Free 2009 Form W-3 - Federal

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 33333
b a Control number For Official Use Only OMB No. 1545-0008 941 Military Hshld. emp. d 943 Medicare govt. emp. 944 Third-party sick pay 1 Wages, tips, other compensation 2 Federal income tax withheld

Kind of Payer
c

CT-1

3

Social security wages

4

Social security tax withheld

Total number of Forms W-2

Establishment number

5

Medicare wages and tips

6

Medicare tax withheld

e

Employer identification number (EIN)

7

Social security tips

8

Allocated tips

f Employer's name

9

Advance EIC payments

10

Dependent care benefits

11

Nonqualified plans

12

Deferred compensation

13

For third-party sick pay use only

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

Income tax withheld by payer of third-party sick pay

15

State

Employer's state ID number

16

State wages, tips, etc.

17

State income tax

18

Local wages, tips, etc.

19

Local income tax

Contact person

Telephone number

For Official Use Only

(
Email address

) )

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

Title

Date

Form

W-3 Transmittal of Wage and Tax Statements

2009

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.

Reminder
Separate instructions. See the 2009 Instructions for Forms W-2 and W-3 for information on completing this form.

Upload a file for employers who use payroll/tax software to print Form(s) W-2, if the vendor software creates a file that can be uploaded to SSA. 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 and hand-printed forms 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 March 1, 2010. 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, 2010.

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

Electronic Filing
The Social Security Administration strongly suggests employers report Form W-3 and W-2 Copy A electronically instead of on paper. SSA provides two e-file options: Free online, fill-in Forms W-2 for employers who file 20 or fewer Form(s) W-2.

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 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.
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