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2019 W-2 SAMPLE: PREFERRED
How to Report Worker Contributions for Unemployment Insurance, Workforce Development
Partnership Fund/Supplemental Workforce Fund, State Disability Insurance,
Family Leave Insurance, Employee Withholding for New Jersey Gross Income Tax
a. Employee’s Social Security number
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
c Employer’s name, address, and ZIP code 3 Social Security wages 4 Social Security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social Security tips 8 Allocated tips
d Control number 9 10 Dependent care benefits
e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a See instructions for box 12
13. Statutory Retirement Third-party 12b
employee plan sick pay C
O
D
E
14. Other 12c
C
O
UI/WF/SWF -146.20 D
E
DI -58.48
DI P.P. # XXXXXXXXXX 12d
C
O
D
f. Employee’s address and ZIP code E
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
NJ 234-567-890/000 34,400.00 525.00
FLI P.P. # XXXXXXXXXXX 27.52 - FLI
Wage and Tax Department of Treasury - Internal Revenue Service
W-2 Statement 2019
New Jersey Taxpayer Worker Contributions Disability Insurance
Identification Number Private Plan Number
• Unemployment Insurance, (DI P.P. #)
Call the New Jersey Division Workforce Development
of Taxation’s Customer Service Partnership Fund/Supplemental To be entered only by
Center at 609-292-6400 or Workforce Fund employers who have an
the New Jersey Department approved contributory
of Labor and Workforce • State Disability Insurance Private Disability Plan.
Development at 609-633-6400 Phone 609-292-2720 if
if you are unsure of your New • Family Leave Insurance you are unsure of your
Jersey Taxpayer Identification Private Plan Number.
Please Note:
Number.
The Taxable Wage Base for
Family Leave Insurance UI/WF/SWF, DI, and FLI purposes
Private Plan Number (FLI for 2019 is $34,400.
P.P. #)
To be entered only by
employers who have an
approved contributory Private
Family Leave Insurance Plan.
Phone 609-292-2720 if you
are unsure of your Private Plan
Number.
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