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Table 1. Format for Report (Under Covering Letter) to Request SSA to Allocate Back Pay
Under Statute Wages
Employer's EIN: xx-xxxxxxx
Tax Year in Which Award Payment Was Paid: 2012
(1) (2)1 (3)2,3 (4)3
SSN and Award Amount and Other Soc. Sec./Med. Wages Paid Allocation
Employee Name Period(s) In Award Year
Soc. Sec. Med./MQGE Year Soc. Sec. Med./MQGE
xxx-xx-xxxx $100,000 $40,000 $40,000 2009 $20,000 $20,000
HELEN T. SMITH 1/2009 - 12/2012 2010 25,000 25,000
2011 27,000 27,000
2012 28,000 28,000
xxx-xx-xxxx 30,000 -0- -0- 1989 6,000
SAM W. EVANS 7/89-12/91 1990 12,000
1991 12,000
xxx-xx-xxxx 15,000 -0- -0- 9/80 3,500
ROLAND S. 7/80-12/81 12/80 3,500
ADAMS 1981 8,000
1Exclude amounts specifically designated as damages, penalties, etc.
2Exclude the amount of back pay, if any, included in that amount.
3For periods before January 1, 1978 (and for state and local government (Section 218) employers before January 1, 1981), show the wage amounts by calendar
quarters. The social security and/or Medicare Qualified Government Employment (MQGE) wages (where applicable) must be shown separately FOR ALL YEARS.
(Wages subject ONLY to MQGE would be shown in the Medicare/MQGE column; no wages would be shown in the Soc. Sec. column.) For tax years 1991 and later,
the social security and Medicare wages must be listed separately.
Explanation of examples.
Helen T. Smith–The back pay award, excluding interest, was $100,000 for the periods 1/2009-12/2012. In 2012, this employee was also paid
$40,000 in other wages. (Her Form W-2 for 2012 reported $110,100 for social security and $140,000 for Medicare. The SSA allocation will result in
adjusted posted wages of $68,000 for social security and $68,000 for Medicare for 2012.)
Sam W. Evans–The back pay award was $30,000 for the periods 7/89-12/91. This employee was hired in 1989 and was subject to MQGE only. He
was no longer employed by this governmental employer in 2012. (His Form W-2 for 2012 reported $30,000 for social security and $30,000 for
Medicare. After the SSA allocation, he will not have any net posted wages for 2012.)
Roland S. Adams–The back pay award was $15,000 for the periods 7/80-12/81. He was no longer employed by this state and local government
(Section 218) employer in 2012. (His Form W-2 for 2012 reported $15,000 for social security and $15,000 for Medicare; after the SSA allocation, he
will not have any net posted wages for 2012.)
If the state Social Security Administrator's office reported to the SSA. Special wage payments may include
needs more information, they can contact the (but are not limited to):
SSA at the following address:
Accumulated sick and vacation pay,
Back pay,
Social Security Administration
Office of Income Security Programs Bonuses,
Office of Earnings and Program Integrity Policy
6401 Security Boulevard 2506 OPS Deferred compensation,
Baltimore, MD 21235
Payments because of retirement,
Sales commissions,
2. Special Wage Payments Severance pay, and
Stock options.
A special wage payment (SWP) is an amount paid by an
employer to an employee (or former employee) for serv-
ices performed in a prior year. Employers should report to Note. Payments made after retirement that are part of
the SSA special wage payments made to employees and the normal payroll cycle should not be routinely reported
former employees who are recipients of social security re- as special wage payments.
tirement benefits. Special wage payments made to a re-
Earnings Test. Benefits paid to a social security benefi-
tired employee receiving social security or to an employee
ciary under full retirement age may be reduced if the ben-
who continues to work while receiving social security ben-
eficiary continues to work. The SSA uses the information
efits may reduce the benefits the individual receives if not
in boxes 1, 3, and 5 of Form W-2 to determine the
Page 4 Publication 957 (January 2013)
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