Free 2009 Form W-3SS - 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 OR FOLD 33333
b a Control number For Official Use Only OMB No. 1545-0008 941-SS Military Medicare govt. emp. d 943 Third-party sick pay 944-SS 1 Wages, tips, other compensation 2 Income tax withheld

Kind of Payer
c

Hshld. emp.

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

f Employer's name

9

Advance EIC payments

10

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 Check the appropriate box Type of Form W-2AS W-2CM W-2GU W-2VI

i

Employer's territorial ID number

Contact person

Telephone number

For Official Use Only

(
Email address

)

Fax number

( ) Copy A--For Social Security Administration
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-3SS

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 Forms W-2AS, W-2CM, W-2GU, or Form W-2VI to the Social Security Administration (SSA). Photocopies are not acceptable. Do not send any remittance (cash, checks, money orders, etc.) with Forms W-2AS, W-2CM, W-2GU, W-2VI, and W-3SS.

Reminders
Separate instructions. See the 2009 Instructions for Forms W-2AS, W-2GU, W-2VI, and Form W-3SS for information on completing this form.

Where To File
Send this form with the entire Copy A page of Form 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. Also see Where to file Copy 1 below. Where to file Copy 1. File Copy 1 of Forms W-2AS and W-3SS with the American Samoa Tax Office, 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.

Purpose of Form
Use Form W-3SS to transmit Copy A of Forms W-2AS, W-2CM, W-2GU, and W-2VI. Make a copy of Form W-3SS and keep it with Copy D (From Employer) of Forms W-2AS, W-2CM, W-2GU, or Form W-2VI for your records. Use Form W-3SS for the correct year. File Form W-3SS even if only one Form W-2AS, W-2CM, W-2GU, or W-2VI is being filed. However, if you are filing your wage and tax information electronically, do not file Form W-3SS.

When To File
File Copy A of Form W-3SS with Copy A of Form W-2AS, W-2CM, W-2GU, or Form W-2VI by March 1, 2010.

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 10117S

DO NOT STAPLE OR FOLD 33333
b a Control number For Official Use Only OMB No. 1545-0008 941-SS Military Medicare govt. emp. d 943 Third-party sick pay 944-SS 1 Wages, tips, other compensation 2 Income tax withheld

Kind of Payer
c

Hshld. emp.

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

f Employer's name

9

Advance EIC payments

10

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

i

Employer's territorial ID number

Contact person

Telephone number

For Official Use Only

(
Email address

)

Fax number

( ) Copy 1--For Local Tax Department
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-3SS Transmittal of Wage and Tax Statements

2009

Department of the Treasury Internal Revenue Service