Form SSA-95-SM Employer Questionnaire--SSA Has No Record of Employer Re

SSA 95 Employer Questionnaire No Record of Report – OOG REVISIONS

EMPLOYER QUESTIONNAIRE

SSA HAS NO RECORD OF EMPLOYER REPORT

IRS records show that you paid taxes on the wages that appear below. However, SSA does not have a record of processing your Forms W-2 and W-3 for these wages. IRS requires you to send Forms W-2 to SSA.

IRS Data (941, 943, 944 or Schedule H (Form 1040) electronic and/or paper returns) for

Tax Year: 2000

EIN: EIN

Employer Name: Employer Name

Employee Soc. Security Wage Totals: $999,999.00

Employee Soc. Security Tip Totals: $999,999.00

Employee Medicare Wage/Tip Totals: $999,999.00

CHECK AND COMPLETE

Check and complete any items that apply to your wage report for the tax year shown above. If you send a wage report that shows a different total from the amount shown above, please explain why in number 6.

1. ( ) I did not file Forms W-2 with SSA. I am now taking the following action (check one):

( ) Enclosing the original Copy A of paper Forms W-2 and W-3, or

( ) Sending SSA an electronic file.

Caution: You must identify this as a reconciliation file when you submit it! Enclose the electronic receipt showing the Wage File ID (WFID) as proof of filing.

2. ( ) I filed Forms W-2 under the EIN for the TY shown above. I am now taking the following action for the wages I previously reported (check one):

( ) Enclosing legible copies of paper Forms W-2 and W-3, or

( ) Sending SSA an electronic file.

Caution: You must identify this as a reconciliation file when you submit it! Enclose the electronic receipt showing the Wage File ID (WFID) as proof of filing.

3. ( ) I filed Forms W-2 under EIN __________, rather than the EIN shown above. Attach legible copies if on paper. Enter the Wage File ID (WFID) if electronic (or other proof of filing if a third-party, such as a payroll service e-filed for you).

4. ( ) I filed but cannot locate my copies of Forms W-2 and W-3. I am now taking the following action (check one):

( ) Enclosing duplicate copies of paper Forms W-2 and W-3, or

( ) Sending SSA an electronic file.

Caution: You must identify this as a reconciliation file when you submit it! Enclose the electronic receipt showing the Wage ID (WFID) as proof of filing.

5. ( ) I was not required to file Forms W-2 with SSA, as I was self-employed. (Attach a legible copy of

Form 1099 or 1040 with a Schedule SE or Schedule C that shows SE tax.)

6. ( ) Other ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

_________________________________________________________ ( ) ______________________

Your Name and Title Daytime Phone, with area code

INFORMATION ABOUT THE DATA YOU SEND SSA

The name, Social Security number, and wage amounts on the Forms W-2 must be readable and complete. If we cannot read all information on the documents you submit, or if any of these items are missing, we cannot add the wages to the employee's wage record. If you need blank copies of the Forms W-2 or W-3, call IRS at 1-800-829-3676. If your copies of the Forms W-2 are illegible, please prepare duplicates on blank copies of the Forms W-2. Make sure the Forms W-2 show the correct year for which the wages are being reportedyou report.

Note: If you send 250 or more wage items to us, you must file your wage reports electronically in accordance with Publication 42-007: name. For more information, please go to our website at URL or call SSA's Employer Reporting Branch at phone from 7:00 A.M. to 7:00 P.M., Eastern time, Monday through Friday.

RETURN THIS QUESTIONNAIRE

Please send all requested information to:

Address

Do not send cash, checks, or money orders to SSA. Tax payments are payable to the Internal Revenue Service.

Readability:

Before OOG Revision

3% passive; Grade level 8.1

After OOG Revision

0% passive; Grade level 8.1