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CCA – DIVISION OF TAXATION
205 W SAINT CLAIR AVE
CLEVELAND OH 44113-1503
216.664.2070 800.223.6317
www.ccatax.ci.cleveland.oh.us
2022
ANNUAL RECONCILIATION
ANNUAL RECONCILIATION (W-3) OF MUNICIPAL INCOME TAX WITHHELD
AND TRANSMITTAL OF WAGE AND TAX STATEMENTS (W-2)
Read instructions for lines 6 and 13 to
ensure Employment wages and Residence
withholding are reported correctly.
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GENERAL INSTRUCTIONS
WHO MUST FILE - Each employer must file Form W-3 which serves as the transmittal statement for Forms W-2 for
each employee from whom municipal tax has been withheld during the year. Filers must also submit copies of Forms 1099-NEC.
Forms W-2 for employees under 18 should be excluded (except: Montpelier, Munroe Falls, New Paris, Oakwood, Obetz,
Phillipsburg, and Riverside have no minimum age, Geneva-on-the-Lake under 15; Grand River and West Milton under 16. New
Carlisle individuals 16 and 17 years old who earn $2,500.00 or more are subject to the tax).
Pursuant to Section 718.03(H) of the Ohio Revised Code if an employer reports local CCA W-2 information for any employee,
the employer is required to file all of the employee’s local W-2 information regardless of whether the municipal income tax is
administered by CCA or not. This change is in effect beginning with tax year 2016.
DUE DATE - February 28, 2023.
REPORTING ON ELECTRONIC MEDIA - If you file 250 or more forms W-2, you must file with CCA on electronic media. If you
have 100 or more Forms W-2 and file using electronic media with the Federal Government, you are required to also file on electronic
media with CCA. All employers are required to complete and submit a written reconciliation (W-3) form. You may be charged a
penalty if you fail to file Forms W-2 on electronic media when required.
MAILING - Forms W-2 may be forwarded in consecutively numbered packages of convenient size, identified by employer’s
name, federal identification number and the number of packages that will be sent. If more than one package of Forms W-2 are
to be sent, they shall be grouped by employment municipalities in order to expedite the processing of the year-end report.
All forms and packages sent by mail are required to be sent First Class mail to 205 W Saint Clair Ave, Cleveland OH 44113-1503.
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SPECIFIC INSTRUCTIONS
Confirm name, address and Federal Identification number. Make corrections, if necessary.
1. Number of Wage and Tax Statements Attached - Show the number of completed Forms W-2 you are transmitting with this Form W-3.
1a. Number of 1099 Statements Attached - Show the number of completed Forms 1099 you are transmitting with this Form W-3.
2. Enter amount of tax remitted to CCA, for each month or quarter end, as shown.
2a. Enter total amount of employment tax remitted to CCA during 2022. Wages subject to employment tax are reported in Column 6.
2b. Enter total amount of residence tax remitted (if any) to CCA during 2022. Wages subject to residence tax are not required to be reported.
2c. Enter total tax remitted to CCA as detailed in 2, above.
3. CCA Municipalities - Enter requested information for each CCA municipality where work was performed and wages earned. Revenue
Sharing JEDD/JEDZ chart below.
4. Numerical code assigned to each CCA municipality.
5. Enter the number of employees by employment municipality. Employees should be counted in the municipality where the majority of
their work was performed.
6. Enter the total taxable employment wages as defined in ORC 718. Do not include wages on which residence tax has been withheld
for that municipality.
7. CCA municipalities tax rates.
8. Enter Amount Due, Multiply Column 6 employment wages by Column 7 tax rate.
9. Enter total CCA tax withheld according to actual amounts shown on Forms W-2. Attach adding machine tape or other list showing how
total municipal tax withheld was obtained.
10. Enter total employment tax amount remitted by municipality on Forms CCA-102 and also shown on Line 2a above.
11. Enter any amount overpaid and credited from the previous year.
12. Enter amount due. Column 8 or 9, whichever is greater, less Columns 10 and 11.
13. Enter residence tax withheld. Do not report wages on the residence tax withheld.
14 Enter residence tax amount remitted for each municipality. Column 14 total should equal Line 2b.
15. Enter amount due. Column 13 less Column 14.
16. Total all columns.
17. Add Column 12 and Column 15 totals to arrive at Net Tax Due. If Box 17 shows a net tax due, remit payment. Make check/money order
payable to CCA and write Federal Identification number on remittance.
18. If a negative figure is shown in Box 17, enter preference as credit or refund. No refund or credit will be made for amounts of $10.00 or
less. If you fail to designate, the overpayment will be treated as a credit.
REVENUE SHARING JEDD/JEDZ
NAME CODE RATE NAME CODE RATE NAME CODE RATE
Burton Village/Twp 982 1.0% High Hills/Cleve 996 2.5% N. Baltimore 988 1.0%
Clayton/Clay 984 1.5% Emerald Park 993 2.5% Prairie Obetz 981 2.5%
Cleve/High Hills 995 2.5% IX Center 992 2.5% Shaker Sq 994 2.5%
Cleve/Warr Hts 998 2.5% Gateway 990 2.5%
KEEP A COPY FOR YOUR RECORDS.
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CCA – DIVISION OF TAXATION 1. Number of W-2 Wage & Tax Statements Attached . . . . . . . .
205 W SAINT CLAIR AVE RECONCILIATION OF MUNICIPAL
CLEVELAND OH 44113-1503 INCOME TAX WITHHELD AND 1a. Number of 1099 Statements Attached . . . . . . . . . . . . . . . . . .
216.664.2070216.664.2070 TRANSMITTAL OF WAGE AND TAX 2. City Income Tax withheld and remitted on Form CCA-102 for month or quarter ended:
www.ccatax.ci.cleveland.oh.us STATEMENTS
JAN FEB MAR
$ $ $
FILE CODE YEAR END FEDERAL IDENTIFICATION NO. EMP CODE APR MAY JUN
$ $ $
JUL AUG SEP
2022 $ $ $
OCT NOV DEC
$ $ $
BUSINESS NAME
ADDRESS 2a. Total Employment Tax above . . . . . . . . . . . . . . . . . . . . . . . . . $
2b. Total Residence Tax (if any) above . . . . . . . . . . . . . . . . . . . . .$
CITY STATE ZIP CODE 2c. Total Tax remitted to CCA . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
EMPLOYMENT TAX – See number 6 of instructions. RESIDENCE TAX
3 4 5 6 7 8 9 10 11 12 13 14 15
MUNICIPALITY CODE NO. OF EMPLOYMENT TAX AMOUNT DUE ANDCCAREPORTEDTAX WITHHELDON W2TAX REMITTED PRIOR YEAR NET EMPLOYMENT CCA RESIDENCE RESIDENCE TAX NET RESIDENCE
EMPLOYEES WAGES CREDIT TAX DUE TAX WITHHELD REMITTED TAX DUE
Burton 176 1.00%
Clayton 199 1.50%
Cleveland 200 2.50%
Dalton 252 1.00%
Elida 276 .75%
Geneva-on-the-Lake 347 1.50%
Germantown 348 1.50%
Grand Rapids 356 1.00%
Grand River 357 2.00%
Highland Hills 371 2.50%
Linndale 420 2.00%
Marble Cliff 459 2.00%
Mentor-on-the-Lake 495 2.00%
Montpelier 517 1.60%
Munroe Falls 533 2.25%
New Carlisle 534 1.50%
New Madison 538 1.00%
New Miami 539 1.75%
New Paris 541 1.00%
North Baltimore 548 1.00%
North Randall 560 2.75%
Oakwood (Paulding County) 585 1.00%
Obetz 587 2.50%
Orwell 605 1.50%
Paulding 640 1.10%
Phillipsburg 659 1.50%
Pitsburg 661 1.00%
Riverside 680 2.50%
Rock Creek 698 1.00%
Russells Point 703 1.00%
Seville 722 1.00%
Shreve 755 1.00%
South Russell 772 1.25%
Union 797 1.50%
Waynesfield 833 1.00%
West Milton 835 1.50%
Revenue Sharing JEDD/JEDZ - complete below
16 TOTALS
17 Net Tax Due (Add Column 12 total and Column 15 total) $
18
If Net Tax Due is a negative, indicate CREDIT REFUND
I DECLARE THAT THIS RETURN, TO THE BEST OF MY KNOWLEDGE AND BELIEF, IS TRUE AND COMPLETE. overpayment preference. . . . @ @
Do you authorize your preparer to contact us regarding this return? YES NO
X @ @
SIGNATURE DATE
Signature of Person or Firm Preparing the Return (Date)
TITLE (OWNER, PRESIDENT, PARTNER, ETC.) PHONE NUMBER Address of Preparer
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