

2010

Department of the Treasury
Internal Revenue Service

Send this entire page with the entire Copy A page of Form(s) W-2AS, W-2CM, W-2GU, or W-2VI to the Social Security
Administration (SSA). Photocopies are not acceptable.
Do not send any remittance (cash, checks, money orders, etc.) with Forms W-2AS, W-2CM, W-2GU, W-2VI, and W-3SS.

Reminders
Separate instructions. See the 2010 Instructions for Forms
W-2AS, W-2GU, W-2VI, and Form W-3SS for information on
completing this form.

Purpose of Form
Use Form W-3SS to transmit paper Copy A of Forms W-2AS,
W-2CM, W-2GU, and W-2VI. Make a copy of Form W-3SS and
keep it with Copy D (employer's copy) of Forms W-2AS, W-2CM,
W-2GU, or W-2VI for your records. Use Form W-3SS for the correct
year. File Form W-3SS even if only one Form W-2AS, W-2CM,
W-2GU, or W-2VI is being filed. However, if you are filing your
wage and tax information electronically, do not file Form W-3SS.

When To File
Mail Copy A of Form W-3SS with Copy A of Form(s) W-2AS,
W-2CM, W-2GU, or W-2VI by February 28, 2011.

Where To File

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.
Where to file Copy 1. File Copy 1 of Forms W-2AS and W-3SS with
the Tax Division, Government of American Samoa, Pago Pago, AS
96799.
File Copy 1 of Forms W-2GU and W-3SS with the Department of
Revenue and Taxation, Government of Guam, P.O. Box 23607,
GMF, GU 96921.
File Copy 1 of Forms W-2VI and W-3SS with the V.I. Bureau of
Internal Revenue, 9601 Estate Thomas, Charlotte Amalie, St.
Thomas, VI 00802.
Contact the Division of Revenue and Taxation, Commonwealth of
the Northern Mariana Islands at (670) 664-1000, for the address to
send Copy 1 of Forms W-2CM and W-3SS.

Send this entire page with the entire Copy A page of Form(s)
W-2AS, W-2CM, W-2GU, or W-2VI to:
Social Security Administration
Data Operations Center
Wilkes-Barre, PA 18769-0001
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 10117S

DO NOT STAPLE OR FOLD
33333

a Control number

For Official Use Only ▶
OMB No. 1545-0008
2 Income tax withheld

3 Social security wages

4 Social security tax withheld

5 Medicare wages and tips

6 Medicare tax withheld

e Employer identification number (EIN)

7 Social security tips

8

f Employer’s name

9 Advance EIC payments

Kind
of
Payer

▲

1 Wages, tips, other compensation

b

941-SS
Hshld.
emp.

Military

943

944-SS

Medicare
Third-party
govt. emp. sick pay

c Total number of Forms W-2

d Establishment number

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
g Employer’s address and ZIP code
h Other EIN used this year
i Employer’s territorial ID number

Contact person

Telephone number

Email address

Fax number

For Official Use Only

Copy 1—For Local Tax Department
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-3SS Transmittal of Wage and Tax Statements

Title ▶

Date ▶

2010

Department of the Treasury
Internal Revenue Service