Revenue

Procedure

2021-46

Reprinted from IR Bulletin 2021-47 Dated November 22, 2021

Publication 1141

General Rules and Specifications for Substitute Forms W-2 and W-3

IRS

Department of the Treasury

Internal Revenue Service

Publication 1141 (Rev. 11-2021)

Catalog Number 47000C

www.irs.gov

NOTE. This revenue procedure will be reproduced as the next revision of IRS Publication 1141, General Rules and Specifications for Substitute Forms W-2 and W-3.

26 CFR 601.602: Tax forms and instructions.

(Also Part I, Sections 6041, 6051, 6071, 6081, 6091; 1.6041-1, 1.6041-2, 31.6051-1, 31.6051-2, 31.6071(a)-1, 31.6081(a)-1, 31.6091-1.)

Rev. Proc. 2021-46

TABLE OF CONTENTS

Part 1 – GENERAL

Section 1.1 – Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Section 1.2 – What’s New . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Section 1.3 – General Rules for Paper Forms W-2 and W-3 . . . . . . . . . . . . . . . . . . . . 3 Section 1.4 – General Rules for Filing Forms W-2 (Copy A) Electronically . . . . . . . . . . 5

Part 2 – SPECIFICATIONS FOR SUBSTITUTE FORMS W-2 AND W-3

Section 2.1 – Specifications for Red-Ink Substitute Form W-2 (Copy A) and Form

W-3 Filed With the SSA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Section 2.2 – Specifications for Substitute Black-and-White Form W-2 (Copy A)

and Form W-3 Filed With the SSA. . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Section 2.3 – Requirements for Substitute Forms Furnished to Employees (Copies

B, C, and 2 of Form W-2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Section 2.4 – Electronic Delivery of Form W-2 and W-2c Recipient Statements. . . . . .16

Part 3 – ADDITIONAL INSTRUCTIONS

Section 3.1 – Additional Instructions for Form Printers. . . . . . . . . . . . . . . . . . . . . .17

Section 3.2 – Instructions for Employers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Section 3.3 – OMB Requirements for Both Red-Ink and Black-and-White

Substitute Forms W-2 and W-3. . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Section 3.4 – Order Forms and Instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Section 3.5 – Effect on Other Documents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Section 3.6 – Exhibits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Part 1

General

Section 1.1 – Purpose

.01 The purpose of this revenue procedure is to state the requirements of the Internal Revenue Service (IRS) and the Social Security Administration (SSA) regarding the preparation and use of substitute forms for Form W-2, Wage and Tax Statement, and Form W-3, Transmittal of Wage and Tax Statements, for wages paid during the 2021 calendar year.

.02 For purposes of this revenue procedure, substitute Form W-2 (Copy A) and substitute Form W-3 are forms that are not printed by the IRS. Copy A or any other copies of a substitute Form W-2 or a substitute Form W-3 must conform to the specifications in this revenue procedure to be acceptable to the IRS and the SSA. No IRS office is authorized to allow deviations from this revenue procedure. Preparers should also refer to the 2021 General Instructions for Forms W-2 and W-3 for details on how to complete these forms. See Section 3.4 for information on obtaining the official IRS forms and instructions. See Sections 2.3 and 2.4 for requirements for the copies of substitute forms furnished to employees and for electronic delivery of employee copies.

.03 For purposes of this revenue procedure, the official IRS-printed red dropout ink Forms W-2 (Copy A) and Form W-3, and their exact substitutes, are referred to as “red-ink.” The SSA-approved black-and-white Forms W-2 (Copy A) and Form W-3 are referred to as “substitute black-and-white Forms W-2 (Copy A)” and “substitute black-and-white Form W-3.”

Any questions about the red-ink Form W-2 (Copy A) and Form W-3 and the substitute employee statements should be emailed to Substituteforms@irs.gov. Please enter “Substitute Forms” on the subject line. Or send your questions to:

Internal Revenue Service

Attn: Substitute Forms Program

SE:W:CAR:MP:P:TP

1111 Constitution Ave. NW

Room 6554

Washington, DC 20224

Any questions about the black-and-white Form W-2 (Copy A) and Form W-3 should be emailed to copy.a.forms@ssa.gov or sent to:

Social Security Administration

Direct Operations Center

Attn: Substitute Black-and-White Copy A Forms, Room 341

1150 E. Mountain Drive

Wilkes-Barre, PA 18702-7997

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Note. You should receive a response from either the IRS or the SSA within 30 days.

.04 Some Forms W-2 that include logos, slogans, and advertisements (including advertisements for tax preparation software) may be considered as suspicious or altered Forms W-2 (also known as “questionable Forms W-2”). An employee may not recognize the importance of the employee copy for tax reporting purposes due to the use of logos, slogans, and advertisements. Thus, the IRS has determined that logos, slogans, and advertising will not be allowed on Copy A of Forms W-2, Forms W-3, or any employee copies reporting wages, with the following exceptions for the employee copies.

Forms may include the exact name of the employer or agent, primary trade name, trademark, service mark, or symbol of the employer or agent.

Forms may include an embossment or watermark on the information return (and copies) that is a representation of the name, a primary trade name, trademark, service mark, or symbol of the employer or agent.

Presentation may be in any typeface, font, stylized fashion, or print color normally used by the employer or agent, and used in a nonintrusive manner.

These items must not materially interfere with the ability of the recipient to recognize, understand, and use the tax information on the employee copies.

The IRS e-file logo on the IRS official employee copies may be included, but it is not required, on any of the substitute form copies.

The information return and employee copies must clearly identify the employer’s name associated with its employer identification number.

Logos and slogans may be used on permissible enclosures, such as a check or account statement, but not on information returns and employee copies.

Forms W-2 and W-3 are subject to annual review and possible change. This revenue procedure may be revised to state other requirements of the IRS and the SSA regarding the preparation and use of substitute forms for Form W-2 and Form W-3 for wages paid during the 2021 calendar year at a future date. If you have comments about the restrictions on including logos, slogans, and advertising on information returns and employee copies, send or email your comments to: Internal Revenue Service, Attn: Substitute Forms Program, SE:W:CAR:MP:P:TP, 1111 Constitution Ave. NW, Room 6554, Washington, DC 20224, or Substituteforms@irs.gov.

.05 The Internal Revenue Service/Information Returns Branch (IRS/IRB) maintains a centralized customer service call site to answer questions related to information returns (Forms W-2, W-3, W-2c, W-3c, 1099 series, 1096, etc.). You can reach the call site at 866-455-7438 (toll free) or 304-263-8700 (not a toll-free number). Persons with a hearing or speech disability with access to Telecommunication Device for the Deaf (TDD) can call 304-579-4827 (not a toll-free number). You may also email questions to mccirp@irs.gov. Do not

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submit employee information via email because it is not secure and the information may be compromised.

File paper or electronic Forms W-2 (Copy A) with the SSA. IRS/IRB does not process Forms W-2 (Copy A). However, IRS/IRB does process Form 8508, Request for Waiver From Filing Information Returns Electronically, and Form 8809, Application for Extension of Time To File Information Returns, for Forms W-2 (Copy A) and requests for an extension of time to furnish the employee copies of Form W-2. See Publication 1220, Specifications for Electronic Filing of Forms 1097, 1098, 1099, 3921, 3922, 5498, and W-2G, for information on waivers and extensions of time.

.06 The following form instructions and publications provide more detailed filing procedures for certain information returns.

General Instructions for Forms W-2 and W-3 (Including Forms W-2AS, W-2CM, W-2GU, W-2VI, W-3SS, W-2c, and W-3c).

Publication 1223, General Rules and Specifications for Substitute Forms W-2c and W-3c.

Section 1.2 – What’s New

.01 Box 14 or separate statement reporting of coronavirus (COVID-19) related sick and family leave wages. Employers must report the amount of qualified sick leave wages and qualified family leave wages paid to employees under the Families First Coronavirus Response Act, as amended by the American Rescue Plan Act, on either 2021 Forms W-2, Box 14, or on a separate statement. See Notice 2021-53 for more information on how to report these amounts.

.02 Editorial changes. We made editorial changes. Redundancies were eliminated as much as possible.

Section 1.3 – General Rules for Paper Forms W-2 and W-3

.01 Employers not filing electronically must file paper Forms W-2 (Copy A) along with Form W-3 with the SSA by using either the official IRS form or a substitute form that exactly meets the specifications shown in Parts 2 and 3 of this revenue procedure.

Note. Substitute territorial forms (W-2AS, W-2GU, W-2VI, W-3SS) must also conform to the specifications as outlined in this revenue procedure. These forms require the form designation (“W-2AS,” “W-2GU,” “W-2VI”) on Form W-2 (Copy A) to be in black ink. If you are an employer in the Commonwealth of the Northern Mariana Islands, you must contact Department of Finance, Division of Revenue and Taxation, Commonwealth of the Northern Mariana Islands, P.O. Box 5234 CHRB, Saipan, MP 96950 or www.finance.gov.mp/forms.php to get

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Form W-2CM and instructions for completing and filing the form. For information on Forms 499R-2/W-2PR, go to www.hacienda.gobierno.pr.

Employers may design their own statements to furnish to employees. Employee statements designed by employers must comply with the requirements shown in Parts 2 and 3.

.02 Red-ink substitute forms that completely conform to the specifications contained in this revenue procedure may be privately printed without prior approval from the IRS or the SSA. Only the substitute black-and-white Forms W-2 (Copy A) and Form W-3 need to be submitted to the SSA for approval, prior to their use (see Section 2.2).

.03 As in the past, SSA-approved black-and-white Forms W-2 (Copy A) and Form W-3 may be generated using a printer by following all guidelines and specifications (also, see Section 2.2). In general, regardless of the method of entering data, use black ink on Forms W-2 (Copy A) and Form W-3, which provides better readability for processing by scanning equipment. Colors other than black are not easily read by the scanner and may result in delays or errors in the processing of Forms W-2 (Copy A) and Form W-3. The printing of the data should be centered within the boxes. The size of the variable data must be printed in a font no smaller than 10-point.

Note. With the exception of the identifying number, the year, the form number for Form W-3, and the corner register marks, the preprinted form layout for the red-ink Forms W-2 (Copy A) and Form W-3 must be in Flint J-6983 red OCR dropout ink or an exact match.

.04 Substitute forms filed with the SSA and substitute copies furnished to employees that do not conform to these specifications are unacceptable. Penalties may be assessed for not complying with the form specifications. Forms W-2 (Copy A) and Form W-3 filed with the SSA that do not conform may be returned.

.05 Substitute red-ink forms should not be submitted to either the IRS or the SSA for specific approval. If you are uncertain of any specification and want clarification, do the following.

Submit a letter or email to the appropriate address in Section 1.1 citing the specification.

State your understanding of the specification.

Enclose an example (if appropriate) of how the form would appear if produced using your understanding. Do not use actual employee information in the example.

Be sure to include your name, complete address, and phone number with your correspondence. If you want the IRS to contact you via email, also provide your email address.

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.06 Any questions about the specifications, especially those for the red-ink Form W-2 (Copy A) and Form W-3, should be emailed to Substituteforms@irs.gov. Please enter “Substitute Forms” on the subject line. Or send your questions to:

Internal Revenue Service

Attn: Substitute Forms Program

SE:W:CAR:MP:P:TP

1111 Constitution Ave. NW

Room 6554

Washington, DC 20224

Any questions about the substitute black-and-white Form W-2 (Copy A) and

Form W-3 should be emailed to copy.a.forms@ssa.gov or sent to:

Social Security Administration

Direct Operations Center

Attn: Substitute Black-and-White Copy A Forms, Room 341

1150 E. Mountain Drive

Wilkes-Barre, PA 18702-7997

Note. You should receive a response within 30 days from either the IRS or the SSA.

.07 Forms W-2 and W-3 are subject to annual review and possible change. Therefore, employers are cautioned against overstocking supplies of privately printed substitutes.

.08 Separate instructions for Forms W-2 and W-3 are provided in the 2021 General Instructions for Forms W-2 and W-3. Form W-3 should be used only to transmit paper Forms W-2 (Copy A). Form W-3 is a single sheet including only essential filing information. Be sure to make a copy of your completed Form W-3 for your records. You can order current year official IRS Forms W-2, W-2AS, W-2GU, W-2VI, W-3, and W-3SS, and the 2021 General Instructions for Forms W-2 and W-3, online at www.irs.gov/OrderForms. The IRS provides only cut sheet sets of Forms W-2 and cut sheets of Form W-3.

.09 Because substitute Forms W-2 (Copy A) and Form W-3 are machine-imaged and scanned by the SSA, the forms must meet the same specifications as the official IRS Forms W-2 and Form W-3 (as shown in the exhibits).

Section 1.4 – General Rules for Filing Forms W-2 (Copy A) Electronically

.01 As of the date of publication of this revenue procedure, employers must file Forms W-2 (Copy A) with the SSA electronically if they are required to file 250 or more for a calendar year unless the IRS grants a waiver. However, see the Caution under E-filing in the 2021 General Instructions for Forms W-2 and W-3 for any changes in this requirement. The SSA publication EFW2, Specifications for Filing Forms W-2 Electronically, contains specifications and procedures for electronic filing of Form W-2 information with the SSA. Employers are

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cautioned to obtain the most recent revision of EFW2 (and supplements) in case there are any subsequent changes in specifications and procedures.

.02 You may obtain a copy of the EFW2 by:

Accessing the SSA website at www.ssa.gov/employer/ EFW2&EFW2C.htm.

.03 Electronic filers do not file a paper Form W-3. See the SSA publication EFW2 for guidance on transmitting Form W-2 (Copy A) information to the SSA electronically.

.04 Employers are encouraged to electronically file Forms W-2 (Copy A) with the SSA. Doing so will enhance the timeliness and accuracy of forms processing. You may visit the SSA’s employer website at www.ssa.gov/ employer. This helpful site has links to Business Services Online (BSO) and tutorials on registering and using BSO to file your Forms W-2.

.05 Employers who do not comply with the electronic filing requirements for Form W-2 (Copy A) and who are not granted a waiver by the IRS may be subject to penalties. Employers who file Form W-2 information with the SSA electronically must not send the same data to the SSA on paper Forms W-2 (Copy A). Any duplicate reporting may subject filers to unnecessary contacts by the SSA or the IRS.

Part 2

Specifications for Substitute Forms W-2 and W-3

Section 2.1 – Specifications for Red-Ink Substitute Form W-2 (Copy A) and Form W-3 Filed With the SSA

.01 The official IRS-printed red dropout ink Form W-2 (Copy A) and Form W-3 and their exact substitutes are referred to as red-ink in this revenue procedure. Employers may file substitute Forms W-2 (Copy A) and Form W-3 with the SSA. The substitute forms must be exact replicas of the official IRS forms with respect to layout and content because they will be read by scanner equipment.

Note. Even the slightest deviation can result in incorrect scanning and may affect money amounts reported for employees.

.02 Paper used for cut sheets and continuous-pinfed forms for substitute Form W-2 (Copy A) and Form W-3 that are to be filed with the SSA must be white 100% bleached chemical wood, 18–20 pound paper only, optical character recognition (OCR) bond produced in accordance with the following specifications.

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•Acidity: Ph value, average, not less than . . . . . . . . . . . . . . . . . . . . . .4.5

•Basis weight: 17 x 22 inch 500 cut sheets, pound . . . . . . . . . . . . . . . .18–20

•Metric equivalent—gm./sq. meter

(a tolerance of +5 pct. is allowed) . . . . . . . . . . . . . . . . . . . . . . . . . .68–75

•Stiffness: Average, each direction, not less than—milligrams

Cross direction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

Machine direction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80

•Tearing strength: Average, each direction, not less

than—grams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40

•Opacity: Average, not less than—percent . . . . . . . . . . . . . . . . . . . . .82

•Reflectivity: Average, not less than—percent . . . . . . . . . . . . . . . . . .68

•Thickness: Average—inch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0.0038

Metric equivalent—mm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0.097

(a tolerance of +0.0005 inch (0.0127 mm) is allowed). Paper cannot

vary more than 0.0004 inch (0.0102 mm) from one edge to the other.

•Porosity: Average, not less than—seconds . . . . . . . . . . . . . . . . . . . .10

•Finish (smoothness): Average, each side—seconds . . . . . . . . . . . . . .20–55

(for information only) the Sheffield equivalent—

units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170-d200

•Dirt: Average, each side, not to exceed—parts per

million . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Note. Reclaimed fiber in any percentage is permitted, provided the requirements of this standard are met.

.03 All printing of red-ink substitute Forms W-2 (Copy A) and Form W-3 must be in Flint red OCR dropout ink except as specified below. The following must be printed in nonreflective black ink.

Identifying number “22222” for Forms W-2 (Copy A) and “33333” for Form W-3 at the top of the forms.

Tax year at the bottom of the forms.

The four (4) corner register marks on the forms.

The form identification number (“W-3”) at the bottom of Form W-3.

All the instructions below Form W-3 beginning with “Send this entire page....” line to the bottom of Form W-3.

.04 The vertical and horizontal spacing for all federal payment and data boxes on Forms W-2 and W-3 must meet specifications. On Form W-3 and Form W-2 (Copy A), all the perimeter rules must be 1-point (0.014-inch), while all other rules must be one-half point (0.007-inch). Vertical rules must be parallel to the left edge of the form; horizontal rules parallel to the top edge.

.05 The official red-ink Form W-3 and Form W-2 (Copy A) are 7.50 inches wide. Employers filing Forms W-2 (Copy A) with the SSA on paper must also file a Form W-3. Form W-3 must be the same width (7.50 inches) as the Form W-2. One Form W-3 is printed on a standard size, 8.5 x 11-inch page. Two

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official Forms W-2 (Copy A) are contained on a single 8.5 x 11-inch page (exclusive of any snap-stubs).

.06 The top, left, and right margins for the Form W-2 (Copy A) and Form W-3 are 0.50 inches (1/2 inch). All margins must be free of printing except for the words “DO NOT STAPLE” on red-ink Form W-3. The space between the two Forms W-2 (Copy A) is 1.33 inches.

.07 The identifying numbers are “22222” for Form W-2 (Copies A (and 1)) and “33333” for Form W-3. No printing should appear anywhere near the identifying numbers.

Note. The identifying number must be printed in nonreflective black ink in OCR-A font of 10 characters per inch.

.08 The depth of the individual scannable image on a page must be the same as that on the official IRS forms. The depth from the top line to the bottom line of an individual Form W-2 (Copy A) must be 4.17 inches and the depth from the top line to the bottom line of Form W-3 must be 4.67 inches.

.09 Continuous-pinfed Forms W-2 (Copy A) must be separated into 11-inch deep pages. The pinfed strips must be removed when Forms W-2 (Copy A) are filed with the SSA. The two Forms W-2 (Copy A) on the 11-inch page must not be separated (only the pages are to be separated (burst)). The words “Do Not Cut, Fold, or Staple Forms on This Page” must be printed twice between the two Forms W-2 (Copy A) in Flint red OCR dropout ink. All other copies (Copies 1, B, C, 2, and D) must be able to be distinguished and separated into individual forms.

.10 Box 12 of Form W-2 (Copy A) contains four entry boxes – 12a, 12b, 12c, and 12d. Do not make more than one entry per box. Enter your first code in box 12a (for example, enter Code D in box 12a, not 12d, if it is your first entry). If more than four items need to be reported in box 12, use a second Form W-2 to report the additional items (see “Multiple forms” in the 2021 General Instructions for Forms W-2 and W-3). Do not report the same federal tax data to the SSA on more than one Form W-2 (Copy A). However, repeat the identifying information (employee’s name, address, and SSN; employer’s name, address, and EIN) on each additional form.

.11 The checkboxes in box 13 of Form W-2 (Copy A) and in box b of Form W-3 must be 0.14 inches each. The space before the first checkbox is 0.24 inches; the space between the first and second checkbox and between the second and third checkbox must be 0.36 inches; the space between the third checkbox to the right border of box 13 should be 0.32 inches (see Exhibit A).

Note. More than 50% of an applicable checkbox must be covered by an “X.”

.12 All substitute Forms W-2 (Copy A) and Form W-3 in the red-ink format must have the tax year, form number, and form title printed on the bottom face of each form using type identical to that of the official IRS form. The red-ink substitute Form W-2 (Copy A) and Form W-3 must have the form producer’s EIN entered directly to the left of “Department of the Treasury,” in red.

.13 The words “For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.” must be printed in Flint red OCR dropout ink in the same

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location as on the official Form W-2 (Copy A). The words “For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.” must be printed at the bottom of the page of Form W-3 in black ink.

.14 The Office of Management and Budget (OMB) Number must be printed on substitute Forms W-3 and W-2 (on each ply) in the same location as on the official IRS forms.

.15 All substitute Forms W-3 must include the instructions that are printed on the same sheet below the official IRS form.

.16 The back of substitute Form W-2 (Copy A) and Form W-3 must be free of all printing.

.17 All copies must be clearly legible. Fading must be minimized to assure legibility.

.18 Chemical transfer paper is permitted for Form W-2 (Copy A) only if the following standards are met.

Only chemically backed paper is acceptable for Form W-2 (Copy A). Front and back chemically treated paper cannot be processed properly by scanning equipment.

Chemically transferred images must be black.

Carbon-coated forms are not permitted.

.19 The Government Printing Office (GPO) symbol and the Catalog Number (Cat. No.) must be deleted from substitute Form W-2 (Copy A) and Form W-3.

Section 2.2 – Specifications for Substitute Black-and-White Form W-2 (Copy A) and Form W-3 Filed With the SSA

.01 Specifications for the SSA-approved substitute black-and-white Forms W-2 (Copy A) and Form W-3 are similar to the red-ink forms (Section 2.1) except for the items that follow (see Exhibits D and E). Exhibits are samples only and must not be downloaded to meet tax obligations.

1. Forms must be printed on 8.5 x 11-inch single-sheet paper only. There must be two Forms W-2 (Copy A) printed on a page. There must be no horizontal perforations between the two Forms W-2 (Copy A) on each page.

2. All forms and data must be printed in nonreflective black ink only.

3. The data and forms must be programmed to print simultaneously. Forms cannot be produced separately from wage data entries.

4. The forms must not contain corner register marks.

5. The forms must not contain any shaded areas, including those boxes that are entirely shaded on the red-ink forms.

6. Identifying numbers on both Form W-2 (Copy A) (“22222”) and Form W-3 (“33333”) must be preprinted in 14-point Arial bold font or a close approximation.

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7. The form numbers (“W-2” and “W-3”) must be in 18-point Arial font or a close approximation. The tax year (for example, “2021”) on Forms W-2 (Copy A) and Form W-3 must be in 20-point Arial bold font or a close approximation.

8. No part of the box titles or the data printed on the forms may touch any of the vertical or horizontal lines, nor should any of the data intermingle with the box titles. The data should be centered in the boxes.

9. Do not print any information in the margins of the substitute black-and-white Forms W-2 (Copy A) and Form W-3 (for example, do not print “DO NOT STAPLE” in the top margin of Form W-3).

10. The word “Code” must not appear in box 12 on Form W-2 (Copy A).

11. A 4-digit vendor code preceded by four zeros and a slash (for example, 0000/9876) must appear in 12-point Arial font, or a close approximation, under the tax year in place of the Cat. No. on Form W-2 (Copy A) and in the bottom right corner of the “For Official Use Only” box at the bottom of Form W-3. Do not display the form producer’s EIN to the left of “Department of the Treasury.” The vendor code will be used to identify the form producer.

12. Do not print Catalog Numbers (Cat. No.) on either Form W-2 (Copy A) or Form W-3.

13. Do not print the checkboxes in:

Box 13 of Form W-2 (Copy A). The “X” should be programmed to be printed and centered directly below the applicable box title.

14. Do not print dollar signs. If there are no money amounts being reported, the entire field should be left blank.

15. The space between the two Forms W-2 (Copy A) is 1.33 inches.

.02 You must submit samples of your substitute black-and-white Forms W-2 (Copy A) and Form W-3 to the SSA. Only black-and-white substitute Forms W-2 (Copy A) and Form W-3 for tax year 2021 will be accepted for approval by the SSA. Questions regarding other red-ink forms (that is, red-ink Forms W-2c, W-3c, 1099 series, 1096, etc.) must be directed to the IRS only.

.03 You will be required to send one set of blank and one set of dummy-data substitute black-and-white Forms W-2 (Copy A) and Forms W-3 for approval. Sample data entries should be filled in to the maximum length for each box entry, preferably using numeric data or alpha data, depending upon the type required to be entered. The “VOID” checkbox must be electronically checked on the dummy-data substitute black-and-white Form W-2 (Copy A). All “Xs” must show in box 13 centered under the applicable checkbox titles on the dummy-data substitute black-and-white Form W-2 (Copy A). All checkboxes on the dummy-data substitute black-and-white Form W-3 must be electronically checked in box b (Kind of Payer, Kind of Employer, and Third-Party sick pay). Include in your submission the name, telephone number, fax number, and email address of a contact person who can answer questions regarding your sample forms.

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.04 To receive approval, you may first contact the SSA via email at copy.a.forms@ssa.gov to obtain a template and further instructions. Send your 2021 sample substitute black-and-white Forms W-2 (Copy A) and Forms W-3 to:

Social Security Administration

Direct Operations Center

Attn: Substitute Black-and-White Copy A Forms, Room 341

1150 E. Mountain Drive

Wilkes-Barre, PA 18702-7997

Send your sample forms via private mail carrier or certified mail in order to verify their receipt. You can expect approval (or disapproval) by the SSA within 30 days of receipt of your sample forms.

.05 Vendor codes from the National Association of Computerized Tax Processors (NACTP) are required by those companies producing the W-2 family of forms as part of a product for resale to be used by multiple employers and payroll professionals. Employers developing Forms W-2 or W-3 to be used only for their individual company require a vendor code issued by the Social Security Administration.

.06 The 4-digit vendor code preceded by four zeros and a slash (0000/9876) must be preprinted on the sample substitute black-and-white Forms W-2 (Copy

A) and Forms W-3. Forms not containing a vendor code will be rejected and will not be submitted for testing or approval. If you have a valid vendor code provided to you through the NACTP, you should use that code. If you do not have a valid vendor code, contact the Social Security Administration via email at copy.a.forms@ssa.gov to obtain an SSA-issued code. (Additional information on vendor codes may be obtained from the SSA or the NACTP via email at president@nactp.org.)

.07 If you use forms produced by a vendor and have questions concerning approval, do not send the forms to the SSA for approval. Instead, you may contact the software vendor to obtain a copy of SSA’s dated approval notice supplied to that vendor.

.08 In response to feedback from the user community, the SSA (and the IRS) have added a 2-D barcoded version for the substitute Form W-2 and Form W-3 to the list of acceptable submission formats. This version is an optional alternative to the nonbarcoded substitute Forms W-2 and W-3. Both versions are fully supported by the SSA. At this time, neither the IRS nor the SSA mandates the use of 2-D barcoded substitute forms.

Note. The data contained in the barcode must not differ from the data displayed on the form. If they differ, the data in the barcode will be ignored and the data displayed on the form will be considered the submission. This also occurs when the barcode is not read correctly. The information on the form needs to be manually keyed into the database.

To get the barcode information:

See the SSA’s BSO website at www.ssa.gov/bso,

11

Request the PDF version of the specifications by emailing copy.a.forms@ssa.gov, and

Download the substitute W3/W2 2-D barcoding standards from www.ssa.gov/employer/subBarCodeStd.pdf.

If you are using a form produced by another vendor that contains a 2-D barcode, you must submit the form for approval using your own NACTP code. Prior to sending your first submission for approval, contact the SSA via email at copy.a.forms@ssa.gov to register your NACTP code and explain what forms you want to submit.

Section 2.3 – Requirements for Substitute Forms Furnished to Employees (Copies B, C, and 2 of Form W-2)

Note. Rules in Section 2.3 apply only to employee copies of Form W-2 (Cop-ies B, C, and 2). Printers are cautioned that the paper filers who send Forms W-2 (Copy A) to the SSA must follow the requirements in Sections 2.1 and/or 2.2 above.

.01 All employers (including those who file electronically) must furnish employees with at least two copies of Form W-2 (three or more for employees required to file a state, city, or local income tax return). The following rules are guidelines for preparing employee copies.

The dimensions of these copies (Copies B, C, and 2), but not Copy A, may differ from the dimensions of the official IRS form to allow space for reporting additional information, including additional entries such as withholding for health insurance, union dues, bonds, or charity in box 14. The limitation of a maximum of four items in box 12 of Form W-2 applies only to Copy A, which is filed with the SSA.

Note. Employee copies (Copies B, C, and 2 of Form W-2) may be furnished electronically if employees give their consent (as described in Treasury Regulations Section 31.6051-1(j)). See also Publication 15-A, Employer’s Supplemental Tax Guide.

.02 The minimum dimensions for employee copies only (not Copy A) of Form W-2 should be 2.67 inches deep by 4.25 inches wide. The maximum dimensions should be no more than 6.50 inches deep by no more than 8.50 inches wide.

Note. The maximum and minimum size specifications in this document are for tax year 2021 only and may change in future years.

.03 Either horizontal or vertical format is permitted (see Exhibit F).

.04 The paper for all copies must be white and printed in black ink. The substitute Copy B, which employees are instructed to attach to their federal income tax returns, should be at least 9-pound paper (basis 17 x 22-500). Other copies furnished to employees should also be at least 9-pound paper (basis 17 x 22-500) unless a state, city, or local government provides other specifications.

.05 Employee copies of Form W-2 (Copies B, C, and 2), including those that are printed on a single sheet of paper, must be easily separated. The best method of

12

separation is to provide perforations between the individual copies. Whatever method of separation is used, each copy should be easily distinguished.

Note. Perforation does not apply to printouts of copies of Forms W-2 that are furnished electronically to employees (as described in Treasury Regulations Section 31.6051-1(j)). However, these employees should be cautioned to carefully separate the copies of Form W-2. See Publication 15-A for information on electronically furnishing Forms W-2 to employees.

.06 Interleaved carbon and chemical transfer paper employee copies must be clearly legible. Fading must be minimized to assure legibility.

.07 The electronic tax logo on the IRS official employee copies is not required on any of the substitute form copies. To avoid confusion and questions by employees, employers are encouraged to delete the identifying number (“22222”) from the employee copies of Form W-2.

.08 All substitute employee copies must contain boxes, box numbers, and box titles that match the official IRS Form W-2. Boxes that do not apply can be deleted. However, certain core boxes must be included. The placement, numbering, and size of this information is specified as follows.

The core boxes must be printed in the exact order shown on the official IRS form. The items and box numbers that constitute the core data are:

Box 1 — Wages, tips, other compensation

Box 2 — Federal income tax withheld

Box 3 — Social security wages

Box 4 — Social security tax withheld

Box 5 — Medicare wages and tips

Box 6 — Medicare tax withheld

The core data boxes (1 through 6) must be placed in the upper right of the form. Substitute vertical-format copies may have the core data across the top of the form. Boxes or other information will definitely not be permitted to the right of the core data.

The form title, number, or copy designation (B, C, or 2) may be at the top of the form. Also, a reversed or blocked-out area to accommodate a postal permit number or other postal considerations is allowed in the upper right.

Boxes 1 through 6 must each be a minimum of 11/8 inches wide x 1/4 inch deep.

Other required boxes are:

a) Employee’s social security number

b) Employer identification number (EIN)

c) Employer’s name, address, and ZIP code

e) Employee’s name

13

f) Employee’s address and ZIP code

Identifying items must be present on the form and be in boxes similar to those on the official IRS form. However, they may be placed in any location other than the top or upper right. You do not need to use the lettering system (a–c, e–

f) used on the official IRS form. The employer identification number (EIN) may be included with the employer’s name and address and not in a separate box.

Note. Box d (“Control number”) is not required.

.09 All copies of Form W-2 furnished to employees must clearly show the form number, the form title, and the tax year prominently displayed together in one area of the form. The title of Form W-2 is “Wage and Tax Statement.” It is recommended (but not required) that this be located on the bottom left of substitute Forms W-2. The reference to the “Department of the Treasury — Internal Revenue Service” must be on all copies of substitute Forms W-2 furnished to employees. It is recommended (but not required) that this be located on the bottom right of Form W-2.

.10 If the substitute employee copies are labeled, the forms must contain the applicable description.

“Copy B, To Be Filed With Employee’s FEDERAL Tax Return.”

“Copy C, For EMPLOYEE’S RECORDS.”

“Copy 2, To Be Filed With Employee’s State, City, or Local Income Tax Return.”

It is recommended (but not required) that these be located on the lower left of Form W-2. If the substitute employee copies are not labeled as to the disposition of the copies, then written notification using similar wording must be provided to each employee.

.11 The tax year (for example, 2021) must be clearly printed on all copies of substitute Form W-2. It is recommended (but not required) that this information be in the middle at the bottom of the Form W-2. The use of 24-pt. OCR-A font is recommended (but not required).

.12 Boxes 1 and 2 (if applicable) on Copy B must be outlined in bold 2-point rule or highlighted in some manner to distinguish them. If “Allocated tips” are being reported, it is recommended (but not required) that box 8 also be outlined. If reported, “Social security tips” (box 7) must be shown separately from “Social security wages” (box 3).

Note. Boxes 8 and 9 may be omitted if not applicable.

.13 If employers are required to withhold and report state or local income tax, the applicable boxes are also considered core information and must be placed at the bottom of the form. State information is included in:

Box 15 (State, Employer’s state ID number)

Box 16 (State wages, tips, etc.)

Box 17 (State income tax)

14

Local information is included in:

Box 18 (Local wages, tips, etc.)

Box 19 (Local income tax)

Box 20 (Locality name)

.14 Boxes 7 through 14 may be omitted from substitute employee copies unless the employer must report any of that information to the employee. For example, if an employee did not have “Social security tips” (box 7), the form could be printed without that box. But, if an employer provided dependent care benefits, the amount must be reported separately, shown in box 10, and labeled “Dependent care benefits.”

.15 Employers may enter more than four codes in box 12 of substitute Copies B, C, and 2 (and 1 and D) of Form W-2, but each entry must use Codes A–HH (see the 2021 General Instructions for Forms W-2 and W-3).

.16 If an employer has employees in any of the three categories in box 13, all checkbox headings must be shown and the proper checkmark made, when applicable.

.17 Employers may use box 14 for any other information that they wish to give to their employees. Each item must be labeled. (See the instructions for box 14 in the 2021 General Instructions for Forms W-2 and W-3.)

.18 The front of Copy C of a substitute Form W-2 must contain the note “This information is being furnished to the Internal Revenue Service. If you are required to file a tax return, a negligence penalty or other sanction may be imposed on you if this income is taxable and you fail to report it.”

.19 Instructions similar to those contained on the back of Copies B, C, and 2 of the official IRS Form W-2 must be provided to each employee. An employer may modify or delete instructions that do not apply to its employees. (For example, remove Railroad Retirement Tier 1 and Tier 2 compensation information for nonrailroad employees or information about dependent care benefits that the employer does not provide.)

.20 Employers must notify their employees who have no income tax withheld that they may be able to claim a tax refund because of the earned income credit (EIC). They will meet this notification requirement if they furnish a substitute Form W-2 with the EIC notice on the back of Copy B, IRS Notice 797, Possible Federal Tax Refund Due to the Earned Income Credit (EIC), or on their own statement containing the same wording. They may also change the font on Copies B, C, and 2 so that the EIC notification and Form W-2 instructions fit differently. For more information about notification requirements, see Notice 1015, “Have You Told Your Employees About the Earned Income Credit (EIC)?”

Note. An employer does not have to notify any employee who claimed exemption from withholding on Form W-4, Employee’s Withholding Certificate, for the calendar year.

15

Section 2.4 – Electronic Delivery of Form W-2 and W-2c Recipient Statements

.01 If you are required to furnish a Form W-2 or W-2c written statement (Copy B or an acceptable substitute) to a recipient, you may furnish the statement electronically instead of on paper.

If you meet the requirements listed below, you are treated as furnishing the statement timely.

.02 The recipient must consent in the affirmative and not have withdrawn the consent before the statement is furnished. The consent by the recipient must be made electronically in a way that shows that he or she can access the statement in the electronic format in which it will be furnished.

You must notify the recipient of any hardware or software changes prior to furnishing the statement. A new consent to receive the statement electronically is required after any new hardware or software is put into service.

To furnish Forms W-2 electronically, you must meet the following disclosure requirements as described in Treasury Regulations Section 31.6051-1(j) and Publication 15-A and provide a clear and conspicuous statement of each requirement to your employees.

The employee must be informed that he or she will receive a paper Form W-2 if consent isn’t given to receive it electronically.

The employee must be informed of the scope and duration of the consent.

The employee must be informed of any procedure for obtaining a paper copy of his or her Form W-2 and whether or not the request for a paper statement is treated as a withdrawal of his or her consent to receiving his or her Form W-2 electronically.

The employee must be notified about how to withdraw a consent and the effective date and manner by which the employer will confirm the withdrawn consent.

The employee must also be notified that the withdrawn consent doesn't apply to the previously issued Forms W-2.

The employee must be informed about any conditions under which electronic Forms W-2 will no longer be furnished (for example, termination of employment).

The employee must be informed of any procedures for updating his or her contact information that enables the employer to provide electronic Forms W-2.

The employer must notify the employee of any changes to the employer's contact information.

.03 Additionally, you must:

Ensure the electronic format complies with the guidelines in this document and contains all the required information described in the 2021 General Instructions for Forms W-2 and W-3.

16

If posting the statement on a website, post it for the recipient to access on or before the January 31 due date through October 15 of that year.

Inform the recipient in person, electronically, or by mail, of the posting and how to access and print the statement.

Part 3

Additional Instructions

Section 3.1 – Additional Instructions for Form Printers

.01 If paper copies are used for filing with the SSA, the substitute copies of Forms W-2 (either red-ink or substitute black-and-white forms) must be assembled in the same order as the official IRS Forms W-2. Copy A must be first, followed sequentially by perforated sets (Copies 1, B, C, 2, and D).

.02 The substitute form to be filed by the employer with the SSA must carry the designation “Copy A.”

Note. Electronic filers do not submit either red-ink or substitute black-and-white paper Form W-2 (Copy A) or Form W-3 to the SSA.

.03 Employers must retain a copy of Forms W-2 and W-3 (or be able to reconstruct the information) for at least 4 years. Employers must also be able to generate Forms W-2 (Copy A) that meet the requirements of this revenue procedure in case of loss.

.04 Except for copies in the official assembly, described in Section 3.1.01 above, no additional copies that may be prepared by employers should be placed ahead of Form W-2 (Copy C) “For EMPLOYEE’S RECORDS.”

.05 You must provide instructions similar to those contained on the back of Copies B, C, and 2 of the official IRS Form W-2 to each employee. You may print them on the back of the substitute Copies B, C, and 2 or provide them to employees on a separate statement. You do not need to use the back of Copy 2. If you do not use Copy 2, you may include all the information that appears on the back of the official Copies B, C, and 2 on the back of your substitute Copies B and C only. As an example, you may use the “Note” on the back of the official Copy C as the dividing point between the text for your substitute Copies B and C. Do not print these instructions on the back of Copy 1. Any Forms W-2 (Copy A) and Form W-3 that are filed with the SSA must have no printing on the reverse side.

17

Section 3.2 – Instructions for Employers

.01 Only originals of Form W-2 (Copy A) and Form W-3 may be filed with the SSA. Carbon copies and photocopies are unacceptable.

.02 Employers should type or machine-print data entries on plain paper forms whenever possible. Ensure good quality by using a high-quality typeface, inserting data in the middle of blocks that are well separated from other printing and guidelines, and taking any other measures that will guarantee clear, sharp images. Black ink must be used with no script type, inverted font, italics, or dual-case alpha characters.

Note. 12-point Courier font is preferred by the SSA.

.03 Form W-2 (Copy A) requires decimal entries for wage data. Do not print dollar signs with money amounts on Forms W-2 (Copy A) and Form W-3.

.04 The employer must provide a machine-scannable Form W-2 (Copy A). The employer must also provide employee copies (Copies B, C, and 2) that are legible and able to be photocopied (by the employee). Do not print any data in the top margin of the payee copies of the forms.

Note. Do not print Forms W-2 (Copy A) on double-sided paper.

.05 Any printing in box d (Control number) on Form W-2 or box a (Control number) on Form W-3 may not touch any vertical or horizontal lines and should be centered in the box.

.06 The filer’s employer identification number (EIN) must be entered in box b of Form W-2 and box e of Form W-3. The EIN entered on Form(s) W-2 (box b) and Form W-3 (box e) must be the same as on Forms 941, 941-SS, 943, 944, CT-1, Schedule H (Form 1040), or any other corresponding forms filed with the IRS. Be sure to use EIN format (00-0000000) rather than SSN format (000-00-0000).

.07 The employer’s name, address, and EIN may be preprinted.

Section 3.3 – OMB Requirements for Both Red-Ink and Black-and-White Substitute Forms W-2 and W-3

.01 The Paperwork Reduction Act (the Act) of 1995 (Public Law 104-13)

requires the following.

The Office of Management and Budget (OMB) approves all IRS tax forms that are subject to the Act.

Each IRS form contains (in or near the upper right corner) the OMB approval number, if assigned. (The official OMB numbers may be found on the official IRS printed forms and are also shown on the forms in the Exhibits in Section 3.6.)

18

Each IRS form (or its instructions) states:

1. Why the IRS needs the information,

2. How it will be used, and

3. Whether or not the information is required to be furnished to the IRS.

.02 This information must be provided to any users of official or substitute IRS forms or instructions.

.03 The OMB requirements for substitute IRS Form W-2 and Form W-3 are the following.

Any substitute form or substitute statement to a recipient must show the OMB number as it appears on the official IRS form.

The OMB number for both Form W-2 (Copy A) and Form W-3 is 1545-0008 and must appear exactly as shown on the official IRS form.

For any copy of Form W-2 other than Copy A, the OMB number must use one of the following formats.

1. OMB No. 1545-0008 (preferred), or

2. OMB # 1545-0008 (acceptable).

.04 Any substitute Form W-2 (Copy A only) and Form W-3 must state “For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.” If no instructions are provided to users of your forms, you must furnish them with the exact text of the Privacy Act and Paperwork Reduction Act Notice in the 2021 General Instructions for Forms W-2 and W-3.

Section 3.4 – Order Forms and Instructions

.01 You can order IRS Forms W-2, Forms W-3, the General Instructions for Forms W-2 and W-3, and other tax material online at www.irs.gov/OrderForms.

.02 Copies of Form W-2 (Copy A) and Form W-3 downloaded from IRS.gov cannot be used for filing with the SSA. These copies of Forms W-2 and W-3 are for information purposes only.

Section 3.5 – Effect on Other Documents

.01 Revenue Procedure 2020-38, I.R.B. 2020-36, dated August 31, 2020 (reprinted as Publication 1141, Revised 08-2020), is superseded.

19

Section 3.6 – Exhibits

Exhibits A through F provide the general measurements for Forms W-2 and W-3 as discussed in this revenue procedure. Certain exhibits show a 0000/ in the location designated for your vendor code. See Section 2.2.01, item 11, and Section 2.2.05 for more information.

Exhibit A — Form W-2 (Copy A) (Red-Ink) 2021

Exhibit B — Form W-2 (Copy B) 2021

Exhibit C — Form W-3 (Red-Ink) 2021

Exhibit D — Form W-2 (Copy A) (Substitute Black-and-White) 2021

Exhibit E — Form W-3 (Substitute Black-and-White) 2021

Exhibit F — Form W-2 Alternative Employee Copies (Illustrating

Horizontal and Vertical Formats)

20

Exhibit A

Form W-2 (Copy A) (Red Ink)

.50 in

7.50 in

.50 in

.10 in

22222

.14 in

a Employee’s social security

number

For Official Use Only

.33 in

VOID

OMB No. 1545-0008

.44 in

b Employer identi

cation number

(EIN)

1 Wages,

tips, other compensation

2 Federal income tax withheld

c Employer’s name, address, and ZIP code

3

Social

security wages

4 Social security tax withheld

5 Medicare wages and tips

6

Medicare tax withheld

5.50 in

7

Social security tips

8

Allocated tips

d Control number

9

4.17 in

10

Dependent care bene ts

e Employee’s rst name and initial

Last name

Suff.

11

Nonquali ed plans

12a See instructions for box 12

C

o

d

e

13

Statutory

Retirement

Third-party

12b

employee

plan

sick pay

C

o

d .50 in

e

14 Other

12c

.14 in

C

d

o

e

12d

.33 in

o

C

d

f Employee’s address and ZIP code

e

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

20 Locality name

.67 in

_FormW-2 Wage and Tax Statement

2021

Department of the Treasury—Internal Revenue Service

For Privacy Act and Paperwork Reduction

Copy A—For Social Security Administration. Send this entire page with

Act Notice, see the separate instructions.

Form W-3 to the Social Security Administration; photocopies are not acceptable.

Do Not Cut, Fold, or Staple Forms on This Page

1.33 in

.90 in

.70 in

1.80 in

.50 in

22222

VOID

a Employee’s social security number

For Official Use Only

4.10 in

OMB No. 1545-0008

b Employer identi

cation number

(EIN)

1 Wages, tips, other compensation

2 Federal income tax withheld

c Employer’s name, address, and ZIP code

3

Social security wages

4 Social security tax withheld

5 Medicare wages and tips

6

Medicare tax withheld

4.10 in

1.70 in

1.70 in

7

Social security tips

8

Allocated tips

d Control number

.30 in

9

10

Dependent care bene ts

e Employee’s rst name and initial

Last name

Suff.

11

Nonquali ed plans

12a See instructions for box 12

1.90 in

1.90 in

.24 in .36 in

.36 in

.32 in

o^C

d

e

2.20 in

13

Statutory

Retirement

Third-party

12b

employee

plan

sick pay

C

o

d

e

14 Other

12c

C

o

d .50 in

e

12d

C

o

d

e

f Employee’s address and ZIP code

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

20 Locality name

2.20 in

1.20 in

1.10 in

1.20 in

1.10 in

.70 in

.40 in

_FormW-2 Wage and Tax Statement

2021

Department of the Treasury—Internal Revenue Service

For Privacy Act and Paperwork Reduction

Copy A—For Social Security Administration. Send this entire page with

Act Notice, see the separate instructions.

Form W-3 to the Social Security Administration; photocopies are not acceptable.

21

Exhibit B

Form W-2 (Copy B)

Safe, accurate,

a

Employee’s social security number

Visit the IRS website at

OMB No. 1545-0008

FAST! Use

www.irs.gov/efile

b Employer identi cation number (EIN)

1 Wages, tips, other compensation

2 Federal income tax withheld

c Employer’s name, address, and ZIP code

3

Social security wages

4 Social security tax withheld

5 Medicare wages and tips

6

Medicare tax withheld

7

Social security tips

8

Allocated tips

d Control number

9

10

Dependent care bene ts

e Employee’s rst name and initial

Last name

Suff.

11

Nonquali ed plans

12a See instructions for box 12

C

o

d

e

13

Statutory

Retirement

Third-party

12b

employee

plan

sick pay

C

o

d

e

14 Other

12c

C

o

d

e

12d

C

o

d

e

f Employee’s address and ZIP code

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

20 Locality name

_FormW-2 Wage and Tax Statement

2021

Department of the Treasury—Internal Revenue Service

Copy B—To Be Filed With Employee’s FEDERAL Tax Return.

0000/

This information is being furnished to the Internal Revenue Service.

22

Exhibit C

Form W-3 (Red Ink)

7.50 in

DO NOT STAPLE

.50 in

33333	a	Control number	For Official Use Only	5.00 in
			OMB No. 1545-0008
.85 in		1.65 in

b

▲

941

Military

943 _{.36 in} 944

▲

None apply

501c non-govt.

Third-party

1.20 in

Kind

Kind

sick pay

of

Hshld.

Medicare

of

State/local

(Check if

.50 in

State/local 501c

Federal govt.

Payer

CT-1_{.36 in}emp.

govt. emp.

Employer

non-501c

applicable)

(Check one)

(Check one)

c Total number of Forms W-2

d Establishment number

1 Wages, tips, other compensation

2 Federal income tax withheld

.50 in

.14 in

1.60 in

1.60 in

e Employer identi cation number (EIN)

3 Social security wages

4 Social security tax withheld

f

Employer’s name

4.67 in

5 Medicare wages and tips

6 Medicare tax withheld

7 Social security tips

2.15 in

8 Allocated tips _{2.15 in}

3.20 in

9

10 Dependent care bene ts

11 Nonquali ed plans

12a Deferred compensation

g Employer’s address and ZIP code

h Other EIN used this year

13 For third-party sick pay use only

12b

15 State

Employer’s state ID number

14 Income tax withheld by payer of third-party sick pay

	.60 in	2.60 in

16 State wages, tips, etc.			17 State income tax	18 Local wages, tips, etc.	19 Local income tax	.33 in



	Employer's contact person			Employer's telephone number	For Of cial Use Only

	Employer's fax number			Employer's email address

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.		.50 in

Signature	Title			Date

Form W-3 Transmittal of Wage and Tax Statements			2021	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 (SSA).

Photocopies are not acceptable. Do not send Form W-3 if you filed electronically with the SSA.

Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3.

Reminder

Separate instructions. See the 2021 General Instructions for Forms

W-2 and W-3 for information on completing this form. Do not le Form

W-3 for Form(s) W-2 that were submitted electronically to the SSA.

Purpose of Form
Complete a Form W-3 Transmittal only when ling paper Copy A of	5.33 in
Form(s) W-2, Wage and Tax Statement. Don't le Form W-3 alone. All
paper forms must comply with IRS standards and be machine readable.
Photocopies are not acceptable. Use a Form W-3 even if only one
paper Form W-2 is being led. Make sure both the Form W-3 and
Form(s) W-2 show the correct tax year and Employer Identi cation
Number (EIN). Make a copy of this form and keep it with Copy D (For
Employer) of Form(s) W-2 for your records. The IRS recommends	When To File Paper Forms
retaining copies of these forms for 4 years.
E-Filing	Mail Form W-3 with Copy A of Form(s) W-2 by January 31, 2022.
The SSA strongly suggests employers report Form W-3 and Forms W-2	Where To File Paper Forms
Copy A electronically instead of on paper. The SSA provides two free	Send this entire page with the entire Copy A page of Form(s) W-2 to:
e- ling options on its Business Services Online (BSO) website.
	Social Security Administration
• W-2 Online. Use ll-in forms to create, save, print, and submit up to
50 Forms W-2 at a time to the SSA.	Direct Operations Center
• File Upload. Upload wage les to the SSA you have created using	Wilkes-Barre, PA 18769-0001
payroll or tax software that formats the les according to the SSA’s	Note: If you use “Certi ed Mail” to le, change the ZIP code to
Specifications for Filing Forms W-2 Electronically (EFW2).
	“18769-0002.” If you use an IRS-approved private delivery service, add
W-2 Online ll-in forms or le uploads will be on time if submitted by
	“ATTN: W-2 Process, 1150 E. Mountain Dr.” to the address and change
January 31, 2022. For more information, go to www.SSA.gov/bso. First-	the ZIP code to “18702-7997.” See Pub. 15 (Circular E), Employer’s Tax
time lers, select “Register”; returning lers select “Log In.”	Guide, for a list of IRS-approved private delivery services.

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

23

Exhibit D

Form W-2 (Copy A) (Substitute Black-and-White)

.90 in.70 in1.80 in

.50 in

22222

VOID

a Employee’s social security number

For Official Use Only

OMB No. 1545-0008

b Employer identi cation number (EIN)

1 Wages, tips, other compensation

2

Federal income tax withheld

c Employer’s name, address, and ZIP code

3

Social security wages

4

Social security tax withheld

5

Medicare wages and tips

6

Medicare tax withheld

.50 in

.50 in

7

Social security tips

8

Allocated tips

d Control number

9

4.17 in

10

Dependent care bene ts

e Employee’s rst name and initial

Last name

Suff. 11

Nonquali ed plans

12a See instructions for box 12

13

Statutory

Retirement

Third-party

12b

employee

plan

sick pay

14 Other

12c

12d

f. Employee’s address and ZIP code

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

20 Locality name

.40 in

1.80 in

1.20 in

1.10 in

1.20 in

1.10 in

.70 in

_FormW-2 Wage and Tax Statement

2021

Department

of the Treasury—Internal Revenue Service

For Privacy Act and Paperwork Reduction

Copy A—For Social Security Administration. Send this entire page with

0000/

1.33 in

Act Notice, see the separate instructions.

Form W-3 to the Social Security Administration; photocopies are not acceptable.

.83 in

Do Not Cut, Fold, or Staple Forms on

This Page

.50 in

22222

VOID

a Employee’s social security number

For Official Use Only

OMB No. 1545-0008

b Employer identi cation number (EIN)

1 Wages, tips, other compensation

2 Federal income tax withheld

c Employer’s name, address, and ZIP code

3

Social security wages

4 Social security tax withheld

5

Medicare wages and tips

6

Medicare tax withheld

7

Social security tips

8

Allocated tips

d Control number

9

10

Dependent care bene ts

e Employee’s rst name and initial

Last name

Suff.

11

Nonquali ed plans

12a See instructions for box 12

13

Statutory

Retirement

Third-party

12b

employee

plan

sick pay

14 Other

12c

12d

f Employee’s address and ZIP code

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

20 Locality name

_FormW-2 Wage and Tax Statement

2021

Department of the Treasury—Internal Revenue Service

For Privacy Act and Paperwork Reduction

Copy A—For Social Security Administration. Send this entire page with

0000/

Act Notice, see the separate instructions.

Form W-3 to the Social Security Administration; photocopies are not acceptable.

24

.50 in

Exhibit E

Form W-3 (Substitute Black-and-White)

.50 in

33333

a

Control number

For Official Use Only

OMB No. 1545-0008

.67 in

b

941

Military

943

944

None apply

501c non-govt.

Third-party

1.20 in

Kind

.36 in

.36 in

.36 in

.36 in

_Kind1.40 in

.55 in

1.25 in

sick pay

of

▲

of

▲

(Check if

Hshld.

Medicare

State/local

Payer

CT-1

Employer

State/local 501c

Federal govt.

applicable)

emp.

govt. emp.

non-501c

(Check one)

(Check one)

.66 in

c Total number of Forms W-2

d Establishment number

1 Wages, tips, other compensation

2 Federal income tax withheld

e Employer identi cation number (EIN)

3 Social security wages

4 Social security tax withheld

.50 in

f Employer’s name

5 Medicare wages and tips

6 Medicare tax withheld

7 Social security tips

8 Allocated tips

1.00 in

9

10 Dependent care bene ts

11 Nonquali ed plans

12a Deferred compensation

g Employer’s address and ZIP code

h Other EIN used this year

13 For third-party sick pay use only

12b

15 State

Employer’s state ID number

14 Income tax withheld by payer of third-party sick pay

16 State wages, tips, etc.

17 State income tax

18 Local wages, tips, etc.

19 Local income tax

Employer’s contact person

Employer’s telephone number

For Of cial Use Only

3.20 in

2.15 in

.33 in

0000/

Employer’s fax number

Employer’s email address

4.30 in

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		2021	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 (SSA).

Photocopies are not acceptable. Do not send Form W-3 if you filed electronically with the SSA.

Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3.

Reminder

Separate instructions. See the 2021 General Instructions for Forms

W-2 and W-3 for information on completing this form. Do notle Form

W-3 for Form(s) W-2 that were submitted electronically to the SSA.

.50 in

Purpose of Form

Complete a Form W-3 Transmittal only when ling paper Copy A of Form(s) W-2, Wage and Tax Statement. Don’t le Form W-3 alone. All paper forms must comply with IRS standards and be machine readable. Photocopies are not acceptable. Use a Form W-3 even if only one paper Form W-2 is being led. Make sure both the Form W-3 and Form(s) W-2 show the correct tax year and Employer Identi cation Number (EIN). Make a copy of this form and keep it with Copy D (For Employer) of Form(s) W-2 for your records. The IRS recommends retaining copies of these forms for 4 years.

E-Filing

The SSA strongly suggests employers report Form W-3 and Forms W-2 Copy A electronically instead of on paper. The SSA provides two free e- ling options on its Business Services Online (BSO) website.

W-2 Online. Use ll-in forms to create, save, print, and submit up to 50 Forms W-2 at a time to the SSA.

File Upload. Upload wage les to the SSA you have created using payroll or tax software that formats the les according to the SSA’s Specifications for Filing Forms W-2 Electronically (EFW2).

W-2 Online ll-in forms or le uploads will be on time if submitted by January 31, 2022. For more information, go to www.SSA.gov/bso. First-time lers, select “Register”; returning lers, select “Log In.”

When To File Paper Forms

Mail Form W-3 with Copy A of Form(s) W-2 by January 31, 2022.

Where To File Paper Forms

Send this entire page with the entire Copy A page of Form(s) W-2 to:

Social Security Administration

Direct Operations Center

Wilkes-Barre, PA 18769-0001

Note: If you use “Certi ed Mail” to le, 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.

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

25

Exhibit F

Form W-2 (Copy B) (Alternative Employee Copies)

Safe, accurate,

Visit the IRS website

at

a

Employee’s social security number

OMB No. 1545-0008

FAST! Use

www.irs.gov/efile

b Employer identi cation number

(EIN)

1 Wages, tips, other compensation

2 Federal income tax withheld

c Employer’s name, address, and ZIP code

3

Social security wages

4 Social security tax withheld

5 Medicare wages and tips

6

Medicare tax withheld

7

Social security tips

8

Allocated tips

d Control number

9

10

Dependent care bene ts

e Employee’s first name and initial

Last name

Suff.

11

Nonquali ed plans

12a See instructions for box 12

C

o

d

e

13

Statutory

Retirement

Third-party

12b

employee

plan

sick pay

C

o

d

e

14 Other

12c

C

o

d

e

12d

C

o

d

e

f Employee’s address and ZIP code

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

20 Locality name

Form W-2

Wage and Tax

2021

Department of the Treasury—Internal Revenue Service

Statement

Copy B—To Be Filed With Employee’s FEDERAL Tax Return.

0000/

This information is being furnished to the Internal Revenue Service.

OMB No. 1545-0008

1	Wages, tips, other compensation	2	Federal income tax withheld

3	Social security wages	4	Social security tax withheld

5	Medicare wages and tips	6	Medicare tax withheld

Employee’s social security number

Employer identi cation number (EIN)

Employer’s name, address, and ZIP code

Employee’s name

Employee’s address and ZIP code

15	State Employer’s state ID number	18 Local wages, tips, etc.


16	State wages, tips, etc.	19 Local income tax

Note: Exhibit F displays examples of how Form W-2 (Copy B) can be furnished to employees. Copy B can be furnished in horizontal or vertical format. Speci cations and requirements for employee copies can be found in Section 2.3 — Requirements for Substitute Forms Furnished to Employees (Copies B, C, and 2 of Form W-2).

Although employee copies can be manipulated, Section 2.3 has speci c requirements for core data boxes that must be present on substitute employee copies.

17 State income tax

20 Locality name

Copy B To Be Filed With Employee’s FEDERAL Tax Return.

Form W-2	2021
Wage and Tax
Statement	0000/

Department of the Treasury—

Internal Revenue Service

26

IRS Releases Publication 1141 (11/2021), General Rules and Specifications for Substitute Forms W-2 and W-3