PDF document
- 1 -
Page 1 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source 15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Revenue 

Procedure 

2023-39

Reprinted from IR Bulletin 2023-52
Dated December 26, 2023

Publication 1223

General Rules and 

Specifications for Substitute 

Forms W-2c and W-3c

IRS
Department of the Treasury
Internal Revenue Service
Publication 1223 (Rev. 12-2023)
Catalog Number 61278W
www.irs.gov



- 2 -
Page 2 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                                                       15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

NOTE. This revenue procedure will be reproduced as the next revision of IRS 
Publication 1223, General Rules and Specifications for Substitute Forms W-2c and 
W-3c.

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. 2023-39
TABLE OF CONTENTS

Part 1 – SUBSTITUTE FORMS W-2C AND W-3C
             Section 1.1 – Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
             Section 1.2 – What's New. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
             Section 1.3 – Filing Forms W-2c and W-3c Electronically             . . . . . . . . . . . . . . . . . . . . . 4
             Section 1.4 – Specifications for Red-Ink Substitute Forms W-2c (Copy A) and 
             W-3c Filed With the SSA                     . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
             Section 1.5 – Specifications for Substitute Black-and-White Forms W-2c (Copy A) 
             and W-3c Filed With the SSA                       . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   8
             Section 1.6 – Requirements for Substitute Privately Printed Forms W-2c (Copies B, 
             C, and 2) Furnished to Employees                      . . . . . . . . . . . . . . . . . . . . . . . . . . .   10
             Section 1.7 – Instructions for Employers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      12
             Section 1.8 – OMB Requirements for Both Red-Ink and Black-and-White Copy A 
             and W-3c Substitute Forms                     . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   13
             Section 1.9 – Order Forms and Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        14
             Section 1.10 – Effect on Other Documents        . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   14
             Section 1.11 – Exhibits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14



- 3 -
Page 3 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                       15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

                                               Part 1

                     Substitute Forms W-2c and W-3c

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-2c, Corrected 
             Wage and Tax Statement, and Form W-3c, Transmittal of Corrected Wage and 
             Tax Statements.
             .02 The official IRS Form W-2c is a six-part form and the official IRS Form 
             W-3c is a one-part form. Red-ink substitute forms that completely conform to 
             the specifications contained in this document may be privately printed without 
             the prior approval of the IRS or the SSA. Only the substitute black-and-white 
             Form (Copy A) and substitute black-and-white W-3c forms need to be 
             submitted to the SSA for approval.

             Note.   Both paper substitute forms filed with the SSA, and those furnished to 
             employees, that do not totally conform to these specifications are not acceptable. 
             Forms W-2c (Copy A) and Forms W-3c that do not conform may be returned. In 
             addition, penalties may be assessed by the IRS.
             .03 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.

             1.  Submit a letter to the appropriate address below citing the specification.

             2.  State your understanding of the specification; enclose an example.

             3.  Be sure to include your name, complete address, phone number, and, if 
                 applicable, your email address with your correspondence.
             .04 Any questions about the red-ink Form W-2c (Copy A) and Form W-3c, 
             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:TP
                     ATSC
                     4800 Buford Highway
                     Mail Stop 061-N
                     Chamblee, GA 30341

             Note.   Do not send completed forms to the Substitute Forms Program via email 
             or mail as they are unable to process those forms. Any examples/samples of 
             substitute forms sent to the Substitute Forms program should not contain 
             taxpayer information.

                                               1



- 4 -
Page 4 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                      15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

             Any questions about the substitute black-and-white Form W-2c (Copy A) and 
             W-3c 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

             Do not email or mail completed Forms W-2c (Copy A) to the SSA Substitute 
             Black-and-White Copy A Forms address as they are unable to process those 
             forms. Submitters should use the address shown on the Form W-3c.

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

             .05 Some Forms W-2c that include logos, slogans, and advertisements 
             (including advertisements for tax preparation software) may be considered as 
             suspicious or altered Forms W-2c (also known as questionable Forms W-2c). 
             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-2c, Forms W-3c, 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 
                  non-intrusive manner.
                These items do 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 (EIN).

             Note. Just as with the forms, an employee may not recognize the importance (or 
             legitimacy) of an envelope containing employee copies of Form W-2c if logos, 
             slogans, and advertisements (including coupons) are on the envelope. Therefore, 
             such items are not allowed on envelopes containing employee copies of Form 
             W-2c.

             Forms W-2c and W-3c are subject to annual review and possible change. This 
             revenue procedure may be revised to state other requirements of the IRS and the 

                                                 2



- 5 -
Page 5 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                       15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

             SSA regarding the preparation and use of substitute forms for Form W-2c and 
             Form W-3c for corrections to be made at a future date. If you have comments 
             about the prohibition against including slogans, advertising, and logos on 
             information returns and employee copies, email or send your comments to: 
             substituteforms@irs.gov or Internal Revenue Service, Attn: Substitute Forms 
             Program, SE:W:CAR:MP:P:TP:TP, ATSC, 4800 Buford Highway, Mail Stop 
             061-N, Chamblee, GA 30341.

             .06 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). Deaf or hard-of-hearing customers may call any of our 
             toll-free numbers using their choice of relay service. You may also email 
             questions to mccirp@irs.gov. Do not submit employee information via email 
             because it is not secure and the information may be compromised.

             File paper or electronic Forms W-2c (Copy A) with the SSA. The IRS/IRB does 
             not process Forms W-2c (Copy A).

             .07 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 1141, General Rules and Specifications for Substitute 
                Forms W-2 and W-3.

Section 1.2 – What's New

             .01 Electronic filing of returns. The Department of the Treasury and the IRS 
             issued final regulations (T.D. 9972) that changed the rules for mandatory 
             electronic filing of correction forms, including Form W-2c, as authorized under 
             the Taxpayer First Act, enacted July 1, 2019. If you were required to 
             electronically file the original Form W-2, you must electronically file any Form 
             W-2c correcting that form. If the original Form W-2 was permitted to be filed 
             on paper and you filed on paper, then you must file any Form W-2c correcting 
             that form on paper. See Regulations section 301.6011-2 for more information.

             .02 IRS address change. Inquiries about the red-ink Form W-2c (Copy A) and 
             Form W-3c should be sent to the IRS at: Internal Revenue Service, Attn: 
             Substitute Forms Program, SE:W:CAR:MP:P:TP:TP, ATSC, 4800 Buford 
             Highway, Mail Stop 061-N, Chamblee, GA 30341.

             .03 Exhibits. All of the exhibits in this publication were updated for the August 
             2023 revisions of those forms.

             .04 Editorial changes. We made editorial changes throughout, including to 
             update references and correspond more closely to Publication 1141. 
             Redundancies were eliminated as much as possible.

                                              3



- 6 -
Page 6 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                      15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Section 1.3 – Filing Forms W-2c and W-3c Electronically

             .01 If an employer was required to electronically file the original Form W-2, 
             they must electronically file any Form W-2c correcting that form. If the original 
             Form W-2 was permitted to be filed on paper and was filed on paper, then the 
             employer must file any Form W-2c correcting that form on paper. See 
             Regulations section 301.6011-2(c)(4)(ii) for more information. SSA publication 
             EFW2C, Specifications for Filing Forms W-2c Electronically, contains 
             specifications and procedures for filing Forms W-2c. Employers are cautioned 
             to obtain the most recent revision of EFW2C (and supplements) due to any 
             subsequent changes in specifications and procedures. Instead of the EFW2C 
             upload format, the employer can use SSA's W-2c Online fill-in forms to create, 
             save, print, and submit up to 25 Forms W-2c at a time to the SSA. For more 
             information, go to SSA.gov/employer/.
             .02 You may obtain a copy of the EFW2C by accessing the SSA website at 
             SSA.gov/employer/EFW2&EFW2C.
             .03 Electronic filers do not file a paper Form W-3c. See the SSA publication 
             EFW2C for guidance on transmitting Form W-2c (Copy A) information to the 
             SSA electronically.
             .04 Employers who do not comply with the electronic filing requirements for 
             Form W-2c (Copy A) and who are not granted a waiver by the IRS may be 
             subject to penalties. Employers who file Form W-2c information with the SSA 
             electronically must not send the same data to the SSA on paper Forms W-2c 
             (Copy A). Any duplicate reporting may subject filers to unnecessary contacts by 
             the SSA or the IRS.

Section 1.4 – Specifications for Red-Ink Substitute Forms W-2c (Copy A) and 
W-3c Filed With the SSA

             .01 The official IRS-printed red dropout ink Form W-2c (Copy A) and W-3c 
             and their exact substitutes are referred to as red-ink in this revenue procedure. 
             Employers may file substitute Forms W-2c (Copy A) and W-3c 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. 
             Even the slightest deviation can result in incorrect scanning, and may affect 
             money amounts reported for employees.
             .02 Color and paper quality for Form W-2c (Copy A) (cut sheets and continuous 
             pin-fed forms) and Form W-3c must be white 100% bleached chemical wood, 
             optical character recognition (OCR) bond. The contractor must initiate or have a 
             quality control program to assure OCR ink density.

                                                  4



- 7 -
Page 7 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                                                      15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

                 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 substitute Forms W-2c (Copy A) and W-3c must be in Flint 
             J-6983 red OCR dropout ink except as specified below. The following must be 
             printed in nonreflective black ink:

              Identifying number “44444” for Forms W-2c (Copy A) or “55555” for 
                Form W-3c at the top of the forms.
              The four (4) corner register marks on the forms.
              The form identification number (“W-3c”) at the bottom of Form W-3c.
              All the instructions below Form W-3c beginning with “Purpose of 
                Form” to the end of Form W-3c.

             .04 The vertical and horizontal spacing on Forms W-2c and W-3c must meet 
             specifications. See Exhibits A and B.

              On Form W-3c and Form W-2c (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.
              The top, left, and right margins on Form W-2c (Copy A) and Form 
                W-3c must be 0.50 inches. The width of a substitute Form W-2c (Copy 
                A) or W-3c must be 7.50 inches. See Exhibits A and B.

                                                                    5



- 8 -
Page 8 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                       15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

               The first three columns on Form W-2c (Copy A) and Form W-3c must 
                 measure 1.90 inches in width.
               The last column on Form W-2c (Copy A) and Form W-3c must 
                 measure 1.80 inches in width.

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

             .06 The top, left, and right margins for the Form W-2c (Copy A) and Form 
             W-3c are 0.50 inches (1/ 2inch). All margins must be free of printing except for 
             the words “DO NOT CUT, FOLD, OR STAPLE THIS FORM” on red-ink Form 
             W-2c (Copy A) and "DO NOT CUT, FOLD, OR STAPLE" on red-ink Form 
             W-3c.

             .07 The identifying numbers are “44444” for Form W-2c and “55555” for Form 
             W-3c. 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 Continuous pin-fed Forms W-2c (Copy A) must be separated into 11-inch 
             deep pages. The pin-fed strips must be removed when Forms W-2c (Copy A) 
             are filed with the SSA.

             .09 Box 12 of Form W-2c (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-2c 
             to report the additional items (see Multiple forms in the most recent 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-2c (Copy A). However, repeat the 
             identifying information (employee’s name, address, and SSN; employer’s name, 
             address, and EIN) on each additional form.

             .10 The checkboxes in box 13 of Form W-2c (Copy A) must be 0.14 inches 
             each. Each space before the first checkbox is 0.20 inches; each space between 
             the first checkbox and second checkbox should be 0.36 inches; each space 
             between the second and third checkboxes should be 0.44 inches; and each space 
             between the third checkbox to the margin of box 13 should be 0.48 inches. The 
             checkboxes in box c of Form W-3c must also be 0.14 inches.

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

             .11 All substitute Forms W-2c (Copy A) and W-3c in the red-ink format must 
             have the form number and form title printed on the bottom face of each form 
             using type identical or a close approximation to that of the official IRS form. 
             The red-ink substitute must have the form producer’s (not the form filer's) EIN 
             entered in red in place of the Cat. No. (directly to the left of “Department of the 
             Treasury” on Form W-2c (Copy A) and at the bottom on Form W-3c).

                                                  6



- 9 -
Page 9 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                       15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

             .12 The words “For Privacy Act and Paperwork Reduction Act Notice, see the 
             separate instructions.” must be printed on all Forms W-2c (Copy A) and Forms 
             W-3c.

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

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

             .15 The appropriate SSA filing address information must be printed on the front 
             of Form W-3c below the body of the form as shown below.

                  Send this entire page with Copy A of Form W-2c to:

                           Social Security Administration
                           Direct Operations Center
                           P.O. Box 3333
                           Wilkes-Barre, PA 18767-3333
                  Note:   If you use "Certified Mail" or an IRS-approved private delivery 
                  service to file, add "Attn: W-2c 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.

             .16 The back of substitute Form W-2c (Copy A) and Form W-3c 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-2c (Copy A) only if the 
             following standards are met:

              Only chemically backed paper is acceptable for Form W-2c (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-2c (Copy A) and Form 
             W-3c.

             .20 The sequence for assembling the copies of Form W-2c is as follows.

              Copy A—For Social Security Administration
              Copy 1—For State, City, or Local Tax Department

              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

                                         7



- 10 -
Page 10 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                        15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

               Copy D—For Employer

Section 1.5 – Specifications for Substitute Black-and-White Forms W-2c (Copy 
A) and W-3c Filed With the SSA

              .01 The SSA-approved substitute black-and-white Forms W-2c (Copy A) and 
              W-3c are referred to as substitute black-and-white Form W-2c (Copy A) and 
              W-3c. Specifications for the substitute black-and-white Form W-2c (Copy A) 
              and W-3c are similar to the red-ink forms (Section 4) except for the items that 
              follow (see Exhibits C and D). You may contact the SSA via email at 
              copy.a.forms@ssa.gov for more information.

              Note. Exhibits are samples only and may not show the required typeface and/or 
              font. Exhibits must not be downloaded to meet tax obligations.

              1. Forms must be printed on 8.5 x 11-inch single-sheet paper only, not on 
                 continuous pin-fed paper. There must be one Form W-2c (Copy A) or W-3c 
                 printed on a 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-2c (“44444”) and Form W-3c 
                 (“55555”) must be preprinted in 14-point Arial bold font or a close 
                 approximation.

              7. The form numbers (“W-2c” and “W-3c”) must be in 18-point Arial 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 black-and-white forms 
                 (for example, do not print “DO NOT CUT, FOLD, OR STAPLE” in the top 
                 margin of Form W-3c).

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

11.              A 4-digit vendor code (not filer code) preceded by four zeros and a slash 
                 (for example, 0000/9876) must appear in 12-point Arial font, or a close 
                 approximation, in place of the Cat. No. to the left of “Department of the 
                 Treasury” on Form W-2c (Copy A) and in the bottom right corner of Form 
                 W-3c.

                                      8



- 11 -
Page 11 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                        15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

                 Note. Do not display the form producer’s EIN. The vendor code will be 
                 used to identify the form producer.

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

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

              Note. Although substitute Copy 1 of Form W-2c can be printed in black instead 
              of the red dropout ink, it should conform as closely as possible to Copy A of the 
              official IRS form in content, format, and layout in order to satisfy state and local 
              reporting requirements.

              .02 The dimensions for the substitute black-and-white Forms W-2c (Copy A) 
              and W-3c are as follows. See Exhibits C and D.

              1. The top, left, and right margins on Form W-2c (Copy A) and Form W-3c 
                 must measure 1/ 2(0.50) inch.

              2. The distance from the top line of Form W-3c to the bottom line of the form 
                 must measure 73/ 16(7.19) inches.

              3. The distance from the top line of Form W-2c (Copy A) to the bottom line of 
                 the form must measure 91/ 3 (9.33) inches.

              4. Each box on Form W-2c (Copy A) and Form W-3c must measure 1/ 3      (0.33) 
                 inch in height except as otherwise established.

              5. Box b on Form W-3c must measure one (1.00) inch in height.

              6. Box a on Form W-2c (Copy A) must measure 11/ 3     (1.33) inches in height 
                 and box 14 must measure 5/ 6 (0.83) inch in height.

              7. The first three columns on the right of Form W-2c (Copy A) and Form 
                 W-3c must measure 19/ 10(1.90) inches in width.

              8. The last column on the right of Form W-2c (Copy A) and Form W-3c must 
                 measure 18/ 10(1.80) inches in width.

              9. The “Explain decreases here” box must measure 1/ 3 (0.33) inch and the 
                 “Signature” box on Form W-3c must measure 1/ 2 (0.50) inch in height.

              .03 You must submit samples of your black-and-white substitute Forms W-2c 
              (Copy A) and W-3c to the SSA. Only black-and-white substitute Forms W-2c 
              (Copy A) and W-3c will be accepted for approval by the SSA. All checkboxes 
              on the dummy-data substitute black-and-white Form W-3c must be 
              electronically checked in box c (Kind of Payer, Kind of Employer, and 
              Third-party sick pay). Questions regarding other forms (that is, red-ink Forms 
              W-2, W-2c, W-3, W-3c, 1099 series, 1096, etc.) must be directed to the IRS. 
              Also, see IRS Publications 1141 and 1179.

              .04 You will be required to send one set of blank and one set of dummy-data 
              substitute black-and-white Form W-2c (Copy A) and W-3c 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. Include in your submission the name, telephone number, 

                                                      9



- 12 -
Page 12 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                    15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

              fax number, and email address of a contact person who can answer questions 
              regarding your sample forms.

              .05 To receive approval, you may first contact the SSA at copy.a.forms@ssa.gov 
              to obtain a template and further instructions. You can either submit your sample 
              substitute black-and-white Forms W-2c (Copy A) and Forms W-3c in a PDF 
              version electronically for approval to the copy.a.forms@ssa.gov or send your 
              paper sample substitute black-and-white Forms W-2c (Copy A) and Forms 
              W-3c 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.

              Do not mail completed Forms W-2c (Copy A) and W-3c to the Substitute 
              Black-and-White Forms (Copy A) address. Submitters should use the address 
              shown on the Form W-3c.

              .06 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-2c or W-3c to be used 
              only for their individual company require a vendor code issued by the SSA.

              .07 The 4-digit vendor code preceded by four zeros and a slash (0000/9876) 
              must be preprinted on the sample black-and-white substitute Forms W-2c and 
              W-3c. 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 SSA 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.)

              .08 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.

Section 1.6 – Requirements for Substitute Privately Printed Forms W-2c 
(Copies B, C, and 2) Furnished to Employees

              Note.  Rules in Section 1.6 apply only to employee copies of Form W-2c 
              (Copies B, C, and 2). Printers are cautioned that the paper filers who send 
              Forms W-2c (Copy A) to the SSA must follow the requirements in Sections 1.4 
              and/or 1.5 above.

                                                 10



- 13 -
Page 13 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                            15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

              .01 All employers (including those who file electronically) must furnish 
              employees with at least two copies of Form W-2c (three or more for employees 
              required to file a state, city, or local income tax return). Employee copies do not 
              require approval as long as these requirements are followed.

              .02 Chemical transfer paper for employee copies must be clearly legible, have 
              the capability to be photocopied, and not fade to such a degree as to preclude 
              legibility and the ability to photocopy.

              .03 The paper for all copies must be white and printed in black ink. The 
              substitute Copy B (or its equal), which employees are instructed to attach to 
              their federal income tax returns, as well as all other copies furnished to 
              employees, should be at least 9-pound paper (basis 17 x 22-500). See Section 
              1.4.02.

              .04 Type must be substantially identical in size and shape to that on the official 
              form.

              .05 Substitute forms for employees need to contain only the payment boxes and 
              captions that are applicable. These boxes, box numbers, and box titles must, 
              when applicable, match the IRS-printed form. In all cases, the employee name, 
              address, and SSN, as well as the employer name, address, and EIN, must be 
              present.

              .06 The dimensions of the boxes on these copies (Copies B, C, and 2), but not 
              Copy A, may be adjusted to allow space for conveying additional information. 
              This may permit the employer to eliminate other statements or notices that 
              would otherwise be furnished to employees.

              .07 The maximum allowable dimensions for employee copies of Form W-2c are 
              no more than 11.00 inches deep by 8.50 inches wide. The minimum allowable 
              dimensions for employee copies of Form W-2c are 2.67 inches deep by 4.25 
              inches wide.

              Note. These maximum and minimum size specifications are subject to future 
              change.

              .08 Either horizontal or vertical format is permitted for substitute employee 
              copies of Forms W-2c. That is, the width of the form may be either greater or 
              less than the depth of the form.

              .09 All copies of Form W-2c must clearly and prominently display the form 
              number and the form title together in one area of the form. It is recommended 
              (but not required) that this be located on the bottom left of Form W-2c. The 
              reference to the “Department of the Treasury – Internal Revenue Service” must 
              be on all copies of Form W-2c. It is recommended (but not required) that this be 
              located on the bottom right of Form W-2c.

              .10 If the substitute Forms W-2c are not labeled as to the disposition of the 
              copies, then written notification must be provided to each employee as specified 
              below.

                 The first copy of Form W-2c (Copy B) is filed with the employee's 
                   federal tax return.
                 The second copy of Form W-2c (Copy C) is for the employee's records.

                                                      11



- 14 -
Page 14 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                         15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

               If applicable, the third copy (Copy 2) of Form W-2c is filed with the 
                 employee's state, city, or local income tax return.

              If the substitute Forms W-2c are labeled, the forms must contain the applicable 
              description as stated on the official form.

              .11 Instructions similar to those on the back of Form W-2c (Copy C) of the 
              official form must be provided to each employee.

Section 1.7 – Instructions for Employers

              .01 Privately printed substitute Forms W-2c are not required to contain a copy to 
              be retained by employers (Copy D). However, employers must retain copies of 
              the Forms W-2c (Copy A) filed with SSA or have the ability to reconstruct the 
              data for at least four years. Employers must be able to generate a facsimile of 
              Form W-2c (Copy A), in case of loss.

              .02 If Copy D is provided for the employer, instructions contained on the back 
              of Copy D of the official form must appear on the back of the substitute form. If 
              Copy D is not provided, these instructions must be furnished to the employer on 
              a separate statement.

              .03 Only originals or compliant substitute copies of Forms W-2c (Copy A) and 
              Forms W-3c may be filed with the SSA. Carbon copies and photocopies are 
              unacceptable.

              .04 Employers should type or machine-print entries on plain paper forms 
              whenever possible and provide good quality data entries by using a high quality 
              type face, 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.

              .05 Because employers must file a machine-scannable Form W-2c, they should 
              meet the following requirements.

               Use 12-point Courier font or a close approximation for data entries.
               Proportional-spaced fonts are unacceptable.
               Do not print any data in the top margin of the forms.

              .06 The employer must also provide employee copies of Forms W-2c (Copies B, 
              C, and 2) that are legible and able to be photocopied (by the employee).

              .07 When Forms W-2c or W-3c are typed, black ink must be used with no script 
              type, inverted font, italics, or dual-case alpha characters.

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

              .09 The filer's employer identification number (EIN) must be entered in box (b) 
              of Form W-2c and box (e) of Form W-3c.

              .10 The employer's name, address, EIN, and state ID number may be preprinted.

                                                  12



- 15 -
Page 15 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                   15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

              .11 Employers must not truncate the employee's SSN on Copy A of Forms 
              W-2c. See the General Instructions for Forms W-2 and W-3 for more 
              information.

Section 1.8 – OMB Requirements for Both Red-Ink and Black-and-White 
Copy A and W-3c Substitute Forms

              .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.
               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-2c and Form W-3c 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-2c (Copy A) and Form W-3c is 
                 1545-0008 and must appear exactly as shown on the official IRS form.
               For any copy of Form W-2c, other than Copy A, the OMB number 
                 must use one of the following formats.
              1. OMB No. 1545-xxxx (preferred) or

              2. OMB # 1545-xxxx (acceptable).
              .04 Any substitute Form W-3c and Form W-2c (Copy A only) 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 General Instructions for Forms W-2 and W-3.

                                              13



- 16 -
Page 16 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                      15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Section 1.9 – Order Forms and Instructions

              .01 You can order official IRS Forms W-2c, Forms W-3c, and the 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), online at IRS.gov/OrderForms.

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

Section 1.10 – Effect on Other Documents

              .01 Revenue Procedure 2016-20, 2016-13 I.R.B. dated March 28, 2016, 
              (reprinted as Publication 1223, Revised 03-2016), is superseded.

Section 1.11 – Exhibits

              Exhibits A through D provide the general measurements for Forms W-2c and 
              W-3c as discussed in this revenue procedure. Exhibits are samples only and may 
              not show the required typeface and/or font. Exhibits must not be downloaded to 
              meet tax obligations. Certain exhibits show a 0000/ in the location designated 
              for your vendor code. SeeSection 1.5.01, item 11, and Section 1.5.06 for more 
              information.
                  Exhibit A — Form W-2c (Copy A) (Red-Ink) 08-2023
                  Exhibit B — Form W-3c (Red-Ink) 08-2023
                  Exhibit C — Form W-2c (Copy A) (Substitute Laser/
                  Black-and-White) 08-2023
                  Exhibit D — Form W-3c (Substitute Laser/Black-and-White) 08-2023

                                                14



- 17 -
Page 17 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                                                                                                        15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit A                                                                                                                                           Form W-2c (Copy A) (Red Ink)
                                                                                                             7.50 in                                                                        
                                     0.50 in                   DO NOT CUT, FOLD, OR STAPLE THIS FORM 
                          For Official Use Only                                                                                                      
        44444             OMB No. 1545-0008 
        a  Employer’s name, address, and ZIP code                                                               c  Tax year/Form corrected               d  Employee’s correct SSN 

0.50 in                                                                                                                     /  W-2                                                                0.50 in
                                                                             1.33 in                            e  Corrected SSN and/or name. (Check this box and complete boxes f and/or 
                                                                                                                    g if incorrect on form previously led.) 
                                                                                                                Complete boxes f and/or g only if incorrect on form previously filed:
                                                                                                                f  Employee’s previously reported SSN 
                                                                                                                                                      3.70 in                                
        b  Employer identication number (EIN)                                                                  g  Employee’s previously reported name 
                                                                                                                h  Employee’s rst name and initial      Last name                           Suff.

        Note: Only complete money elds that are being corrected.                           (Exception: for 
        corrections involving MQGE, see the General Instructions for Forms W-2 
        and W-3, underSpecific Instructions for Form W-2c                     , boxes 5 and 6).                  i  Employee’s address and ZIP code 
              Previously reported                              Correct information                                      Previously reported                      Correct information 
        1   Wages, tips, other compensation               1   Wages, tips, other compensation                   2   Federal income tax withheld              2   Federal income tax withheld 
        3   Social security wages                         3   Social security wages                            4   Social security tax withheld             4   Social security tax withheld
                                                                                             0.33 in
                                                                                            
        5   Medicare wages and tips                       5   Medicare wages and tips                           6   Medicare tax withheld                    6   Medicare tax withheld
        7   Social security tips                          7   Social security tips                              8   Allocated tips                           8   Allocated tips 
        9                                                 9                                                     10   Dependent care benets              10   Dependent care benets 

                                                                                                                                                         12aCo   See instructions for box 12 
        11   Nonqualied plans                            11   Nonqualied plans                                12aCedo See instructions for box 12      de
        13 Statutory 
           employee  Retirementplan  sickThird-partypay   13StatutoryemployeeplanRetirement sickThird-partypay                                   9.33 in 12boC
                                                                                                                12bdeCo                                  ed 
        14  Other (see instructions)                     14  Other (see instructions) 
                                                                                                                                                         12coC
                                                                                            0.14 in             12cdoCe                                  de
                                    0.83 in                                                                                                           
                                                                                                                12ddeCo     1.90 in                     de          1.80 in                 
                     1.90 in                                                1.90 in                                                                    12dCo 
                                         
                                                                                 State Correction Information 
              Previously reported                              Correct information                                      Previously reported                      Correct information 
        15  State                                         15  State                                             15  State                                15  State
           Employer’s state ID number                     Employer’s state ID number                                  Employer’s state ID number             Employer’s state ID number 
        16  State wages, tips, etc.                       16  State wages, tips, etc.                           16  State wages, tips, etc.              16  State wages, tips, etc. 
        17  State income tax                              17  State income tax                                  17  State income tax                     17  State income tax 

                                                                               Locality Correction Information 
              Previously reported                              Correct information                                      Previously reported                      Correct information 
        18  Local wages, tips, etc.                       18  Local wages, tips, etc.                           18  Local wages, tips, etc.              18  Local wages, tips, etc. 
        19  Local income tax                              19  Local income tax                                  19  Local income tax                     19  Local income tax 

        20  Locality name                                 20  Locality name                                     20  Locality name                       20  Locality name 
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.                                                               Copy A—For Social Security Administration 
                                                                                                                                                                     Department of the Treasury 
Form  W-2c  (Rev. 8-2023)                                                    Corrected Wage and Tax Statement                                                        Internal Revenue Service 

                                                                                                              15



- 18 -
Page 18 of 20     Fileid: … ns/p1223/202312/a/xml/cycle04/source                                                                                                      15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit B                                                                                                                                     Form W-3c (Copy A) (Red Ink)
                                                         
                                                             0.50 in                 7.50 in                                                                                                  
                                                             DO NOT CUT, FOLD, OR STAPLE 
                          a   Tax year/Form corrected                                      For Official Use Only:                                                         
               55555                           / W-                                        OMB No. 1545-0008 
         b  Employer’s name, address, and ZIP code                                      c Kind  of  Payer (Check one)                     Kind  of  Employer (Check one) Third-party 
                                                                                      941/941-SS  Military        943          944         None apply 501c non-govt.            sick pay 
                                                              1.00 in                                                                                                                   
                                                                                                                                                                                      
                                      3.18 in                                                            Hshld.   Medicare                 State/local  State/local  Federal    (Check if 
                                                                                         CT-1            emp.  govt. emp.                  non-501c        501c       govt.     applicable)
                                                                        
         d   Total number of Forms W-2c                  e   Employer identication number (EIN)          f   Establishment number                    g   Employer’s state ID number 
                                                                                                                  0.14 in
             Complete boxes h, i, or j only if           h   Employer’s originally reported EIN           i   Incorrect establishment number          j    Employer’s incorrect state ID number
             incorrect on last form filed. 
         Total of amounts previously reported            Total of corrected amounts as                   Total of amounts previously reported           Total of corrected amounts as        
         as shown on enclosed Forms W-2c.                shown on enclosed Forms W-2c.                   as shown on enclosed Forms W-2c.               shown on enclosed Forms W-2c. 
         1   Wages, tips, other compensation             1   Wages, tips, other compensation              2   Federal income tax withheld             2   Federal income tax withheld 
       3   Social security wages                       3   Social security wages                        4   Social security tax withheld            4   Social security tax withheld 
0.50 in                                                                                                                                                                                         0.50 in
         5   Medicare wages and tips                     5   Medicare wages and tips                      6   Medicare tax withheld                   6   Medicare tax withheld 
                                                                                                                                                                                 0.33 in
                                                                                                                                                                                
         7   Social security tips                        7   Social security tips                         8   Allocated tips                          8   Allocated tips 7.19 in
         9                                      9                                                      10   Dependent care benets               10   Dependent care benets 
                       1.90 in                               1.90 in                                                  1.90 in                                1.80 in                 
         11   Nonqualied plans                          11   Nonqualied plans                          12a Deferred compensation                    12a Deferred compensation
         14   Inc. tax w/h by third-party sick pay payer 14   Inc. tax w/h by third-party sick pay payer 12b                                          12b
         16   State wages, tips, etc.                    16   State wages, tips, etc.                    17   State income tax                        17   State income tax 
         18   Local wages, tips, etc.                    18   Local wages, tips, etc.                    19   Local income tax                        19   Local income tax 
                                                                         
         Explain decreases here:                                          0.33 in
                                                                         
         Has an adjustment been made on an employment tax return led with the Internal Revenue Service?                                                   Yes        No
         If “Yes,” give date the return was led:                                                                               
         Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it is true,  
         correct, and complete.                                                                                                     0.50 in
         Signature:                                                               Title:                                                               Date:
         Employer’s contact person                                                          Employer’s telephone number                                      For Official Use Only  
         Employer’s fax number                                                              Employer’s email address 
                                                                                                                                                                         
                                                                                                                                                             Department of the Treasury 
        Form W-3c (Rev. 8-2023)                          Transmittal of Corrected Wage and Tax Statements                                                       Internal Revenue Service 
        Purpose of Form                                                                                  For more information, go to www.SSA.gov/employer. First-time lers, select 
                                                                                                         Register”; returning lers, select “Log In.”
        Complete a Form W-3c transmittal only when ling paper Copy A of the most 
        recent version of Form(s) W-2c, Corrected Wage  and Tax Statement. Make a                        When To File 
        copy of Form W-3c and keep it with Copy D (For Employer) of Forms W-2c for                       File this form and Copy A of Form(s) W-2c with the Social Security Administration 
        your records. File Form W-3c even if only one Form W-2c is being led or if those                as soon as possible after you discover an error on Forms W-2, W-2AS, W-2GU, 
        Forms W-2c are being led only to correct an employee’s name and social security                 W-2CM, W-2VI, or W-2c. Provide Copies B, C, and 2 of Form W-2c to your 
        number (SSN) or the employer identication number (EIN). See the General                         employees as soon as possible. 
        Instructions for Forms W-2 and W-3 for information on completing this form. 
        E-Filing                                                                                         Where To File Paper Forms
        The SSA strongly suggests employers report Form W-3c and Forms W-2c Copy A                       Send this entire page with Copy A of Form W-2c to:
        electronically instead of on paper. The SSA provides two free e-ling options on its                      Social Security Administration   
        Business Services Online (BSO) website:                                                                   Direct Operations Center   
         W-2c Online. Use ll-in forms to create, save, print, and submit up to 25 Forms                         P.O. Box 3333   
        W-2c at a time to the SSA.                                                                                Wilkes-Barre, PA 18767-3333 
         File Upload. Upload wage les to the SSA you have created using payroll or tax                 Note: If you use “Certied Mail” or an IRS-approved private delivery service to le, 
        software that formats the les according to the SSA’s Specifications for Filing                   add “Attn: W-2c Process, 1150 E. Mountain Dr.” to the address and change the 
        Forms W-2c Electronically (EFW2C).                                                               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. 

                                                                                                 16



- 19 -
Page 19 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                                                                                                         15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit C                                                                                                             Form W-2c (Copy A) (Substitute Black-and-White)
     
                         For Official Use Only 
44444                    OMB No. 1545-0008 
a  Employer’s name, address, and ZIP code                                                                         c  Tax year/Form corrected             d  Employee’s correct SSN 

                                                                                                                            /  W-2 
                                                                                                                  e  Corrected SSN and/or name. (Check this box and complete boxes f and/or 
                                                                                                                     g if incorrect on form previously led.) 
                                                                                                                  Complete boxes f and/or g only if incorrect on form previously filed:
                                                                                                                  f  Employee’s previously reported SSN 
b  Employer identication number (EIN)                                                                            g  Employee’s previously reported name 
                                                                                                                  h  Employee’s rst name and initial    Last name                            Suff.

Note: Only complete money elds that are being corrected.                                   (Exception: for 
corrections involving MQGE, see the General Instructions for Forms W-2 
and W-3, underSpecific Instructions for Form W-2c                             , boxes 5 and 6).                    i  Employee’s address and ZIP code 
              Previously reported                            Correct information                                       Previously reported                        Correct information 
1   Wages, tips, other compensation                     1   Wages, tips, other compensation                       2   Federal income tax withheld             2   Federal income tax withheld 
3   Social security wages                               3   Social security wages                                 4   Social security tax withheld            4   Social security tax withheld
5   Medicare wages and tips                             5   Medicare wages and tips                               6   Medicare tax withheld                   6   Medicare tax withheld
7   Social security tips                                7   Social security tips                                  8   Allocated tips                          8   Allocated tips 
9                                                       9                                                         10   Dependent care benets            10   Dependent care benets 
11   Nonqualied plans                                  11   Nonqualied plans                                    12a See instructions for box 12        12a See instructions for box 12 

13 employeeStatutory planRetirement sick payThird-party 13 employeeStatutory planRetirement sick payThird-party   12b                                    12b
0.20 in       0.36 in    0.44 in    0.48 in
14  Other (see instructions)                            14  Other (see instructions)                              12c                                    12c
                                                                                                                  12d                                    12d

                                                                                 State Correction Information 
              Previously reported                            Correct information                                       Previously reported                        Correct information 
15  State                                               15  State                                                 15  State                              15  State
     Employer’s state ID number                         Employer’s state ID number                                   Employer’s state ID number               Employer’s state ID number 
16  State wages, tips, etc.                             16  State wages, tips, etc.                               16  State wages, tips, etc.            16  State wages, tips, etc. 
17  State income tax                                    17  State income tax                                      17  State income tax                   17  State income tax 

                                                                               Locality Correction Information 
              Previously reported                            Correct information                                       Previously reported                        Correct information 
18  Local wages, tips, etc.                             18  Local wages, tips, etc.                               18  Local wages, tips, etc.            18  Local wages, tips, etc. 
19  Local income tax                                    19  Local income tax                                      19  Local income tax                   19  Local income tax 
20  Locality name                                       20  Locality name                                         20  Locality name                      20  Locality name 

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.                                                            Copy A—For Social Security Administration 
                                                                                                                                                                      Department of the Treasury 
Form  W-2c  (Rev. 8-2023)                                                    Corrected Wage and Tax Statement                                      0000/              Internal Revenue Service 

                                                                                                                17



- 20 -
Page 20 of 20  Fileid: … ns/p1223/202312/a/xml/cycle04/source                                                                                                   15:25 - 6-Dec-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit D                                                                                             Form W-3c (Copy A) (Substitute Black-and-White)
     
                  a   Tax year/Form corrected                                      For Official Use Only: 
     55555                             / W-                                        OMB No. 1545-0008 
 b  Employer’s name, address, and ZIP code                                       c Kind  of  Payer (Check one)                     Kind  of  Employer (Check one) Third-party 
                                                                              941/941-SS  Military        943          944         None apply 501c non-govt.              sick pay 
                                                                                                                                                 0.65 in            
                                                                              0.20   0.36 in          0.36 in   0.36 in     0.28                                                
                                                                              in                 Hshld.   Medicare           in    State/local  State/local  Federal      (Check if 
                                                                                 CT-1            emp.   govt. emp.                 non-501c        501c       govt.       applicable)
                                                                                                                                           0.46 in        
                                                                                                                                   0.20                 0.36 in
 d   Total number of Forms W-2c                  e   Employer identication number (EIN)          f   Establishment number         in         g   Employer’s state ID number 

     Complete boxes h, i, or j only if           h   Employer’s originally reported EIN           i   Incorrect establishment number          j    Employer’s incorrect state ID number
     incorrect on last form filed. 
 Total of amounts previously reported            Total of corrected amounts as                   Total of amounts previously reported           Total of corrected amounts as        
 as shown on enclosed Forms W-2c.                shown on enclosed Forms W-2c.                   as shown on enclosed Forms W-2c.               shown on enclosed Forms W-2c. 
 1   Wages, tips, other compensation             1   Wages, tips, other compensation              2   Federal income tax withheld             2   Federal income tax withheld 
 3   Social security wages                       3   Social security wages                        4   Social security tax withheld            4   Social security tax withheld 
 5   Medicare wages and tips                     5   Medicare wages and tips                      6   Medicare tax withheld                   6   Medicare tax withheld 
 7   Social security tips                        7   Social security tips                         8   Allocated tips                          8   Allocated tips 
 9                                               9                                               10   Dependent care benets                  10   Dependent care benets 
 11   Nonqualied plans                          11   Nonqualied plans                          12a Deferred compensation                    12a Deferred compensation
 14   Inc. tax w/h by third-party sick pay payer 14   Inc. tax w/h by third-party sick pay payer 12b                                          12b
 16   State wages, tips, etc.                    16   State wages, tips, etc.                    17   State income tax                        17   State income tax 
 18   Local wages, tips, etc.                    18   Local wages, tips, etc.                    19   Local income tax                        19   Local income tax 

 Explain decreases here: 
 Has an adjustment been made on an employment tax return led with the Internal Revenue Service?                                                   Yes        No
 If “Yes,” give date the return was led:
 Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and, to the best of my knowledge and belief, it is true,  
 correct, and complete. 
 Signature:                                                               Title:                                                                Date:
 Employer’s contact person                                                           Employer’s telephone number                                        For Official Use Only  
                                                                                                                                                     0.33 in
 Employer’s fax number                                                              Employer’s email address                                                                   
                                                                                                                            4.00 in
                                                                                                                                                        Department of the Treasury 
Form W-3c (Rev. 8-2023)                          Transmittal of Corrected Wage and Tax Statements                                                           Internal Revenue Service 
Purpose of Form                                                                                  For more information, go to www.SSA.gov/employer. First-time lers, select 
                                                                                                 Register”; returning lers, select “Log In.”
Complete a Form W-3c transmittal only when ling paper Copy A of the most 
recent version of Form(s) W-2c, Corrected Wage  and Tax Statement. Make a                        When To File 
copy of Form W-3c and keep it with Copy D (For Employer) of Forms W-2c for                       File this form and Copy A of Form(s) W-2c with the Social Security Administration 
your records. File Form W-3c even if only one Form W-2c is being led or if those                as soon as possible after you discover an error on Forms W-2, W-2AS, W-2GU, 
Forms W-2c are being led only to correct an employee’s name and social security                 W-2CM, W-2VI, or W-2c. Provide Copies B, C, and 2 of Form W-2c to your 
number (SSN) or the employer identication number (EIN). See the General                         employees as soon as possible. 
Instructions for Forms W-2 and W-3 for information on completing this form. 
E-Filing                                                                                         Where To File Paper Forms
The SSA strongly suggests employers report Form W-3c and Forms W-2c Copy A                       Send this entire page with Copy A of Form W-2c to:
electronically instead of on paper. The SSA provides two free e-ling options on its                      Social Security Administration   
Business Services Online (BSO) website:                                                                   Direct Operations Center   
 W-2c Online. Use ll-in forms to create, save, print, and submit up to 25 Forms                         P.O. Box 3333   
W-2c at a time to the SSA.                                                                                Wilkes-Barre, PA 18767-3333 
 File Upload. Upload wage les to the SSA you have created using payroll or tax                 Note: If you use “Certied Mail” or an IRS-approved private delivery service to le, 
software that formats the les according to the SSA’s Specifications for Filing                   add “Attn: W-2c Process, 1150 E. Mountain Dr.” to the address and change the 
Forms W-2c Electronically (EFW2C).                                                               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.                                                                                      0000/

                                                                                         18






PDF file checksum: 1396553200

(Plugin #1/9.12/13.0)