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                                              PA W-2 RECONCILIATION WORKSHEET
START PA-40 W-2 RW (EX) 12-22
HERE  Name                                                                                                                                                              Social Security Number 
Ü      
      Employer’s identification number from Box b                                       FEDERAL WAGES            FEDERAL WAGES           MEDICARE WAGES
                                                                                                 (Box 1)                               (Box 1)                               (Box 5)                                    
                                                                                                                                     
      SECTION I – Starting Point 
      SECTION II – Additions                                                                     COLUMN A                    COLUMN B                  COLUMN C 
          1.    Company contribution to deferred compensation plan. 
          2.    Elective deferrals to IRC Section 401(k) - Code “D” 
                  in Box 12. 
          3.    Elective deferrals under IRC Section 403(b) salary reduction 
                  agreement - Code “E” in Box 12. 
          4.     Elective deferrals under IRC Section 408(k)(6) salary reduction 
                  agreement (SEP) - Code “F” in Box 12. 
          5.    Elective and non-elective deferrals under IRC Section 457(b) 
                  deferred compensation plan - Code “G” in Box 12. 
          6.    Elective deferrals to a Section 501 (C)(18)(D) tax-exempt 
                  organization plan - Code “H” in Box 12. 
          7.    Income from a nonqualified deferred compensation (NQDC) 
                   plan - Code “Z” in Box 12. 
          8.    Deferrals to a NQDC plan qualifying under IRC Section 409A -  
                  Code “Y” in Box 12. 
          9.    Other Additions (provide full descriptions) 
                               Fields 9a. through 9e.
        9a. 
        9b. 
        9c. 
        9d. 
        9e. 

        10.    TOTAL (add Lines 1 through 9e.) 
      SECTION III – Subtractions                                                               COLUMN A                    COLUMN B                  COLUMN C 
         11.    Company contribution to deferred compensation plan. 
        12.    Cost of group-term life - Code “C” in Box 12. 
        13.    Income from a NQDC plan - Code “Z” in Box 12. 
        14.    Deferrals to a NQDC plan qualifying under IRC Section 409A -  
                  Code “Y” in Box 12. 
        15.    Personal use of company vehicle. 
        16.    Distributions from a NQDC plan. 
        17.    Distributions from a NQDC plan previously taxed for 
                  Pennsylvania purposes. 
        18.    Other Subtractions (provide full descriptions) 
                               Fields 18a. through 18e.
      18a. 
      18b. 
      18c. 
      18d. 
      18e. 

        19.    TOTAL (add Lines 11 through 18e.) 

      SECTION IV – Finishing Point 
      [Add Section I and Section II, Line 10 then subtract Section III, Line 19]        MEDICARE WAGES                 PA WAGES                        PA WAGES 
                                                                                                                                     (Box 5)                              (Box 16)                             (Box 16)
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                                                              Instructions for PA W-2 RW 
PA-40 W-2 RW IN (EX) 12-22                                                                         Interest Income  

         GENERAL INFORMATION                                          GENERAL INSTRUCTIONS                       
PURPOSE OF SCHEDULE                                           Column A reconciles the amount of federal wages in Box 1 
Use the PA W-2 RW to provide supplemental information         of the W-2 to the amount of Medicare wages reported in 
regarding amounts reported on federal Form W-2, Wage          Box 5 of W-2. Include those items of compensation, such 
and Tax Statement, so that the department may reconcile       as various types of retirement plan deferrals and any other 
                                                              items of compensation that are not included in federal 
the wages to determine if the proper amount of gross com-
                                                              wages but are included Medicare wages in Section II of the 
pensation income is reported for Pennsylvania personal 
                                                              W-2 RW. Include those items of compensation included in 
income tax purposes. The W-2 RW may also be used to           federal wages that are not included in Medicare wages in 
provide additional information regarding nonqualified         Section III of the W-2 RW. 
deferred compensation distributions previously taxed. 
                                                              Column B reconciles federal wages in Box 1 of the W-2 to 
                                                              Pennsylvania wages in Box 16 or to what Pennsylvania 
RECORDING DOLLAR AMOUNTS
                                                              wages should be (for wages earned by a Pennsylvania res-
Show money amounts in whole-dollars only. Eliminate any       ident outside the state or by nonresidents). Include those 
amount less than $0.50 and increase any amount that is        items of compensation, such as various types of retirement 
$0.50 or more to the next highest dollar.                     plan deferrals and any other items of compensation that 
                                                              are not included in federal wages but are included 
                                                              Pennsylvania wages in Section II of the W-2 RW. Include 
         WHO MUST COMPLETE
                                                              those items of compensation included in federal wages that 
The W-2 RW must be completed by taxpayers when the            are not included in Pennsylvania wages in Section III of the 
amount shown as Medicare wages in Box 5 of the W-2 are        W-2 RW. 
greater than Pennsylvania wages shown in Box 16 and           Column C reconciles Medicare wages in Box 5 of the W-2 
there is insufficient information included on the W-2 to rec- to Pennsylvania wages in Box 16 or to what Pennsylvania 
oncile the wages without the additional information repre-    wages should be (for wages earned by a Pennsylvania res-
sented on the W-2 RW. The W-2 RW must also be complet-        ident outside the state or by nonresidents). Include those 
ed when a PA resident taxpayer works in another state and     items of compensation, that are not included in Medicare 
Pennsylvania tax is not withheld from the wages when          wages but are included Pennsylvania wages in Section II of 
                                                              the W-2 RW. Include those items of compensation included 
insufficient information is included on the W-2 to adjust the 
                                                              in Medicare wages that are not included in Pennsylvania 
wages to the amount of world-wide wages a Pennsylvania        wages in Section III of the W-2 RW. 
resident would be subject to using Pennsylvania personal 
income tax rules.                                             NOTE: The most common differences between fed-
                                                              eral, Medicare and Pennsylvania wages are included 
                                                              on Lines 1 thru 8 and Lines 10 thru 17. Other additions and 
         SCHEDULE INSTRUCTIONS
                                                              subtractions not listed may be reported on Lines 9 and 17, 
IDENTIFICATION INFORMATION                                    respectively. 
NAME OF TAXPAYER ON W-2                                       IMPORTANT: If including the W-2 RW with a PA-40, 
Enter the name of the taxpayer shown on the W-2.              Personal Income Tax Return, all three columns of the 
                                                              W-2 RW must be completed. 
SOCIAL SECURITY NUMBER 
Enter the Social Security number (SSN) of the taxpayer                                                           
                                                                            LINE INSTRUCTIONS
shown on the W-2. 
                                                                                                                 
EMPLOYER’S IDENTIFICATION NUMBER                                             SECTION I
Enter the federal employer identification number from Box     STARTING POINT 
b of the W-2 for the employer whose wages are being rec-      Enter the amount of federal wages from Box 1 of the W-2 
onciled.                                                      in the space above the headings for Columns A and B. 

www.revenue.pa.gov                                                                                 PA-40 W-2 RW 1

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Enter the amount of Medicare wages from Box 5 of the W-     Box 12 of the W-2, enter the amount from the last pay 
2 in the space above the heading for Column C.              statement of the year from the employer. 
                                                
              SECTION II                                                       LINE 7                        
ADDITIONS                                                   COLUMN A 
                                                            Enter the amount of earnings on amounts deferred that are 
                LINE 1                                      included in Box 1 when a nonqualified deferred compensa-
COLUMN A                                                    tion (NQDC) plan fails to satisfy the requirements under 
Enter the amount of any company contributions to a          IRC Section 409A plan shown as Code Z in Box 12 of the 
deferred compensation plan not included in federal wages    W-2. 
that are included in Medicare wages. 
                                                                               LINE 8                        
                LINE 2
                                                            COLUMNS A AND B 
COLUMNS A AND B                                             Enter the amount of any deferrals the taxpayer/employee 
Enter the amount of any elective deferrals the              made to a nonqualified deferred compensation (NQDC) 
taxpayer/employee made to an IRC Section 401(k) cash or     plan that are not required to be included in compensation 
deferred arrangement plan shown as Code D in Box 12 of      under IRC Section 409A shown as Code Y in Box 12 of the 
the W-2. If contributions were made but are not shown in    W-2. If contributions were made but are not shown in Box 
Box 12 of the W-2, enter the amount from the last pay       12 of the W-2, enter the amount from the last pay statement 
statement of the year from the employer.                    of the year from the employer. 

                LINE 3
                                                                         LINES 9a THROUGH 9e                 
COLUMNS A AND B                                             COLUMNS A AND B 
Enter the amount of any elective deferrals the              Enter the amount of any items of compensation not shown 
taxpayer/employee made to an IRC Section 403(b) salary      on Lines 1 thru 8 that are not included in federal wages that 
reduction agreement shown as Code E in Box 12 of the W-
                                                            are included in Medicare or Pennsylvania wages. 
2. If contributions were made but are not shown in Box 12 
of the W-2, enter the amount from the last pay statement of COLUMN C 
the year from the employer.                                 Enter the amount of any items of compensation not shown 
                                                            on Lines 1 thru 8 that are not included in Medicare wages 
                LINE 4                                      that are included in Pennsylvania wages. 
COLUMNS A AND B 
Enter the amount of any elective deferrals the                                 LINE 10                       
taxpayer/employee made to an IRC Section 408(k)(6)          COLUMNS A AND B 
salary reduction agreement shown as Code F in Box 12 of     Add the amounts on Lines 1 thru 9e and enter the total for 
the W-2. If contributions were made but are not shown in    each column. 
Box 12 of the W-2, enter the amount from the last pay 
statement of the year from the employer.                                                                     
                                                                               SECTION III
                                                            SUBTRACTIONS 
                LINE 5                          
COLUMNS A AND B                                                                LINE 11
                                                                                                             
Enter the amount of any elective and non-elective deferrals 
the taxpayer/ employee made to an IRC Section 457(b)        COLUMN C 
deferred compensation plan shown as Code G in Box 12 of     Enter the amount of any company contributions to a 
the W-2. If contributions were made but are not shown in    deferred compensation plan not included in federal wages 
Box 12 of the W-2, enter the amount from the last pay       that are included in Medicare wages. 
statement of the year from the employer. 
                                                                               LINE 12                       
                LINE 6                                      COLUMNS B AND C 
COLUMNS A AND B                                             Enter the amount of the cost of group-term life insurance 
Enter the amount of any elective deferrals the              payments shown as Code C in Box 12 of the W-2. If pay-
taxpayer/employee made to an IRC Section 501(C)(18)(D)      ments were made but are not shown in Box 12 of the W-2, 
tax-exempt organization plan shown as Code H in Box 12      enter the amount from the last pay statement of the year 
of the W-2. If contributions were made but are not shown in from the employer. 

2 PA-40 W-2 RW                                                                             www.revenue.pa.gov

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                        LINE 13                              LINES 18a THROUGH 18e                                
COLUMN C                                                     COLUMNS A AND B 
Enter the amount of earnings on amounts deferred that are    Enter the amount of any items of compensation not shown 
included in Box 1 when the NQDC plan fails to satisfy the    on Lines 11 thru 16 that are included in federal wages that 
requirements under IRC Section 409A plan shown as Code       are not included in Medicare or Pennsylvania wages. 
Z in Box 12 of the W-2. 
                                                             COLUMN C 
                                                             Enter the amount of any items of compensation not shown 
                        LINE 14                              on Lines 11 thru 16 that are included in Medicare wages 
COLUMN C                                                     that are not included in Pennsylvania wages. 
Enter the amount of any deferrals the taxpayer/employee 
made to a NQDC plan that are not required to be included                      LINE 19                             
in compensation under IRC Section 409A shown as Code 
                                                             COLUMNS A, B AND C 
Y in Box 12 of the W-2. If contributions were made but are 
                                                             Add the amounts on Lines 11 thru 18e and enter the total 
not shown in Box 12 of the W-2, enter the amount from the 
                                                             for each column. 
last pay statement of the year from the employer. 
                                                                                                                  
                        LINE 15                                               SECTION IV

COLUMNS B AND C                                              FINISHING POINT 
Enter the amount of any personal use of company vehicle      COLUMNS A, B AND C 
included in federal wages.  This amount is sometimes         Add the amount from Section I and Section II, Line 10 and 
included in Box 14 of the W-2. If not included as a separate subtract the amount from Section III, Line 19 and enter the 
amount in Box 14 of the W-2, enter the amount from the       result for each column.  
last pay statement of the year from the employer. 
                                                             IMPORTANT:  The Finishing Point amounts from 
                                                             Columns B and C should be the same and equal the 
                        LINE 16
                                                             amount of Pennsylvania wages reported on Form W-2 pro-
COLUMN A                                                     vided by an employer for a Pennsylvania resident working 
Enter the amount of any distributions from a NQDC plan       in Pennsylvania. When the amounts do not match, include 
that were not previously included in Pennsylvania wages.     the amount from Column C in the total as Gross 
                                                             Compensation on Line 1a of the PA-40 Return.
                        LINE 17                           
COLUMN B 
Enter the amount of any distributions from a NQDC plan 
that were previously included in Pennsylvania wages.  
IMPORTANT: Proof that the amounts deferred for a 
NQDC plan were previously included in Pennsylvania 
wages is also required to be included with the return. 

www.revenue.pa.gov                                                                      PA-40 W-2 RW             3

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