Attention: 

This form is provided for informational purposes only. Copy A appears in red, similar to the  
official IRS form. Do not file copy A downloaded from this website with the SSA. The official 
printed version of this IRS form is scannable, but the online version of it, printed from this  
website, is not. 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 for more  
information. 

To order official IRS forms, call 1-800-TAX-FORM (1-800-829-3676) or Order Information  
Returns and Employer Returns Online, and we’ll mail you the scannable forms and other  
products.   

You may file Forms W-2 and W-3 electronically on the SSA’s website at Employer  
Reporting Instructions & Information. 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.  

See IRS Publications 1141, 1167, 1179 and other IRS resources for information about  
printing these tax forms. 

                                              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 

                                                                                              /  W-2 
                                                                                  e  Corrected SSN and/or name (Check this box and complete boxes f and/or 
                                                                                     g if incorrect on form previously filed.) 
                                                                                  Complete boxes f and/or g only if incorrect on form previously filed   ▶
                                                                                  f  Employee’s previously reported SSN 

b  Employer's Federal EIN                                                         g  Employee’s previously reported name 

                                                                                  h  Employee’s first name and initial   Last name                             Suff.

Note. Only complete money fields that are being corrected (exception: for 
corrections involving MQGE, see the General Instructions for Forms W-2 
and W-3, under Specific 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 benefits           10   Dependent care benefits 

                                                                                                                         12aCo     See instructions for box 12 
11   Nonqualified plans                  11   Nonqualified plans                  12aCedo See instructions for box 12    de
13 Statutory Retirement      Third-party 13 Statutory Retirement      Third-party 
   employee  plan            sick pay       employee  plan            sick pay
                                                                                                                         12boC
                                                                                  12bdeCo                                ed 
14  Other (see instructions)             14  Other (see instructions) 
                                                                                                                         12coC
                                                                                  12cdeCo                                ed 
                                                                                                                         12doC
                                                                                  12ddeCo                                ed 

                                                           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 separate instructions.                                     Copy A—For Social Security Administration 
                                                                                                                                       Department of the Treasury 
Form  W-2c  (Rev. 8-2014)                             Corrected Wage and Tax Statement                                Cat. No. 61437D  Internal Revenue Service 

                  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 filed.) 
                                                                                  Complete boxes f and/or g only if incorrect on form previously filed    ▶
                                                                                  f  Employee’s previously reported SSN 

b  Employer's Federal EIN                                                         g  Employee’s previously reported name 

                                                                                  h  Employee’s first name and initial   Last name                             Suff.

Note. Only complete money fields that are being corrected (exception: for 
corrections involving MQGE, see the General Instructions for Forms W-2 
and W-3, under Specific 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 benefits           10   Dependent care benefits 

                                                                                                                         12aCo     See instructions for box 12 
11   Nonqualified plans                  11   Nonqualified plans                  12aCedo See instructions for box 12    de
13 Statutory Retirement      Third-party 13 Statutory Retirement      Third-party 
   employee  plan            sick pay       employee  plan            sick pay
                                                                                                                         12boC
                                                                                  12bdeCo                                ed 
14  Other (see instructions)             14  Other (see instructions) 
                                                                                                                         12coC
                                                                                  12cdeCo                                ed 
                                                                                                                         12doC
                                                                                  12ddeCo                                ed 

                                                           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 

                                                                                                               Copy 1—State, City, or Local Tax Department
                                                                                                                                       Department of the Treasury 
Form  W-2c  (Rev. 8-2014)                             Corrected Wage and Tax Statement                                                 Internal Revenue Service 

                  For Official Use Only     ▶                                                 Safe, accurate,                          Visit the IRS website  
44444             OMB No. 1545-0008                                                           FAST!   Use                              at www.irs.gov.
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 filed.) 
                                                                                  Complete boxes f and/or g only if incorrect on form previously filed    ▶
                                                                                  f  Employee’s previously reported SSN 

b  Employer's Federal EIN                                                         g  Employee’s previously reported name 

                                                                                  h  Employee’s first name and initial   Last name                             Suff.

Note. Only complete money fields that are being corrected (exception: for 
corrections involving MQGE, see the General Instructions for Forms W-2 
and W-3, under Specific 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 benefits           10   Dependent care benefits 

                                                                                                                         12aCo     See instructions for box 12 
11   Nonqualified plans                  11   Nonqualified plans                  12aCedo See instructions for box 12    de
13 Statutory Retirement      Third-party 13 Statutory  Retirement     Third-party 
   employee  plan            sick pay         employee plan           sick pay
                                                                                                                         12boC
                                                                                  12bdeCo                                ed 
14  Other (see instructions)             14  Other (see instructions) 
                                                                                                                         12coC
                                                                                  12cdeCo                                ed 
                                                                                                                         12doC
                                                                                  12ddeCo                                ed 

                                                            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 

                                                                                              Copy B—To Be Filed with Employee’s FEDERAL Tax Return
                                                                                                                                       Department of the Treasury 
Form  W-2c  (Rev. 8-2014)                             Corrected Wage and Tax Statement                                                 Internal Revenue Service 

                  For Official Use Only     ▶                                                 Safe, accurate,                          Visit the IRS website  
44444             OMB No. 1545-0008                                                           FAST!   Use                              at www.irs.gov.
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 filed.) 
                                                                                  Complete boxes f and/or g only if incorrect on form previously filed    ▶
                                                                                  f  Employee’s previously reported SSN 

b  Employer's Federal EIN                                                         g  Employee’s previously reported name 

                                                                                  h  Employee’s first name and initial   Last name                             Suff.

Note. Only complete money fields that are being corrected (exception: for 
corrections involving MQGE, see the General Instructions for Forms W-2 
and W-3, under Specific 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 benefits           10   Dependent care benefits 

                                                                                                                         12aCo     See instructions for box 12 
11   Nonqualified plans                  11   Nonqualified plans                  12aCedo See instructions for box 12    de
13 Statutory Retirement      Third-party 13 Statutory  Retirement     Third-party 
   employee  plan            sick pay         employee plan           sick pay
                                                                                                                         12boC
                                                                                  12bdeCo                                ed 
14  Other (see instructions)             14  Other (see instructions) 
                                                                                                                         12coC
                                                                                  12cdeCo                                ed 
                                                                                                                         12doC
                                                                                  12ddeCo                                ed 

                                                            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 

                                                                                                                       Copy C—For EMPLOYEE’s RECORDS 
                                                                                                                                       Department of the Treasury 
Form  W-2c  (Rev. 8-2014)                             Corrected Wage and Tax Statement                                                 Internal Revenue Service 

Notice to Employee

This is a corrected Form W-2, Wage and Tax Statement,      If you have not filed your return for the year shown in 
(or Form W-2AS, W-2CM, W-2GU, W-2VI or W-2c) for the       box c, attach Copy B of the original Form W-2 you 
tax year shown in box c. If you have filed an income tax   received from your employer and Copy B of this Form 
return for the year shown, you may have to file an         W-2c to your return when you file it. 
amended return. Compare amounts on this form with 
those reported on your income tax return. If the corrected For more information, contact your nearest Internal 
amounts change your U.S. income tax, file Form 1040X,      Revenue Service office. Employees in American Samoa, 
Amended U.S. Individual Income Tax Return, with Copy B     Commonwealth of the Northern Mariana Islands, Guam, 
of this Form W-2c to amend the return you already filed.   or the U.S. Virgin Islands should contact their local taxing 
                                                           authority for more information. 
If there is a correction in box 5, Medicare wages and 
tips, use the corrected amount to determine if you need 
to file or amend Form 8959, Additional Medicare Tax. If 
you need to file Form 8959 or an amended Form 8959, 
attach it to Form 1040 or Form 1040X, as applicable.

                  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 filed.) 
                                                                                  Complete boxes f and/or g only if incorrect on form previously filed    ▶
                                                                                  f  Employee’s previously reported SSN 

b  Employer's Federal EIN                                                         g  Employee’s previously reported name 

                                                                                  h  Employee’s first name and initial   Last name                             Suff.

Note. Only complete money fields that are being corrected (exception: for 
corrections involving MQGE, see the General Instructions for W-2 and W-3, 
under Specific 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 benefits           10   Dependent care benefits 

                                                                                                                         12aCo     See instructions for box 12 
11   Nonqualified plans                  11   Nonqualified plans                  12aCedo See instructions for box 12    de
13 Statutory Retirement      Third-party 13 Statutory Retirement      Third-party 
   employee  plan            sick pay       employee  plan            sick pay
                                                                                                                         12boC
                                                                                  12bdeCo                                ed 
14  Other (see instructions)             14  Other (see instructions) 
                                                                                                                         12coC
                                                                                  12cdeCo                                ed 
                                                                                                                         12doC
                                                                                  12ddeCo                                ed 

                                                           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 

                                                                              Copy 2—To Be Filed with Employee’s State, City, or Local Income Tax Return
                                                                                                                                       Department of the Treasury 
Form  W-2c  (Rev. 8-2014)                             Corrected Wage and Tax Statement                                                 Internal Revenue Service 

                  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 filed.) 
                                                                                  Complete boxes f and/or g only if incorrect on form previously filed    ▶
                                                                                  f  Employee’s previously reported SSN 

b  Employer's Federal EIN                                                         g  Employee’s previously reported name 

                                                                                  h  Employee’s first name and initial   Last name                             Suff.

Note. Only complete money fields that are being corrected (exception: for 
corrections involving MQGE, see the General Instructions for W-2 and W-3, 
under Specific 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 benefits           10   Dependent care benefits 

                                                                                                                         12aCo     See instructions for box 12 
11   Nonqualified plans                  11   Nonqualified plans                  12aCedo See instructions for box 12    de
13 Statutory Retirement      Third-party 13 Statutory Retirement      Third-party 
   employee  plan            sick pay        employee plan            sick pay
                                                                                                                         12boC
                                                                                  12bdeCo                                ed 
14  Other (see instructions)             14  Other (see instructions) 
                                                                                                                         12coC
                                                                                  12cdeCo                                ed 
                                                                                                                         12doC
                                                                                  12ddeCo                                ed 

                                                           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 

                                                                                                                                       Copy D—For Employer 
                                                                                                                                       Department of the Treasury 
Form  W-2c  (Rev. 8-2014)                             Corrected Wage and Tax Statement                                                 Internal Revenue Service 

                                                         E-filing.  If you file 250 or more Form(s) W-2c, you must 
Employers, Please Note:                                  file electronically. Even if you are not required to file 
Specific information needed to complete Form W-2c is     electronically, doing so can save you time and effort. 
given in the separate General Instructions for Forms W-2 Employers may now use the SSA's W-2 Online service to 
and W-3, under Specific Instructions for Form W-2c. You  create, save, print and submit up to 50 Form(s) W-2c at a 
can order those instructions and additional forms by     time over the Internet. When you e-file with the SSA, no 
calling 1-800-TAX-FORM (1-800-829-3676).  You can        separate Form W-3c filing is required.  An electronic Form 
also get forms and instructions from the IRS website at  W-3c will be created for you by the W-2 Online service. 
www.irs.gov.                                             For information, visit the SSA's Employer W-2 Filing 
                                                         Instructions & Information website at 
                                                         www.socialsecurity.gov/employer.