REV-1667 (SU) MOD 03-22 
  ANNUAL WITHHOLDING RECONCILIATION STATEMENT

  The Annual Withholding Reconciliation Statement (REV-1667)                                  PART I. RECONCILIATION 
  along with an individual Wage and Tax Statement/Information                                 Line 1a.  Enter the number of W-2 forms attached. 
  Statement (W-2/1099) for each employee/distribution recipient 
  must be submitted annually on or before Jan. 31 following the                               Line 1b.  Enter the number of 1099 forms with PA 
  year in which wages were paid or distributions occurred. These                                             withholding. 
  documents must be filed at the same time and via the same                                   Line 2.    Enter the total compensation/distribution subject to 
  method. 
                                                                                                             PA withholding. 
  ELECTRONIC REPORTING                                                                        Line 3.    Enter the total amount of PA personal income tax 
  Employers can file year-end employee W-2 Wage and Tax 
  Statements and the  Annual Withholding Reconciliation                                                      withheld. 
  Statement (REV-1667) online through myPATH, the portal for 
  taxpayers to interact with the department. Employers can also                               PART II. ANNUAL RECONCILIATION 
  upload files containing W-2  data or 1099 data to myPATH,                                   Enter the amount of wages or distributions subject to PA 
  eliminating the need to enter the data. Visit mypath.pa.gov for                             withholding and the amount of PA tax withheld for each quarter. 
  additional information and instructions.                                                    Add the amounts for the four quarters and enter the total. 
  To Complete the Annual Withholding Reconciliation                                           Mail the Annual Withholding Reconciliation Statement with the 
  Statement:                                                                                  accompaniments to: 
  ●  Complete the following required fields: calendar year, 
                                                                                              PA DEPARTMENT OF REVENUE 
     Employer Account ID and Entity ID (federal EIN) in the 
                                                                                              PO BOX 280412 
     blocks at the top of the Annual Withholding Reconciliation 
                                                                                              HARRISBURG PA  17128-0412  
     Statement. Enter the business name and address in the 
     area provided.                                                                           Additional information on employer withholding requirements 
  ●  If this is an amended REV-1667, check the appropriate                                    can be found on our website at www.revenue.pa.gov. 
     box. 
  ●  Sign, date and include a daytime telephone number and 
     title on the Annual Withholding Reconciliation Statement, 
     which must accompany the materials submitted. 

                                                                           t   Detach here   t
✁
                                                             YEAR                             EMPLOYER ACCOUNT ID                 ENTITY ID (EIN)
                                  START
                        REV-1667 (SU) 03-22
  Part I          RECONCILIATION
  1a Number of W-2 forms attached                                                                                    AMENDED STATEMENT                                                   DUE DATE 
                                                                                                                                                                                         JANUARY 31
  1b Number of 1099 forms with PA withholding
                                                                                                                                                            ANNUAL WITHHOLDING 
  2  Total compensation/distribution                                                                        ●
     subject to PA withholding    $                        ▲             ▲                  ▲                            RECONCILIATION STATEMENT
  3  PA personal income                                                                                                   BUSINESS NAME AND ADDRESS 
                                                                                                            ●
     tax withheld                 $                        ▲             ▲                  ▲
  Part II         ANNUAL RECONCILIATION                                                                       LEGAL NAME 
                        Wages/distribution paid subject to PA withholding                   PA tax withheld 
   1st Quarter                                                                                                TRADE NAME 
 2nd Quarter                                                                                                  ADDRESS 
  3rd Quarter 
                                                                                                              CITY,   STATE,   ZIP
  4th Quarter 
  TOTAL
                                                                                                                  DO NOT SEND PAYMENT WITH THIS FORM.
                                                             RESET FORM                       PRINT
                        MM/DD/YYYY
               DATE                     DAYTIME TELEPHONE #                      EXT.    TITLE                                                                                 SIGNATURE 
                                           (             )                                                                        Please sign after printing.