INSTRUCTIONS fOR THE ANNUAL WITHHOLDING RECONCILIATION STATEMENT(REv-1667)

The Annual Withholding Reconciliation Statement (REV-1667)                               Part I.  Reconciliation
along with an individual Wage and Tax Statement/Information                              Line 1a. Enter the number of W-2 forms attached.
Statement (W-2/1099) for each employee/distribution recipient
                                                                                         Line 1b. Enter the number of 1099 forms with PA
must be submitted annually on or before Jan. 31 following the
                                                                                                         withholding.
year in which wages were paid or distributions occurred.
These documents must be filed at the same time and via the                               Line 2.  Enter the total compensation/distribution subject to
same method.                                                                                             PA withholding.
Electronic Reporting. Employers can file year-end employee                               Line 3.  Enter the total amount of PA personal income tax
W-2 Wage and Tax Statements and the Annual Withholding                                                   withheld.
Reconciliation Statement (REV-1667) online through the
                                                                                         Part II.Annual Reconciliation
e-TIDES business tax filing website. Employers can also upload
files containing W-2  data or 1099 data to e-TIDES, eliminating                          Enter the amount of wages or distributions subject to PA
the need to enter the data. Visit the instructions linkon e-TIDES                        withholding and the amount of PA tax withheld for each quarter.
at www.etides.state.pa.us for more information.                                          Add the amounts for the four quarters and enter the total.
                                                                                         Mail the Annual Withholding Reconciliation Statementwith the
To Complete the Annual Withholding Reconciliation
                                                                                         accompaniments to:
Statement:
● Complete the following required fields: calendar year,                                 PA DEPARTMENT Of REvENUE
   Employer Account ID and Entity ID (federal EIN) in the                                PO BOX 280412
   blocks at the top of the Annual Withholding Reconciliation                            HARRISBURG PA  17128-0412
   Statement. Enter the business name and address in the
                                                                                         Additional information on employer withholding requirements
   area provided.
                                                                                         can be found on our website at www.revenue.pa.gov.
● Sign, date and include a daytime telephone number and
   title on the Annual Withholding Reconciliation Statement,
   which must accompany the materials submitted.

                      PLEASE READ THE INSTRUCTIONS BEfORE COMPLETING THIS COUPON.
                                           DETACH HERE BEfORE MAILING
✁                                           YEAR                                        EMPLOYER ACCOUNT ID                     ENTITY ID (EIN)
                                      START
                      REv-1667 (AS) 12-17
  Part I       RECONCILIATION
1a Number of W-2 forms attached                                                                                                                                        DUE DATE
                                                                                                                                                                       JANUARy 31
1b Number of 1099 forms with PA withholding                                                                                                                
2  Total compensation/distribution $                                                                   ●                ANNUAL WITHHOLDING
   subject to PA withholding                                                                                          RECONCILIATION STATEMENT
                                           ▲                           ▲                ▲
3  PA personal income                                                                                                 BUSINESS NAME AND ADDRESS
   tax withheld                       $                                                                ●
                                           ▲                           ▲                ▲
  Part II      ANNUAL RECONCILIATION                                                                        LEGAL NAME
                      Wages/distribution paid subject to PA withholding                 PA tax withheld
  1st Quarter                                                                                               TRADE NAME
 2nd Quarter                                                                                                ADDRESS
 3rd Quarter
                                                                                                            CITY,   STATE,   ZIP
 4th Quarter
  TOTAL
                                                                                                            DO NOT SEND PAyMENT WITH THIS fORM.
                                             RESET FORM                                  PRINT
              MM/DD/YYYY
              DATE                   DAyTIME TELEPHONE #                  EXT.   TITLE                                                                        SIGNATURE
                                                                                                                                Please sign after printing.