SSA-97-SM (second Second Request -Employer Questionnaire- Discrepancy Betw

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Date: MM/DD/YYYY

Form Approved
OMB No. 0960-0432

SECOND REQUEST
EMPLOYER QUESTIONNAIRE
DISCREPANCY BETWEEN IRS AND SSA RECORDS
There’s a discrepancy between the wage totals you reported to the IRS and SSA. The total
wages and tips on your Forms W-2 and W-3 for a tax year should equal the sum of the amounts
that you report quarterly or annually to IRS on your Forms 941, 943, 944, or Schedule H (Form
1040).

Tax Year: YYYY
Employer Identification Number (EIN): 99-9999999
Employer’s Name: [Employer’s Name]
SSA Processed
Social Security Wages
Social Security Tips
Medicare Wages

$999,999.99
$999,999.99
$999,999.99

IRS Processed
$999,999.99
$999,999.99
$999,999.99

Difference
-$999,999.99
-$999,999.99
-$999,999.99

CHECK AND COMPLETE
Check and complete any items that apply to your wage reports for EIN 999999999 and tax year
9999.
1. I didn’t file all of my employees' Forms W-2 with SSA. I’m taking the following action
(check one):
___

I’m filing Forms W-2 and W-3 electronically, either through the Business
Services Online (BSO) website or through a third party, such as a payroll service.
The Wage File Identifier (WFID) is ________________________________
(optional).

___

I’m enclosing legible copies of Forms W-2 and W-3 for tax year 9999.

Note: If you’re filing 250 or more Forms W-2 with SSA, you must file your wage
reports electronically in accordance with the General Instructions for Forms W-2 and W3, at https://www.irs.gov/pub/irs-pdf/iw2w3.pdf. You can sign in or register for an
account at www.ssa.gov/employer to report your wages electronically.
2. I filed one or more Forms W-2 and W-3 with SSA containing incorrect information. I’m
taking the following action (check one):

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___

I’m filing Forms W-2c and W-3c electronically, either through the BSO website
or through a third party, such as a payroll service, to correct my originally filed
Forms W-2 and W-3. The WFID is ________________________________
(optional).

___

I’m enclosing legible copies of Forms W-2c and W-3c to correct my originally
reported wages.

Note: If you’re filing 250 or more Forms W-2 with SSA, you must file your wage
reports electronically in accordance with the General Instructions for Forms W-2 and W3, at https://www.irs.gov/pub/irs-pdf/iw2w3.pdf. You can sign in or register for an
account at www.ssa.gov/employer to report your wages electronically.
3. I reported incorrect wages to the IRS. The wages I reported to SSA are correct. I’m
taking the following action:
___

I’m filing adjusted tax returns with the IRS to fix the incorrect wages.

Note: For additional information, visit https://www.irs.gov/businesses/small-businessesself-employed/correcting-employment-taxes. Don’t send your adjusted tax returns to
SSA.
4. The difference is due to sick pay from a third party. I’m taking the following action:
___

I’m contacting the IRS regarding the third party sick pay discrepancy and
providing the following to SSA:
Third Party Provider Name: __________________________________________
Third Party EIN: ___________________________________________________
Sick Pay Amount: ________________________

For additional information regarding third party sick pay, visit
https://www.irs.gov/pub/irs-drop/n-15-06.pdf or https://www.irs.gov/forms-pubs/aboutform-8922.
5. I can’t explain the difference between my SSA processed wages and my IRS processed
wages. I’m taking the following action:
___

I’m enclosing legible copies of Forms W-2, W-2c, W-3 and/or W-3c that I filed
with SSA, and original and adjusted IRS tax returns 941, 943, 944 or Schedule H
(Form 1040), that I filed with the IRS, for SSA’s review.

6. I don’t have access to the Forms W-2, W-2c, W-3 and W-3c for tax year 9999 due to:
___
___
___

Extraordinary Circumstance (e.g., bankruptcy, death, or divorce)
Catastrophe (e.g., fire, flood, or hurricane)
Other:____________________________________________________________
_________________________________________________________________

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_________________________________________________________________
7. I’m unable to provide Forms W-2, W-2c, W-3, and/or W-3c within the allotted time
because:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
8. None of the options above cover my situation. My explanation is as follows: ________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

_________________________________

(

) _________________________

Your Name and Title

Daytime Phone Number

_________________________________
Email
INFORMATION ABOUT THE DATA YOU SEND SSA
The name, Social Security number, and wage amounts on the Forms W-2, W-2c, W-3, and W-3c must be
readable and complete for SSA to correct your employees’ wage records. If they aren’t, prepare readable
copies and submit them. If you need additional Forms W-2, W-2c, W-3, and W-3c, visit
https://www.irs.gov/businesses or call the IRS at 1-800-829-3676. Ensure that all forms show the correct
EIN and tax year for the wages you report.
Important: Do not send cash, checks, or money orders to SSA. Send your tax payments directly to the
Internal Revenue Service.

Privacy Act Statement
Collection and Use of Personal Information
Sections 205(c)(2)(A) and 232 of the Social Security Act, as amended, allow us to collect this
information. Furnishing us this information is voluntary. However, failing to provide all or part
of the information may result in incorrect payments to beneficiaries due to missing and
discrepant earnings information and in referral of your case to the Internal Revenue Service
(IRS) for penalty assessment purposes.

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We will use the information you provide to properly post employee wages and maintain accurate
earnings records. We may also share your information for the following purposes, called routine
uses:
•

To employers or former employers, including State Social Security administrators, for
correcting and reconstructing State employee earnings records and for Social Security
purposes; and

•

To officers and employees of Federal, State or local agencies upon written request in
accordance with the Internal Revenue Code (IRC) U.S.C 6103(l)(7), tax return
information (e.g., information with respect to net earnings from self-employment,
wages, payments of retirement income which have been disclosed to the Social
Security Administration, and business and employment addresses) for purposes of,
and to the extent necessary in, determining an individual’s eligibility for, or the
correct amount of, benefits under certain programs listed in the IRC.

In addition, we may share this information in accordance with the Privacy Act and other Federal
laws. For example, where authorized, we may use and disclose this information in computer
matching programs, in which our records are compared with other records to establish or verify a
person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent
debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notice (SORN)
60-0059, entitled Earnings Recording and Self-Employment Income System, as published in the
Federal Register (FR) on January 11, 2006, at 71 FR 1819. Additional information, and a full
listing of all our SORNs, is available on our website at www.ssa.gov/privacy.
Paperwork Reduction Act Statement - This information collection meets the requirements of
44 U.S.C. 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not
need to answer these questions unless we display a valid Office of Management and Budget
(OMB) control number. The employer has an obligation to provide the information in this
information collection request to the Social Security Administration. While respondents are not
required to use this particular information collection tool to provide the information, if they do
not, they must use other means. For example, employers may use our Business Services Online
(OMB Control #0960-0626) to submit W-2(c)/W-3(c) information. We estimate that it will take
about 30 minutes to read the instructions, gather the facts, and answer the questions. Send only
comments regarding this burden estimate or any other aspect of this collection, including
suggestions for reducing this burden to: SSA, 6401 Security Blvd, Baltimore, MD 212356401.

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SSA-97-SM (XX-XX)