PDF document

- 1 -

Attention:

You may file Forms W-2 and W-3 electronically on the SSA’s Employer
W-2 Filing Instructions and Information web page, which is also accessible
at www.socialsecurity.gov/employer. You can create fill-in versions of
Forms W-2 and W-3 for filing with SSA. You may also print out copies for
filing with state or local governments, distribution to your employees, and
for your records.

Note: Copy A of this form is provided for informational purposes only. Copy A appears in
red, similar to the official IRS form. The official printed version of this IRS form is scannable,
but the online version of it, printed from this website, is not. Do not print and file Copy A
downloaded from this website with the SSA; a penalty may be imposed for filing forms that
can’t be scanned. See the penalties section in the current General Instructions for Forms
W-2 and W-3, available at www.irs.gov/w2, for more information.

Please note that Copy B and other copies of this form, which appear in black, may be
downloaded, filled in, and printed and used to satisfy the requirement to provide the
information to the recipient.

To order official IRS information returns such as Forms W-2 and W-3, which include a
scannable Copy A for filing, go to IRS’ Online Ordering for Information Returns and
Employer Returns page, or visit www.irs.gov/orderforms and click on Employer and
Information returns. We’ll mail you the scannable forms and any other products you order.

See IRS Publications 1141,1167 , and1179 for more information about printing these tax
forms.

- 2 -

Enlarge image

DO NOT STAPLE OR FOLD
a Control number For Official Use Only ▶
33333 OMB No. 1545-0008
b ▲ ▲
941-SS Military 943 944 None apply 501c non-govt. Third-party
Kind Kind sick pay

of Hshld. Medicare of State/local (Check if
Payer emp. govt. emp. Employer non-501c State/local 501c Federal govt. applicable)
(Check one) (Check one)
c Total number of Forms W-2 d Establishment number 1 Wages, tips, other compensation 2 Income tax withheld

e Employer identification number (EIN) 3 Social security wages 4 Social security tax withheld

f Employer’s name 5 Medicare wages and tips 6 Medicare tax withheld

7 Social security tips 8

9 10

11 Nonqualified plans 12a Deferred compensation
g Employer’s address and ZIP code
h Other EIN used this year 13 For third-party sick pay use only 12b

15 Employer’s territorial ID number 14 Income tax withheld by payer of third-party sick pay

18 Check the appropriate box
Type of Form ▶ W-2AS W-2CM W-2GU W-2VI
Employer’s contact person Employer’s telephone number For Official Use Only

Employer’s fax number Employer’s email address

Copy A—For Social Security Administration
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and complete.

Signature ▶ Title ▶ Date ▶
Department of the Treasury
Form W-3SS Transmittal of Wage and Tax Statements 2022 Internal Revenue Service
Send this entire page with the entire Copy A page of Form(s) W-2AS, W-2CM, W-2GU, or W-2VI to the Social Security
Administration (SSA). Photocopies are not acceptable. Do not send Form W-3SS if you filed electronically with the SSA.
Do not send any payment (cash, checks, money orders, etc.) with Form(s) W-2AS, W-2CM, W-2GU, W-2VI, and W-3SS.
Reminder • File Upload. Upload wage files to the SSA you have created using payroll
or tax software that formats the files according to the SSA’s Specifications
Separate instructions. See the 2022 General Instructions for Forms W-2 for Filing Forms W-2 Electronically (EFW2).
and W-3 for information on completing this form. Do not file Form W-3SS for W-2 Online fill-in forms or file uploads will be on time if submitted by
Form(s) W-2AS, W-2CM, W-2GU, or W-2VI that were submitted electronically January 31, 2023. For more information, go to www.SSA.gov/bso. First-time
to the SSA. filers, select “Register”; returning filers, select “Log In.”
Purpose of Form When To File Paper Forms
Complete a Form W-3SS transmittal only when filing paper Copy A of Mail Copy A of Form W-3SS with Copy A of Form(s) W-2AS, W-2CM,
Form(s) W-2AS, W-2CM, W-2GU, or W-2VI. Don’t file Form W-3SS alone. All W-2GU, or W-2VI by January 31, 2023.
paper forms must comply with IRS standards and be machine readable.
Photocopies are not acceptable. Use a Form W-3SS even if only one paper
Form W-2AS, W-2CM, W-2GU, or W-2VI is being filed. Make sure both the Where To File Paper Forms
Form W-3SS and Form(s) W-2AS, W-2CM, W-2GU, or W-2VI show the Send this entire page with the entire Copy A page of Form(s) W-2AS,
correct tax year and employer identification number (EIN). Make a copy of W-2CM, W-2GU, or W-2VI to:
this form and keep it with Copy D (For Employer) of Form(s) W-2AS, W-2CM, Social Security Administration
W-2GU, or W-2VI for your records. The IRS recommends retaining copies of Direct Operations Center
these forms for 4 years. Wilkes-Barre, PA 18769-0001
E-Filing Note: If you use “Certified Mail” to file, change the ZIP code to
“18769-0002.” If you use an IRS-approved private delivery service, add
The SSA strongly suggests employers report Form W-3SS and Form(s) “ATTN: W-2 Process, 1150 E. Mountain Dr.” to the address and change the
W-2AS, W-2CM, W-2GU, or W-2VI Copy A electronically instead of on paper. ZIP code to “18702-7997.” See Pub. 15 (Circular E), Employer’s Tax Guide,
The SSA provides two free e-filing options on its Business Services Online for a list of IRS-approved private delivery services.
(BSO) website.
• W-2 Online. Use fill-in forms to create, save, print, and submit up to 50
Forms W-2AS, W-2CM, W-2GU, or W-2VI at a time to the SSA.
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10117S

- 3 -

Enlarge image

DO NOT STAPLE OR FOLD 
                   a   Control number                 For Official Use Only  ▶
   33333                                              OMB No. 1545-0008
b             ▲                                                                                                ▲
                       941-SS       Military 943        944                                                                 None apply   501c non-govt.                  Third-party 
  Kind                                                                                              Kind                                                                 sick pay     
                                                                                                                                                                           
  of                                Hshld.   Medicare                                               of                      State/local                                  (Check if 
  Payer                             emp.     govt. emp.                                             Employer                  non-501c   State/local 501c  Federal govt. applicable) 
  (Check one)                                                                                       (Check one)
c Total number of Forms W-2         d Establishment number                                          1 Wages, tips, other compensation    2 Income tax withheld

e Employer identification number (EIN)                                                              3 Social security wages              4 Social security tax withheld

f  Employer’s name                                                                                  5 Medicare wages and tips            6 Medicare tax withheld

                                                                                                    7 Social security tips               8

                                                                                                    9                                    10

                                                                                                    11 Nonqualified plans                12a Deferred compensation
g Employer’s address and ZIP code
h Other EIN used this year                                                                          13 For third-party sick pay use only 12b

15 Employer’s territorial ID number                                                                 14 Income tax withheld by payer of third-party sick pay

  Employer’s contact person                                                                           Employer’s telephone number          For Official Use Only

  Employer’s fax number                                                                               Employer’s email address

                                                        Copy 1—For Local Tax Department 
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and complete. 

Signature ▶                                                                                         Title ▶                                                Date ▶
Form W-3SS Transmittal of Wage and Tax Statements Form W-3SS Transmittal of Wage and Tax Statements                                                              Department of the Treasury Department of the Treasury 
                                                                                                                20222022                                         Internal Revenue Service Internal Revenue Service 

Where To File
For more information about where to file Copy 1, contact your state, city, or local tax department.
American Samoa. File Copy 1 of Form W-3SS and Form(s) W-2AS at the following address.
 American Samoa Department of Treasury  
 Tax Office 
 Executive Office Building  
 Pago Pago, AS 96799
Guam. File Copy 1 of Form W-3SS and Form(s) W-2GU at the following address.
 Guam Department of Revenue and Taxation 
 P.O. Box 23607 
 Barrigada, GU 96921
U.S. Virgin Islands. File Copy 1 of Form W-3SS and Form(s) W-2VI at the following address.
 Virgin Islands Bureau of Internal Revenue 
 6115 Estate Smith Bay 
 Suite 225 
 St. Thomas, VI 00802
Commonwealth of the Northern Mariana Islands. File Form OS-3710 and Copy 1 of Form(s) W-2CM at the following address.
 Division of Revenue and Taxation 
 Commonwealth of the Northern Mariana Islands 
 P.O. Box 5234 CHRB 
 Saipan, MP 96950

PDF file checksum: 2718836204

(Plugin #1/9.12/13.0)