Free Form 6559 (Rev. 1-2003) - Federal

Form 6559
(Rev. January 2003)

Department of the Treasury Internal Revenue Service

Transmitter Report and Summary of Magnetic Media

OMB No. 1545-0441
(Check one) United States
Tax Year (19 or 20

(SSA date of filing stamp)

Other

Page

of

1. Name and address of transmitter (include street, city, state and ZIP code)

2. Employer identification number (EIN) of transmitter 3. Number of reporting media this file
Magnetic tape(s) Diskette(s) Cartridge(s)

4. Name and address of person to contact about this magnetic media file (Include street, city, state and ZIP code)

5. Telephone number (Include area code)

6. Your inventory number

7. Type of data being reported (Check only
one)

W-2 Original W-2 Reconciliation W-2 Resubmittal W-2c for W-2 Affidavit Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and to the best of my knowledge and belief it is true, correct and complete. 8. Signature 9. Title 10. Date

11. Employer Summary of Form W-2 Magnetic Media Wage and Tip Information
Name of employer Check if MQGE

11. Employer Summary of Form W-2 Magnetic Media Wage and Tip Information Name of employer
Check if MQGE

Employer identification number

Other EIN

Employer identification number

Other EIN

Total Amount of Form W-2 Fields
Number of Forms W-2

Total Amount of Form W-2 Fields
Number of Forms W-2

Social security wages Social security tips
Wages, tips, other compensation Federal income tax withheld

$ $ $ $ $ $ $ $

Social security wages Social security tips
Wages, tips, other compensation Federal income tax withheld

$ $ $ $ $ $ $ $

Social security tax withheld Medicare wages and tips
Medicare tax withheld

Social security tax withheld Medicare wages and tips
Medicare tax withheld

Advance Earned Income Credit

Advance Earned Income Credit

Cat. No. 43444U

Form 6559 (Rev. 1-2003)

Instructions for Forms 6559 and 6559-A
Form 6559 is used to identify the transmitter of a magnetic media file. For form W-2 magnetic media reporting, a FILE is a report that begins with a Code A-Transmitter record and ends with a Code F-Final record. Prepare a Form 6559 for each separate magnetic media file being transmitted. Send Form 6559 and the magnetic media file, ALL IN THE SAME PACKAGE, to: Via the U S Postal Service Tapes & Cartridges Social Security Administration AWR Magnetic Media Processing 5-F-1 7, N B, Metro West P.O. Box 33009 Baltimore, MD 21290-3009 Diskettes Social Security Administration AWR Magnetic Media Processing 5-F-1 7, N B, Metro West P.O. Box 33014 Baltimore, MD 21290-3014 Via carrier OTHER than the U S Postal Service Tapes & Cartridges Diskettes Social Security Administration AWR Magnetic Media Processing 5-F-1 7, N B, Metro West 300 N. Greene Street Baltimore, MD 21290 Social Security Administration AWR Magnetic Media Processing 5-F-1 7, N B, Metro West 300 N. Greene Street Baltimore, MD 21290

If you want us to acknowledge receipt of your report, send the report by Return Receipt Requested. Use Form 6559-A, Continuation Sheet for Form 6559, whenever your magnetic media report includes more than two employers, to complete the required Item 11 blocks for additional employers. Each Form 6559 can transmit only one type of data: W-2 Copy A or W-2c for W-2. Only one type of data can be reported on any one file and must be in the same order as reported on the magnetic file.

Specific instructions for Form 6559
Indicate whether this file contains Form W-2 data for employees residing in the United States or in any of the U.S. territories or possessions (Puerto Rico, Guam, American Samoa, Virgin Islands) or the Commonwealth of the Northern Mariana Islands (CNMI). Check the block marked ''Other'' to indicate that the file contains Form W-2 data for employees residing in territories, possessions, or the CNMI Form W-2 data for territorial employees must not be included in the same report with U.S. employees. Item 2 - Enter the 9-digit EIN assigned by IRS to the transmitter. Item 3 - Indicate if tapes, cartridges or diskettes are covered by this transmittal, e.g., ' 4 diskettes'' (SSA does not accept multi-volume tapes/cartridges), Item 6 - Enter the inventory number of each tape or diskette in this file. The inventory number is any type of identification number assigned by the transmitter to a tape, cartridge or diskette for the transmitter's own purposes. If this is a multi-volume diskette file, list the inventory number in order. Item 7 - Indicate whether this file contains original or corrected W-2 data. If you are submitting a file that replaces a file that SSA originally could not process, check the form type marked ''Resubmittal.'' If you are submitting a file to explain differences between IRS and SSA records based on receipt of a letter from SSA, check the form type marked ''Reconciliation.'' Check only one box. 1 Item 11 - Complete an Employer Summary of Form W-2 Magnetic Media Wage and Tip Information'' (Item 11) for each employer for which information is 1 being reported. If data for more than two employers is being reported, use the additional Item 11 blocks on Form 6559-A. MQGE (Medicare Qualified Government Employee) Box - Check this box if you are a U.S., State, Puerto Rico, Virgin Islands, or local agency with employees subject only to the 1.45% hospital insurance benefits (Medicare) tax. Other EIN box - If during the year you used an employer identification number (EIN) that is different from the one entered in the ''Employer Identification Number'' box, enter the other EIN used. If you used more than one prior EIN, show only the latest prior EIN. NOTE: Only the number of Forms W-2 filed for an employer and the eight money fields listed (Social security wages; Social security tips; Wages, tips and other compensation; Federal income tax withheld; Social security tax withheld; Medicare wages and tips; Medicare tax withheld); and Advance Earned Income Credit are required to be completed on line 11 of Forms 6559 and 6559-A. Even though the other money fields are not required on Form 6559, they MUST be included on the magnetic media report. See the instructions for Forms W-2 and W-3 for information on the requirements for reporting specific money field amounts. Substitute Forms 6559 and 6559-A. Filers may use privately printed or computer-generated substitutes for Forms 6559 or 6559-A that closely follow the government printed form. Approval is not required for the use of substitute Forms 6559 or 6559-A. However, the general layout and format of the official form must be followed. CAUTION: Penalties may be imposed for filing incorrect reports. The amounts entered on this form should match the totals on your magnetic media report and the totals reported to IRS on Forms 941, or 943 for the tax year.

Paperwork Reduction Act Notice
We ask for the information on these forms to carry out the Internal Revenue laws of the United States. We need this information to ensure that taxpayers are complying with these laws and to allow us to figure and collect the right amount of tax. You are required to give us this information. 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 Code section 6103.

The time needed to complete and file these forms will vary depending on individual circumstances. The estimated average time for Form 6559 is 15 minutes and for Form 6559-A is 15 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, Attention: Tax Forms Committee, Western Area Distribution Center Rancho Cordova, CA 95743-0001. Please do not send Forms 6559 or 6559-A to this office. Instead, send them to the address shown at the top of this page.

Cat. No. 43444U

Form 6559 (Rev. 1-2003)

Form 6559-A
(Rev. June 2003)

Continuation Sheet for Form 6559
(Transmitter Report and Summary of Magnetic Media)
See Form 6559 for instructions on how to complete this continuation sheet

OMB No. 1545-0441
Tax Year (19 or 20

Page

Department of the Treasury Internal Revenue Service . Name and address of transmitter

of

Employer identification number (EIN) of transmitter ( must be enter)

11. Employer Summary of Form W-2 Magnetic Media Wage and Tip Information
Name of employer Check if MQGE

11. Employer Summary of Form W-2 Magnetic Media Wage and Tip Information Name of employer
Check if MQGE

Employer identification number

Other EIN

Employer identification number

Other EIN

Total Amount of Form W-2 Fields
Number of Forms W-2

Total Amount of Form W-2 Fields
Number of Forms W-2

Social security wages Social security tips
Wages, tips, other compensation Federal income tax withheld

$ $ $ $ $ $ $ $

Social security wages Social security tips
Wages, tips, other compensation Federal income tax withheld

$ $ $ $ $ $ $ $

Social security tax withheld Medicare wages and tips
Medicare tax withheld

Social security tax withheld Medicare wages and tips
Medicare tax withheld

Advance Earned Income Credit

Advance Earned Income Credit

11. Employer Summary of Form W-2 Magnetic Media Wage and Tip Information Name of employer Check if MQGE Other EIN

11. Employer Summary of Form W-2 Magnetic Media Wage and Tip Information Name of employer Check if MQGE Other EIN

Employer identification number

Employer identification number

Total Amount of Form W-2 Fields Number of Forms W-2 Social security wages Social security tips Wages, tips, other compensation Federal income tax withheld Social security tax withheld Medicare wages and tips Medicare tax withheld Advance Earned Income Credit $ $ $ $ $ $ $ $

Total Amount of Form W-2 Fields Number of Forms W-2 Social security wages Social security tips Wages, tips, other compensation Federal income tax withheld Social security tax withheld Medicare wages and tips Medicare tax withheld Advance Earned Income Credit $ $ $ $ $ $ $ $

Cat. No. 43444U

Form 6559-A (Rev. 6-2003)

11. Employer Summary of Form W-2 Magnetic Media Wage and Tip Information Name of employer Check if MQGE Other EIN

11. Employer Summary of Form W-2 Magnetic Media Wage and Tip Information Name of employer Check if MQGE Other EIN

Employer identification number

Employer identification number

Total Amount of Form W-2 Fields Number of Forms W-2 Social security wages Social security tips Wages, tips, other compensation Federal income tax withheld Social security tax withheld Medicare wages and tips Medicare tax withheld Advance Earned Income Credit $ $ $ $ $ $ $ $

Total Amount of Form W-2 Fields Number of Forms W-2 Social security wages Social security tips Wages, tips, other compensation Federal income tax withheld Social security tax withheld Medicare wages and tips Medicare tax withheld Advance Earned Income Credit $ $ $ $ $ $ $ $

11. Employer Summary of Form W-2 Magnetic Media Wage and Tip Information Name of employer Check if MQGE Other EIN

11. Employer Summary of Form W-2 Magnetic Media Wage and Tip Information Name of employer Check if MQGE Other EIN

Employer identification number

Employer identification number

Total Amount of Form W-2 Fields Number of Forms W-2 Social security wages Social security tips Wages, tips, other compensation Federal income tax withheld Social security tax withheld Medicare wages and tips Medicare tax withheld Advance Earned Income Credit $ $ $ $ $ $ $ $

Total Amount of Form W-2 Fields Number of Forms W-2 Social security wages Social security tips Wages, tips, other compensation Federal income tax withheld Social security tax withheld Medicare wages and tips Medicare tax withheld Advance Earned Income Credit $ $ $ $ $ $ $ $

Cat. No. 43444U

Form 6559-A (Rev. 6-2003)