Wage and Tax Statements W-2/W-3 series

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Page 1 of 8 Inst. for Form W-2AS, W-2GU, W-2VI, and W-3SS (2010) 17:47 - 17-APR-2010
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2010

Department of the Treasury
Internal Revenue Service

Instructions for Forms
W-2AS, W-2GU, W-2VI, and
Form W-3SS
Section references are to the Internal Revenue Code unless
otherwise noted.
Contents
Page
What’s New . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Reminders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Need Help? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
General Instructions for Form W-3SS . . . . . . . . . . . . . . . . . . 1
Who Must File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
When To File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Where To File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
General Instructions for Forms W-2AS, W-2CM,
W-2GU, and Form W-2VI . . . . . . . . . . . . . . . . . . . . . . . . 2
Special Reporting Situations . . . . . . . . . . . . . . . . . . . . . . . . 3
Specific Instructions for Forms W-2AS, W-2GU, and
Form W-2VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Specific Instructions for Form W-3SS . . . . . . . . . . . . . . . . . . 7

Employment Tax Forms Referenced in These
Instructions
Form

Title

940

Employer’s Annual Federal Unemployment
(FUTA) Tax Return

941

Employer’s QUARTERLY Federal Tax Return

941-SS

Employer’s QUARTERLY Federal Tax Return
(American Samoa, Guam, the Commonwealth of
the Northern Mariana Islands, and the U.S. Virgin
Islands)

941-X

Adjusted Employer’s QUARTERLY Federal Tax
Return or Claim for Refund

943

Employer’s Annual Federal Tax Return for
Agricultural Employees

What’s New

943-X

Adjusted Employer’s Annual Federal Tax Return
for Agricultural Employees or Claim for Refund

HIRE wages and tips paid to qualified employees. The
Hiring Incentives to Restore Employment (HIRE) Act exempts
employers from the employer’s share of social security tax
(referred to as the payroll tax exemption) on wages paid to
qualified employees from March 19, 2010, through December
31, 2010. For employers to report the amount of wages and tips
covered by the payroll tax exemption, we added a new code for
box 12, Code CC, for HIRE exempt wages and tips. The total of
code CC is reported in new box 12b on Form W-3SS. The total
of deferred compensation amounts, previously reported in box
12, is now reported in new box 12a on Form W-3SS. See HIRE
wages and tips paid to qualified employees on page 3.

944

Employer’s ANNUAL Federal Tax Return

944-SS

Employer’s ANNUAL Federal Tax Return
(American Samoa, Guam, the Commonwealth of
the Northern Mariana Islands, and the U.S. Virgin
Islands)

944-X

Adjusted Employer’s ANNUAL Federal Tax
Return or Claim for Refund

General Instructions for Form W-3SS
Use Copy A of Form W-3SS to transmit Copy A of Form
W-2AS, W-2CM, W-2GU, or W-2VI to the Social Security
Administration (SSA). File Copy 1 of Form W-3SS and Copy 1
of Form W-2AS, W-2CM, W-2GU, or W-2VI with your local tax
department.

Reminders
Form 944-SS. If you file Form 944-SS, use the “944-SS”
checkbox in box b on Form W-3SS.
Notice to employers in the Commonwealth of the Northern
Mariana Islands. If you are an employer in the
Commonwealth of the Northern Mariana Islands, contact the
Department of Revenue and Taxation, Capitol Hill, Saipan, MP
96959, to get Form W-2CM, Wage and Tax Statement, and the
instructions for completing and filing the form.

Need Help?
The IRS operates a centralized customer service site to answer
questions about reporting on information returns, including
Forms W-3SS, W-2AS, W-2CM, W-2GU, and W-2VI. If you
have questions about reporting on these forms, call
1-866-455-7438 (toll free, except from American Samoa), or
1-304-263-8700 (not toll free). The hours of operation are
Monday through Friday from 8:30 a.m. to 4:30 p.m., Eastern
time.
Using TYY/TDD equipment. If you have questions about
reporting on any of the above forms, call 1-304-579-4827 (not
toll free). For any other information, call 1-800-829-4059 (toll
free except from American Samoa).

Who Must File
Anyone required to file Forms W-2AS, W-2CM, W-2GU, or
W-2VI must file Form W-3SS to transmit Copy A of these forms
to the SSA. Make a copy of Form W-3SS; keep it and Copy D
(for employer) of Forms W-2AS, W-2CM, W-2GU, or W-2VI with
your records for 4 years. Be sure to use Form W-3SS for the
correct year. If you are filing these forms electronically, see
Electronic reporting on page 2.
Household employers. Even employers with only one
household employee must file Form W-3SS with Form W-2AS,
W-2CM, W-2GU, or W-2VI. On Form W-3SS, check “Hshld.
emp.” in box b.

When To File
File Copy A of Form W-3SS with Copy A of Forms W-2AS,
W-2CM, W-2GU, or W-2VI by February 28, 2011.
However, if you file electronically, you may file by March 31,
2011. Visit SSA’s Business Services Online (BSO) website at

Cat. No. 48440A

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www.socialsecurity.gov/employer and click on “Business
Services Online” for electronic filing options.
File Copy 1 of Form W-3SS with Copy 1 of Forms W-2AS,
W-2CM, W-2GU, or W-2VI by February 28, 2011.
Extension to file. You may request an automatic extension of
time to file Form W-2AS, W-2CM, W-2GU, or W-2VI by sending
Form 8809, Application for Extension of Time To File
Information Returns, to the address shown on that form. You
must request the extension by the due date of Form W-2AS,
W-2CM, W-2GU, or W-2VI. You will have an additional 30 days
to file. See Form 8809 for details.

Who Must File
Employers and other payers in American Samoa, the
Commonwealth of the Northern Mariana Islands, Guam, and
the U.S. Virgin Islands must report wages, withheld income tax,
U.S. social security, and U.S. Medicare taxes to their local tax
department and to the SSA.
Furnishing Copies B and C to employees. Furnish Copies B
and C of Forms W-2AS, W-2CM, W-2GU, or W-2VI to your
employees by January 31, 2011. You will meet the “furnish”
requirement if the form is properly addressed and mailed on or
before the due date.
Employment ends before December 31. You may furnish
copies to the employee any time after employment ends, but
not later than January 31, 2011. If an employee asks for the
form, furnish 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 on page 4.
Extension to furnish Forms W-2AS, W-2CM, W-2GU, or
W-2VI to employees. You may request an extension of time
to furnish Form W-2AS, W-2CM, W-2GU, or W-2VI to
employees by sending a letter to:

Even if you receive an extension of time to file Forms
W-2AS, W-2CM, W-2GU, or W-2VI, you must still
CAUTION furnish the forms to your employees by January 31,
2011. See Extension to furnish Forms W-2AS, W-2CM, W-2GU,
or W-2VI to employees, later.

!

Where To File
Copy A. Send the entire first page of Form W-3SS (Copy A)
with the entire Copy A page of Forms W-2AS, W-2CM, W-2GU,
or W-2VI to:
Social Security Administration
Data 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.
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.
Shipping and mailing. If you file forms for more than one
territory, use a separate Form W-3SS for each territory. For
example, send Forms W-2GU with one Form W-3SS and
Forms W-2AS with a second Form W-3SS. Forms W-2AS,
W-2CM, W-2GU, and W-2VI are printed two forms to a page.
Send the whole page of Copy A and Copy 1, even if one of the
forms on the page is blank or “Void.” See the specific
instructions for box b of Form W-3SS on page 7.
Prepare and file Forms W-2AS, W-2CM, W-2GU, or W-2VI
either alphabetically by employees’ last names or numerically
by employees’ social security numbers. Do not staple or tape
Form W-3SS to the related Forms W-2AS, W-2CM, W-2GU, or
W-2VI. Do not staple or tape any forms to each other. These
forms are machine read and staple holes or tears interfere with
machine reading. Also, do not fold or cut Forms W-2AS,
W-2CM, W-2GU, or W-2VI. Send the forms in a flat mailing.

IRS – Enterprise Computing Center – Martinsburg
Information Reporting Program
Attn: Extension of Time Coordinator
240 Murall Drive
Kearneysville, WV 25430
Mail your letter on or before the due date for furnishing
Forms W-2AS, W-2CM, W-2GU, or W-2VI to employees. It
must include:
• Your name and address,
• Your employer identification number (EIN),
• A statement that you are requesting an extension to furnish
Forms W-2AS, W-2CM, W-2GU, or W-2VI to employees,
• Reason for delay, and
• Your signature or that of your authorized agent.
Undeliverable forms. Keep for 4 years any employee
copies of Forms W-2AS, W-2CM, W-2GU, or W-2VI that you
tried to deliver but could not. However, if the undelivered forms
can be produced electronically through April 15th of the fourth
year after the year of issue, you do not need to keep
undeliverable employee copies. Do not send undeliverable
Forms W-2AS, W-2CM, W-2GU, or W-2VI to the SSA. For more
information on electronic recordkeeping, see Rev. Proc. 97-22,
which is on page 9 of Internal Revenue Bulletin 1997-13 at
www.irs.gov/pub/irs-irbs/irb97-13.pdf.
Electronic reporting. If you are required to file 250 or more
Forms W-2AS, W-2CM, W-2GU, or W-2VI, you must file them
electronically. You can get specifications for filing these forms
electronically by visiting SSA’s Employer W-2 Filing Instructions
& Information website at www.socialsecurity.gov/employer and
selecting “E-Filing Format.” You can also contact an SSA
Employer Services Liaison Officer (ESLO) at 1-212-264-1117
(not toll free) for the U.S. Virgin Islands, or 1-510-970-8247 (not
toll free) for Guam, American Samoa, and the Commonwealth
of the Northern Mariana Islands. SSA no longer accepts any
type of physical media (magnetic tape, cartridge, diskette, etc.)
submissions of Forms W-2AS, W-2CM, W-2GU, or W-2VI
reports.
Note. You are encouraged to file electronically even if you
file fewer than 250 Forms W-2AS, W-2CM, W-2GU, and W-2VI.
You may request a waiver on 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-2AS, W-2CM, W-2GU, or W-2VI. See Form 8508 for filing
information.

General Instructions for Forms W-2AS,
W-2CM, W-2GU, and W-2VI
Form W-2AS is used to report American Samoa wages, Form
W-2CM is used to report the Commonwealth of the Northern
Mariana Islands wages, Form W-2GU is used to report Guam
wages, and Form W-2VI is used to report U.S. Virgin Islands
wages. 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.

!

If you file electronically, do not file the same returns on
paper.

CAUTION

Taxpayer identification numbers (TINs). Employers use an
employer identification number (EIN) (00-0000000). Employees

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use a social security number (SSN) (000-00-0000). When you
list a number, separate the nine digits properly to show the kind
of number. Do not accept an individual taxpayer identification
number (ITIN) for employment purposes. You can identify an
ITIN because it is a 9-digit number, beginning with the number
“9” with either a “7” or “8” as the fourth digit, and is formatted
like an SSN (for example, 9NN-7N-NNNN). For more
information about EINs and SSNs, see 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.

However, if the address was incorrect on the Form W-2AS,
W-2CM, W-2GU, or W-2VI furnished to the employee, you must
do one of the following.
• Issue a new, corrected Form W-2AS, W-2CM, W-2GU, or
W-2VI to the employee, including the new address. Indicate
“REISSUED STATEMENT” on the new copies. Do not send
Copy A to the SSA.
• Issue a Form W-2c to the employee showing the correct
address in box i and all other correct information. Do not send
Copy A to the SSA.
• Mail the Form W-2AS, W-2CM, W-2GU, or W-2VI with the
incorrect address to the employee in an envelope showing the
correct address or otherwise deliver it to the employee.
Archer MSA. An employer’s contribution to an employee’s
Archer MSA is not subject to income tax withholding, social
security, or Medicare 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 and must be reported in boxes 1, 3, and 5.
You must report all employer contributions to an Archer MSA
in box 12 with code R. Employer contributions to an Archer
MSA that are not excludable from the income of the employee
also must be reported in box 1.
An employee’s contributions to an Archer MSA are includible
in income as wages and are subject to income tax withholding
and social security and Medicare taxes. Employee contributions
may be deductible, within limits, on the employee’s tax return.
For more information, see Pub. 969, Health Savings
Accounts and Other Tax-Favored Health Plans, and Notice
96-53, 1996-2 C.B. 219, which is found on page 5 of Internal
Revenue Bulletin 1996-51 at www.irs.gov/pub/irs-irbs/irb96-51.
pdf.
Designated Roth contributions. Under section 402A, a
participant in a section 401(k) plan or under a 403(b) salary
reduction agreement 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 income tax withholding and
social security and Medicare taxes and must be reported in
boxes 1, 3, and 5.
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. For
reporting instructions, see Code AA and Code BB on page 7.
Educational assistance programs. A $5,250 exclusion for
employer-provided educational assistance applies to benefits
provided to your employees under an educational assistance
program. However, educational assistance that exceeds $5,250
may be excluded from an employee’s wages if it qualifies as a
working condition benefit. See Pub. 970, Tax Benefits for
Education, and section 2 of Pub. 15-B, Employer’s Tax Guide to
Fringe Benefits, for more information.
Election workers. Report on Form W-2AS, W-2CM, W-2GU,
or W-2VI payments of $600 or more to election workers for
services performed in territorial, county, and municipal
elections. File Form W-2AS, W-2CM, W-2GU, or W-2VI 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.
Employee’s social security and Medicare taxes 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 income tax withholding and social security and
Medicare taxes. These payments are also subject to federal
unemployment (FUTA) taxes in the U.S. Virgin Islands (USVI).
The amount to include as wages is determined by using the

Social security numbers are used to record employee
earnings for future social security and Medicare benefits. When
you prepare Forms W-2AS, W-2CM, W-2GU, or W-2VI, be sure
to show the correct SSN for each employee. For information on
verification of SSNs, see section 3 of Pub. 80 or go to
www.socialsecurity.gov/employer and select “Social Security
Number Verification Service (SSNVS).”

Special Reporting Situations
HIRE wages and tips paid to qualified employees.
Employers who hired a qualified employee under the HIRE Act
must report the amount of social security wages and tips paid
after March 18, 2010, for which the employer claimed the
payroll tax exemption. A qualified employee is one who:
• Was hired after February 3, 2010, and before January 1,
2011;
• Was not hired to replace another employee unless the other
employee separated from employment voluntarily or for cause
(including downsizing);
• Was not a family member or other related individual of the
employer; and
• Signed Form W-11, Hiring Incentives to Restore Employment
(HIRE) Act Employee Affidavit, or other similar statement under
penalties of perjury, certifying under penalties of perjury that he
or she had not worked more than 40 hours during the 60 days
prior to beginning employment.
Report the amount of wages and tips paid to the qualified
employee for which you claimed the payroll tax exemption in
Box 12, using code CC. This will include wages and tips paid to
the qualified employee from April 1, 2010, through December
31, 2010, for which you claimed the payroll tax exemption, plus
wages and tips paid to the qualified employee from March 19,
2010, through March 31, 2010, for which you claimed a credit in
the second quarter of 2010. The amount may not exceed
$106,800 (2010 maximum social security wage base). For more
information, visit IRS.gov and enter the keywords HIRE Act
payroll tax exemption.
Corrections. Use the current version of Form W-2c, Corrected
Wage and Tax Statement, to correct errors (such as an
incorrect name, SSN, or amount) on a previously filed Form
W-2AS, W-2CM, W-2GU, or W-2VI. Always send Form W-3c,
Transmittal of Corrected Wage and Tax Statements, with Forms
W-2c to the SSA, even if you are filing a Form W-2c only to
correct an employee’s name or SSN. See the separate
Instructions for Forms W-2c and W-3c. Also, see below for
information on correcting an employee’s address.
If you are making a correction to a previously filed Form 941,
943, or 944, use Form 941-X, 943-X, or 944-X, for the return
period in which you found the error. See the Instructions for
Form 941-X for more details. Issue the employee a Form W-2c
if the error discovered was for the prior year. If you are
correcting social security or Medicare wages or tips, also file the
entire Copy A page of Form W-2c and Form W-3c with the SSA
to correct the social security records and any other items on the
original Form W-2AS, W-2CM, W-2GU, or W-2VI (or previously
filed Form W-2c) that were in error.
Incorrect employee address. If you filed a Form W-2AS,
W-2CM, W-2GU, or W-2VI with the SSA showing an incorrect
address for an employee but all other information on the form is
correct, do not file Form W-2c with the SSA merely to correct
the address.
Inst. for Form W-2AS, W-2GU, W-2VI, and W-3SS (2010)

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formula contained in the discussion of Employee’s Portion of
Taxes Paid by Employer in section 7 of Pub. 15-A, Employer’s
Supplemental Tax Guide.

amounts are subject to income tax withholding and social
security and Medicare taxes.
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 unless certain requirements
are met. If section 409A requires an amount to be included in
gross income, the section imposes a substantial additional tax.
Section 409A, generally, is effective with respect to amounts
deferred in tax years beginning after December 31, 2004, but
deferrals made prior to 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. For more
information, see Notice 2008-115, available at www.irs.gov/irb/
2008-52_IRB/ar10.html. If you report section 409A deferrals,
show the amount in box 12 using code Y.
Income included under section 409A from an NQDC plan will
be reported in box 1, and in box 12 using code Z. This income
is also subject to an additional tax reported on the employee’s
tax return. For more information, see section 5 of Pub. 15-A.
For more information on amounts includible in gross income,
see Notice 2008-113, available at www.irs.gov/irb/
2008-51_IRB/ar12.html, and Notice 2008-115.
Sick pay. If you had employees who received sick pay in 2010
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-2AS, W-2CM, W-2GU, or W-2VI. 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-2AS, W-2CM, W-2GU, or W-2VI, and W-3SS for your
employees showing the sick pay. For specific reporting
instructions, see section 6 of Pub. 15-A.
Terminating a business. If you terminate your business, you
must provide Forms W-2AS, W-2CM, W-2GU, or W-2VI to your
employees for the calendar year of termination by the due date
of your final Form 941-SS, 944-SS, or 943. If filing on paper,
make sure you obtain Forms W-2AS, W-2CM, W-2GU, or
W-2VI preprinted with the correct year. If filing electronically,
make sure your software has been updated for the current tax
year. You must also file Forms W-2AS, W-2CM, W-2GU, or
W-2VI with the SSA by the last day of the month that follows the
due date of your final Form 941-SS, 944-SS, or 943.
If any of your employees are immediately employed by a
successor employer, see Rev. Proc. 2004-53 for information on
who must file Forms W-2AS, W-2CM, W-2GU, or W-2VI, and
employment tax returns. You can find Rev. Proc. 2004-53,
2004-34 I.R.B. 320, at www.irs.gov/irb/2004-34_IRB/ar13.html.
For information on automatic extensions for furnishing Forms
W-2AS, W-2CM, W-2GU, or W-2VI to employees and filing
them with the SSA, see Rev. Proc. 96-57, which is on page 14
of Internal Revenue Bulletin 1996-53 at www.irs.gov/pub/
irs-irbs/irb96-53.pdf.

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 (USVI only) taxes. For information on
completing Forms W-2AS, W-2CM, W-2GU, W-2VI and W-3SS
in this situation, see the Instructions for Schedule H (Form
1040), Household Employment Taxes, and section 3 of Pub. 51
(Circular A), Agricultural Employer’s Tax Guide.
Group-term life insurance. If you paid for group-term life
insurance coverage over $50,000 for an employee or a former
employee, you must report the taxable cost of excess coverage
(determined by using the table in section 2 of Pub. 15-B) in
boxes 1, 3, and 5 of Form W-2AS, W-2CM, W-2GU, or W-2VI.
Also, show the amount in box 12 with code C. For employees,
you must withhold social security and Medicare taxes, but not
income tax. Former employees must pay the employee part of
social security and Medicare taxes on the taxable cost of
group-term life insurance coverage over $50,000 on their tax
return. You are not required to collect those taxes. However,
you must report the uncollected social security tax with code M
and the uncollected Medicare tax with code N in box 12 of Form
W-2AS, W-2CM, W-2GU, or W-2VI.
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 income tax withholding,
social security, or Medicare taxes (or FUTA tax (USVI only)) 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
(and FUTA tax (USVI only)) and must be reported in boxes 1, 3,
and 5 (and on Form 940 (USVI only)).
You must report all employer contributions to an HSA in box
12 with code W. Employer contributions to an HSA that are not
excludable from the income of the employee also must be
reported in boxes 1, 3, and 5.
An employee’s contributions to an HSA (unless made
through a cafeteria plan) are includible in income as wages and
are subject to income tax withholding and social security and
Medicare taxes. Employee contributions may be deductible,
within limits, on the employee’s tax return. For more information
about HSAs, see Notice 2004-2, 2004-2 I.R.B. 269, available at
www.irs.gov/irb/2004-02_IRB/ar09.html. Also see Notice
2004-50, 2004-33 I.R.B. 196, available at www.irs.gov/irb/
2004-33_IRB/ar08.html. You can also find information in the
Form 8889 instructions and Pub. 969, both dealing with health
savings accounts.
Lost form — reissued statement. If an employee loses a
form, enter “REISSUED STATEMENT” on the new copy (unless
it was furnished electronically), and furnish it to the employee.
Do not send Copy A of the reissued statement to the SSA.
Employers are not prohibited (by the Internal Revenue Code)
from charging a fee for issuing a duplicate Form W-2AS,
W-2CM, W-2GU, or W-2VI.
Moving expenses. Report moving expenses 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-2AS, W-2CM, W-2GU,
or W-2VI.
• Qualified moving expense reimbursements paid directly to an
employee by an employer are reported only in box 12 of Form
W-2AS, W-2CM, W-2GU, or W-2VI with code P.
• Nonqualified moving expense reimbursements are reported
in boxes 1, 3, and 5 of Form W-2AS, W-2GU, or W-2VI. These

!

Specific Instructions for Forms W-2AS,
W-2GU, and W-2VI
Form W-2CM. For specific instructions for the 2010 Form
W-2CM, see the 2010 Supplemental Instructions for Forms
W-2CM and OS-3710, published by the Division of Revenue
and Taxation, Commonwealth of the Northern Mariana Islands.
How to complete Forms W-2AS, W-2GU, or W-2VI. These
are 5-part forms. Ensure that all copies are legible. Send Copy
A to the SSA, Copy 1 to your tax department, and Copies B and
C to your employee. Keep Copy D, and a copy of Form W-3SS,
with your records for 4 years.
Type entries on these forms using black ink and 12-point
Courier font. Copy A is read by machine and must be typed
clearly with no corrections made to the entries and no entries
exceeding the size of the boxes. Entries completed by hand, in
script or italics fonts, or in colors other than black cannot be

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read by the machines. Make all dollar entries 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.
Calendar year basis. Base all entries on Forms W-2AS,
W-2GU, W-2VI, or W-3SS on a calendar year. Use the current
year form.
Void. Check this box when an error is made on Forms W-2AS,
W-2GU, or W-2VI and you are voiding it because you will
complete a new form. Do not include any amounts shown on
“Void” forms in the totals you enter on Form W-3SS. See
Corrections on page 3.
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. If the employee has applied for a social security number,
enter “Applied For” in box a on paper Forms W-2AS, W-2GU, or
W-2VI filed with the SSA. Enter zeros (000000000) if the form is
filed electronically.
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 1-800-772-1213 (toll free except in American
Samoa).
If you do not provide the correct employee name and TIN on
Form W-2AS, W-2GU, or W-2VI, you may owe a penalty unless
you have reasonable cause. For more information, see
Publication 1586, Reasonable Cause Regulations and
Requirements for Missing and Incorrect Name/TINs.
Box b — Employer identification number (EIN). Show the
employer identification number (EIN) assigned to you by the
IRS (00-0000000). This should be the same number that you
used on your Form 941-SS, 944-SS, or 943. Do not use a prior
owner’s EIN. If you do not have an EIN, enter “Applied For” in
box b; do not use your SSN. You can get an EIN by applying
online at IRS.gov, by calling the toll-free (except in American
Samoa) number 1-800-829-4933, or by filing Form SS-4,
Application for Employer Identification Number.
Box c — Employer’s name, address, and ZIP code. This
entry should be the same as shown on your Form 941-SS,
944-SS, or 943.
Box d — Control number. You may use this box to identify
individual forms. You do not have to use this box.
Boxes e and f — Employee’s name and address. Enter the
name as shown on the employee’s social security card (first,
middle initial, last). Do not enter “Jr.,” “Sr.,” etc. on Copy A
unless the suffix appears on the card. You may enter an
employee’s name suffix in the designated area of box e, but
SSA prefers that you do not enter the suffix on Copy A. If the
name does not fit, you may show first name initial, middle initial,
and last name (and ignore the vertical lines). If the name has
changed, the employee must get a corrected 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.
Include in the address the number, street, apartment or suite
number (or P.O. box number if mail is not delivered to a street
address).
Third-party payers of sick pay filing a third-party sick pay
recap Form W-2AS, W-2GU, or W-2VI must enter “Third-Party
Sick Pay Recap” in place of the employee’s name in box e. Do
not enter the employee’s SSN in box a. See section 6 of Pub.
15-A.
Box 1 — Wages, tips, other compensation. Show the total
taxable wages, tips, and other compensation (before any
payroll deductions) you paid to your employee during the year,
such as: (a) wages, bonuses, prizes, and awards; (b) noncash
payments, including certain fringe benefits; (c) tips reported; (d)
Inst. for Form W-2AS, W-2GU, W-2VI, and W-3SS (2010)

taxable cost of group-term life insurance over $50,000; (e)
distributions from a nonqualified or nongovernmental section
457(b) plan; and (f) cost of current insurance protection under a
compensatory split-dollar life insurance arrangement. Other
compensation includes amounts you pay the employee from
which income tax is not withheld. You may show other
compensation on a separate Form W-2AS, W-2GU, or W-2VI.
Note. Show payments to statutory employees whose earnings
are subject to social security and Medicare taxes but not
subject to income tax withholding in box 1 as other
compensation. See Pub. 80 (Circular SS) for the definition of a
statutory employee.
Box 2 — Income tax withheld. Show the total American
Samoa, Guam, or U.S. Virgin Islands income tax withheld. Do
not reduce this amount by any advance EIC payments.
Box 3 — Social security wages. Show the total wages paid
(before payroll deductions) subject to employee social security
tax. Do not include tips. Generally, noncash payments are
considered wages. 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 paid
by employer on page 3. The total of boxes 3 and 7 cannot be
more than $106,800 (2010 maximum social security wage
base). See Pub. 80 (Circular SS) for more information.
Box 4 — Social security tax withheld. Show the total
employee social security tax (not your share) withheld or paid
by you for the employee, including social security tax on tips.
Do not reduce this amount by any advance EIC payments
made to the employee. For 2010, the amount shown should not
exceed $6,621.60 ($106,800 x 6.2%). Include only tax withheld
(or paid by you for the employee) for 2010 wages and tips. If
you paid your employee’s share, see Employee’s social security
and Medicare taxes paid by employer on page 3.
Box 5 — Medicare wages and tips. Show the total wages
paid and tips reported subject to employee Medicare tax. There
is no wage base limit for Medicare tax. Be sure to enter tips the
employee reported even if you did not have enough employee
funds to collect the Medicare tax for those tips. If you paid your
employee’s share of taxes, see Employee’s social security and
Medicare taxes paid by employer on page 3.
Box 6 — Medicare tax withheld. Enter the total employee
Medicare tax (not the employer’s share) withheld or paid by you
for the employee. Include only tax withheld for 2010 wages and
tips. Do not reduce this amount by any advance EIC made to
the employee. The rate is 1.45% of all wages and tips. If you
paid your employee’s share of taxes, see Employee’s social
security and Medicare taxes paid by employer on page 3.
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 $106,800 for 2010.
Report all tips in box 1, along with wages and other
compensation. Include in box 5 any tips reported in box 7.
Box 9 — Advance EIC payment. (Forms W-2GU and W-2VI
only.) Show the total advance earned income credit (EIC) paid
to the employee.
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 box(es) 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.
Show distributions to an employee from a nonqualified
deferred compensation plan or nongovernmental section 457(b)
plan. Also report these distributions in box 1. Make only one
entry in this box. Distributions from governmental section 457(b)
plans must be reported on Form 1099-R, not in box 1 of Form
W-2AS, W-2GU, or W-2VI.
If you did not make distributions this year, show deferrals
(plus earnings) under a nonqualified deferred compensation
plan or any section 457(b) plan that became taxable for social
security and Medicare taxes during the year (but were for prior

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year services) because the deferred amounts were no longer
subject to a substantial risk of forfeiture. Also report these
amounts in boxes 3 (up to the social security wage base) and 5.
Do not report in box 11 deferrals included in box(es) 3 and/or 5
and deferrals for current year services (such as those with no
risk of forfeiture).

instructions on page 7 for reporting designated Roth
contributions.
Code D — Elective deferrals to 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.

If you made distributions and are also reporting any
deferrals in box(es) 3 and/or 5, do not complete box 11.
CAUTION 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
special reporting instructions for these and other kinds of
compensation earned in prior years. However, do not file Form
SSA-131 in this situation if the employee will not be age 62 or
older by the end of that year.
Note. Do not report special wage payments, such as
accumulated sick 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. On Copy A, do not enter more than four items
in box 12. If more than four items need to be reported in box 12,
use a separate Form W-2AS, W-2GU, or W-2VI for additional
items. You may enter more than four items on all other copies
when using an approved substitute form.
Show the IRS code (using a capital letter or letters) to the left
of the vertical line in boxes 12a – 12d and the dollar amount to
the right of the vertical line. Use decimal points but no dollar
signs or commas (for example, D 5300.00).
Code A — Uncollected social security tax on tips. Show
the employee social security tax on 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 on 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 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 on page 4.
Also include this amount in boxes 1, 3 (up to the social security
wage base), and 5.
Codes D through H, S, Y, AA, and BB. Use these codes
to show pre-tax elective deferrals and designated Roth
contributions made to the plans listed. Do not report amounts
for other types of plans. The example under Code D, later,
shows how to report elective deferrals under a section 401(k)
plan.
Report as elective deferrals and designated Roth
contributions 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 the designated Roth
“catch-up” contributions as a single sum in box 12 using the
appropriate code.
The following are not elective deferrals and may be reported
in box 14, but not in box 12: (a) nonelective employer
contributions on behalf of an employee; (b) 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; and (c) required employee and
employer matching contributions. See the code AA and BB

Example of reporting excess elective deferrals and
designated Roth contributions under a section 401(k) plan.
For 2010, Employee A (age 45) elected to defer $18,300 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 2010 limit for elective deferrals and
designated Roth contributions is $16,500, the employee’s total
elective deferral amount of $18,300 is reported in box 12 with
code D (D 18300.00). The designated Roth contribution is
reported in box 12 with code AA (AA 1000.00). The employer
must separately report the actual amounts of $18,300 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 salary deferrals and excess designated
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
nonelective contribution and the $3,000 nonelective
profit-sharing employer contribution are not required to be
reported on Form W-2AS, W-2GU, or W-2VI, 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.
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 a 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 income tax return.
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.
Code M — Uncollected social security 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 existed, enter the amount of uncollected social
security tax on the coverage in box 12. See Group-term life
insurance on page 4.
Code N — Uncollected Medicare tax on taxable cost of
group-term life insurance over $50,000 (for former
employees). Enter any uncollected Medicare tax on the cost
of group-term life insurance coverage over $50,000 for your
former employees. See Code M above.
Code P — Excludable moving expense reimbursements
paid directly to employee. Show the total moving expense
reimbursements that you paid directly to your employee for
qualified (deductible) moving expenses. See Moving expenses
on page 4.
Code Q — Nontaxable combat pay. If you are a military
employer, report any nontaxable combat pay in box 12.

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Code R — Employer contributions to an Archer MSA.
Show any employer contributions to an Archer MSA. See
Archer MSA on page 3.
Code S — Employee salary reduction contributions
under a section 408(p) SIMPLE. Show deferrals under a
section 408(p) salary reduction SIMPLE retirement account.
However, if the SIMPLE is part of a section 401(k)
arrangement, use code D.
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 to 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 $12,170 exclusion.
Code V — Income from the exercise of nonstatutory
stock option(s). Show the spread (that is, 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.
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 an employee’s
health savings account (HSA). Show any employer
contributions (including amounts the employee elected to pay
using a section 125 (cafeteria) plan) to your employee’s HSA.
See Health savings account (HSA) on page 4.
Code Y — Deferrals under a section 409A nonqualified
deferred compensation plan. It is not necessary to show
deferrals under this type of plan. For more information see
Notice 2008-115, 2008-52 I.R.B. 1367, available at www.irs.
gov/irb/2008-52_IRB/ar10.html. However, if you do report these
deferrals, show current year deferrals, including earnings during
the year on current year and prior year deferrals, in box 12 with
code Y. See Nonqualified deferred compensation plans on
page 4.
Code Z — Income under section 409A on a nonqualified
deferred compensation plan. Enter all amounts deferred
(including earnings on amounts deferred) that are includible in
income under section 409A because the nonqualified deferred
compensation (NQDC) plan fails to satisfy the requirements of
section 409A. Do not include amounts properly reported on a
Form 1099-MISC, or a corrected Form 1099-MISC, W-2AS,
W-2GU, W-2VI, or 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 through 1.409A-6, Notice
2008-113, and Notice 2008-115.
The amount reported in box 12 using code Z is also reported
in box 1, and is subject to an additional tax reported on the
employee’s tax return.
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 on page 3.
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 on page 3.
Code CC — HIRE exempt wages and tips. See HIRE
wages and tips paid to qualified employees on page 3.
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
Inst. for Form W-2AS, W-2GU, W-2VI, and W-3SS (2010)

taxes but not subject to income tax withholding. Do not check
this box for common law employees. See section 1 of Pub.
15-A for the definition of statutory employees.
• Retirement plan. Check this box if the employee was an
“active participant” (for any part of the year) in any of the
following plans.
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 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, 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 section
219(g)(5); Notice 87-16, 1987-1 C.B. 446; and Pub. 590,
Individual Retirement Arrangements (IRAs). Also see Notice
98-49, which is on page 5 of Internal Revenue Bulletin 1998-38
at www.irs.gov/pub/irs-irbs/irb98-38.pdf.

!

Do not check this box for contributions made to a
nonqualified plan or section 457(b) plan.

CAUTION

• Third-party sick pay. Check this box only if you are a
third-party sick pay payer filing a Form W-2AS, W-2GU, or
W-2VI 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. The lease value of a vehicle provided to your
employee and reported in box 1 must be reported here or on a
separate statement to your employee. You may also use this
box for any other information that you want to give to your
employee, such as health insurance premiums deducted, union
dues, voluntary after-tax contributions (but not designated Roth
contributions) to a pension plan, or nontaxable income. Label
each entry.

Specific Instructions for Form W-3SS
How to complete Form W-3SS. Type entries using black ink
and 12-point Courier font. Make all entries without the dollar
sign and comma but with the decimal point (00000.00). If a box
does not apply, leave it blank.
Box a — Control number. This is an optional box that you
may use for numbering the whole transmittal.
Box b — Kind of Payer. Check only one box unless the
second checked box is “Third-party sick pay.” If you have
Forms W-2AS, W-2CM, W-2GU, or W-2VI with more than one
kind of payer, send each type with a separate Form W-3SS.
However, “third-party sick pay” does not designate a separate
kind of payer. When this box is checked, it will always be in
addition to the box that designates the kind of payer.
941-SS. Check this box if you file Form 941-SS and no
other category (except “Third-party sick pay”) applies. A church
or church organization should check this box even if it is not
required to file Form 941-SS or 944-SS.
Military. Check this box if you are a military employer
sending Forms W-2AS, W-2CM, W-2GU, or W-2VI for members
of the uniformed services.

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943. Check this box if you file Form 943 and are sending
forms for agricultural employees. For nonagricultural
employees, send their Forms W-2AS, W-2CM, W-2GU, or
W-2VI with a separate Form W-3SS.
944-SS. Check this box if you file Form 944-SS and no
other category (except “Third-party sick pay”) applies.
Hshld. emp. Check this box if you are a household
employer sending Forms W-2AS, W-2CM, W-2GU, or W-2VI for
household employees, and you did not include a household
employee’s taxes on Form 941-SS, 944-SS, or 943.
Medicare govt. emp. Check this box if you are a U.S. or a
U.S. Virgin Islands government employer with employees
subject only to the 1.45% Medicare tax.
Third-party sick pay. Check this box (and one other box) if
you are a payer of third-party sick pay (or are reporting sick pay
payments made by a third party) filing Forms W-2AS, W-2CM,
W-2GU, or W-2VI with “Third-party sick pay” checked in box 13.
Box c — Total number of Forms W-2. Show the number of
completed individual Forms W-2AS, W-2CM, W-2GU, or W-2VI
filed with this Form W-3SS. Do not count “Void” forms.
Box d — Establishment number. You may use this box to
identify separate establishments in your business. You may file
a separate Form W-3SS, with Forms W-2AS, W-2CM, W-2GU,
or W-2VI, for each establishment even if they all have the same
EIN; or you may use a single Form W-3SS for all Forms
W-2AS, W-2CM, W-2GU, or W-2VI of the same type.
Box e — Employer identification number (EIN). If you
received a preprinted Form W-3SS from the IRS with Pub. 80
(Circular SS), verify that your EIN is correct. Make any
necessary corrections on the form. If you are not using a
preprinted IRS Form W-3SS, enter the nine-digit EIN assigned
to you by the IRS. The EIN should be the same as that shown
on your Form 941-SS, 944-SS, or 943 and in the following
format: 00-0000000. Do not use a prior owner’s EIN. If you do
not have an EIN, see Box b — Employer identification number
(EIN) on page 5. See also Box h below.
Boxes f and g — Employer’s name and address. If you are
not using a preprinted Form W-3SS, enter your name and
address as shown on your Form 941-SS, 944-SS, or 943. Make
any necessary corrections on your preprinted Form W-3SS.
Box h — Other EIN used this year. If you have used an EIN
(including a prior owner’s EIN) on Form 941-SS, 944-SS, or 943
submitted for 2010 that is different from the EIN reported in
box e on this form, enter the other EIN used.
Contact person, telephone number, fax number, and email
address. Include this information for use by the SSA if
questions arise during processing.
Boxes 1 through 7. Enter the totals reported in boxes 1
through 7 of Forms W-2AS, W-2CM, W-2GU, or W-2VI being
filed with this Form W-3SS.
Box 9 — Advance EIC payments. Enter the total advance EIC
payments shown on Forms W-2GU or Form W-2VI being filed
with this Form W-3SS.
Box 11 — Nonqualified plans. Enter the total reported in box
11 on Forms W-2AS, W-2CM, W-2GU, or W-2VI being filed with
this Form W-3SS.
Box 12a — Deferred compensation. Enter the total of all
amounts reported with codes D through H, S, Y, AA, and BB in
box 12 on Forms W-2AS, W-2GU, W-2CM, or W-2VI. Do not
enter a code.
Box 12b — HIRE exempt wages and tips. Enter the total of
all amounts reported with code CC in box 12 on Forms W-2AS,

W-2GU, W-2CM, or W-2VI. See HIRE wages and tips paid to
qualified employees on page 3.
Box 13 — For third-party sick pay use only. Third-party
payers of sick pay (or employers using the optional rule for
Form W-2AS, W-2CM, W-2GU, or W-2VI described in section 6
of Pub. 15-A) filing third-party sick pay recap Forms W-2AS,
W-2CM, W-2GU, or W-2VI, and W-3SS must enter “Third-Party
Sick Pay Recap” in this box. See section 6 of Pub. 15-A for
details.
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 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 shown
separately here.
Box 15 — Type of form. Check this box for the type of forms
you are submitting with this Form W-3SS.
Signature. The signature on Copies A and 1 of Form W-3SS
must be an original (not a copy).
Privacy Act and Paperwork Reduction Act Notice We ask
for the information on Forms W-2AS, W-2CM, W-2GU, W-2VI,
and W-3SS 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 and to the Social Security
Administration. Section 6109 requires you to provide your
employer identification number (EIN). If you fail to provide this
information in a timely manner, you may be subject 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-2AS — 23 minutes; Form W-2GU — 24
minutes; Form W-2VI — 24 minutes; Form W-3SS — 24
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 write to the
Internal Revenue Service, Tax Products Coordinating
Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave.
NW, IR-6526, Washington, DC 20224. Do not send Form
W-2AS, W-2CM, W-2GU, W-2VI, or W-3SS to this address.
Instead, see Where To File on page 2.

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Inst. for Form W-2AS, W-2GU, W-2VI, and W-3SS (2010)