Every year, employers grapple with the task of preparing and submitting accurate tax documents for their employees. Among these, the IRS Publication 1141 plays a pivotal role, detailing the General Rules and Specifications for Substitute Forms W-2 and W-3. The latest revision, encapsulated in Revenue Procedure 2021-46, provides exhaustive guidance for the creation of these essential forms. The publication outlines the intricate specifications required for both paper and electronic submissions, ensuring that non-IRS printed substitute forms adhere to strict standards for acceptance by the IRS and the Social Security Administration. Changes and updates, such as the inclusion of coronavirus-related sick and family leave wages reporting instructions, signify the form's adaptability to new legislative requirements. The restrictions on the inclusion of logos, slogans, and advertisements on these forms reflect the IRS's commitment to maintaining the clarity and integrity of tax documents. Moreover, the IRS and SSA's openness to comments on these restrictions demonstrates their engagement in a feedback loop with preparers and employers. With an explicit prohibition against deviations from the stipulated guidelines, IRS Publication 1141 serves as a critical resource for employers to comply with reporting wages paid during the 2021 calendar year.
Question | Answer |
---|---|
Form Name | Irs Pub 1141 Form |
Form Length | 28 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 7 min |
Other names | Fillable Online Revenue Procedure 2002-53 Reprinted from ... |
Revenue Procedure
Reprinted from IR Bulletin
Publication 1141
General Rules and Specifications for Substitute Forms
IRS
Department of the Treasury
Internal Revenue Service
Publication 1141 (Rev.
Catalog Number 47000C
www.irs.gov
NOTE. This revenue procedure will be reproduced as the next revision of IRS Publication 1141, General Rules and Specifications for Substitute Forms
26 CFR 601.602: Tax forms and instructions.
(Also Part I, Sections 6041, 6051, 6071, 6081, 6091;
Rev. Proc.
TABLE OF CONTENTS
Part 1 – GENERAL
Section 1.1 – Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Section 1.2 – What’s New . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Section 1.3 – General Rules for Paper Forms
Part 2 – SPECIFICATIONS FOR SUBSTITUTE FORMS
Section 2.1 – Specifications for
Section 2.2 – Specifications for Substitute
and Form
Section 2.3 – Requirements for Substitute Forms Furnished to Employees (Copies |
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B, C, and 2 of Form |
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Section 2.4 – Electronic Delivery of Form |
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Part 3 – ADDITIONAL INSTRUCTIONS |
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Section 3.1 – Additional Instructions for Form Printers |
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Section 3.2 – Instructions for Employers |
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Section 3.3 |
– OMB Requirements for Both |
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Substitute Forms |
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Section 3.4 |
– Order Forms and Instructions |
19 |
Section 3.5 |
– Effect on Other Documents |
19 |
Section 3.6 |
– Exhibits |
20 |
Part 1
General
Section 1.1 – Purpose
.01 The purpose of this revenue procedure is to state the requirements of the Internal Revenue Service (IRS) and the Social Security Administration (SSA) regarding the preparation and use of substitute forms for Form
.02 For purposes of this revenue procedure, substitute Form
.03 For purposes of this revenue procedure, the official
Any questions about the
Internal Revenue Service
Attn: Substitute Forms Program SE:W:CAR:MP:P:TP
1111 Constitution Ave. NW Room 6554 Washington, DC 20224
Any questions about the
Social Security Administration
Direct Operations Center
Attn: Substitute
1150 E. Mountain Drive
1
Note. You should receive a response from either the IRS or the SSA within 30 days.
.04 Some Forms
•Forms may include the exact name of the employer or agent, primary trade name, trademark, service mark, or symbol of the employer or agent.
•Forms may include an embossment or watermark on the information return (and copies) that is a representation of the name, a primary trade name, trademark, service mark, or symbol of the employer or agent.
•Presentation may be in any typeface, font, stylized fashion, or print color normally used by the employer or agent, and used in a nonintrusive manner.
•These items must not materially interfere with the ability of the recipient to recognize, understand, and use the tax information on the employee copies.
The IRS
The information return and employee copies must clearly identify the employer’s name associated with its employer identification number.
Logos and slogans may be used on permissible enclosures, such as a check or account statement, but not on information returns and employee copies.
Forms
.05 The Internal Revenue Service/Information Returns Branch (IRS/IRB) maintains a centralized customer service call site to answer questions related to information returns (Forms
2
submit employee information via email because it is not secure and the information may be compromised.
File paper or electronic Forms
.06 The following form instructions and publications provide more detailed filing procedures for certain information returns.
•General Instructions for Forms
•Publication 1223, General Rules and Specifications for Substitute Forms
Section 1.2 – What’s New
.01 Box 14 or separate statement reporting of coronavirus
.02 Editorial changes. We made editorial changes. Redundancies were eliminated as much as possible.
Section 1.3 – General Rules for Paper Forms
.01 Employers not filing electronically must file paper Forms
Note. Substitute territorial forms
3
Form
Employers may design their own statements to furnish to employees. Employee statements designed by employers must comply with the requirements shown in Parts 2 and 3.
.02
.03 As in the past,
Note. With the exception of the identifying number, the year, the form number for Form
.04 Substitute forms filed with the SSA and substitute copies furnished to employees that do not conform to these specifications are unacceptable. Penalties may be assessed for not complying with the form specifications. Forms
.05 Substitute
•Submit a letter or email to the appropriate address in Section 1.1 citing the specification.
•State your understanding of the specification.
•Enclose an example (if appropriate) of how the form would appear if produced using your understanding. Do not use actual employee information in the example.
•Be sure to include your name, complete address, and phone number with your correspondence. If you want the IRS to contact you via email, also provide your email address.
4
.06 Any questions about the specifications, especially those for the
Internal Revenue Service
Attn: Substitute Forms Program SE:W:CAR:MP:P:TP
1111 Constitution Ave. NW Room 6554 Washington, DC 20224
Any questions about the substitute
Form
Social Security Administration
Direct Operations Center
Attn: Substitute
1150 E. Mountain Drive
Note. You should receive a response within 30 days from either the IRS or the SSA.
.07 Forms
.08 Separate instructions for Forms
.09 Because substitute Forms
Section 1.4 – General Rules for Filing Forms
.01 As of the date of publication of this revenue procedure, employers must file Forms
5
cautioned to obtain the most recent revision of EFW2 (and supplements) in case there are any subsequent changes in specifications and procedures.
.02 You may obtain a copy of the EFW2 by:
•Accessing the SSA website at www.ssa.gov/employer/ EFW2&EFW2C.htm.
.03 Electronic filers do not file a paper Form
.04 Employers are encouraged to electronically file Forms
.05 Employers who do not comply with the electronic filing requirements for Form
Part 2
Specifications for Substitute Forms
Section 2.1 – Specifications for
.01 The official
Note. Even the slightest deviation can result in incorrect scanning and may affect money amounts reported for employees.
.02 Paper used for cut sheets and
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Acidity: Ph value, average, not less than |
4.5 |
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Basis weight: 17 x 22 inch 500 cut sheets, pound |
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Metric |
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(a tolerance of +5 pct. is allowed) |
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Stiffness: Average, each direction, not less |
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Cross direction |
50 |
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Machine direction |
80 |
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Tearing strength: Average, each direction, not less |
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40 |
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Opacity: Average, not less |
82 |
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Reflectivity: Average, not less |
68 |
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Thickness: |
0.0038 |
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Metric |
0.097 |
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(a tolerance of +0.0005 inch (0.0127 mm) is allowed). Paper cannot |
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vary more than 0.0004 inch (0.0102 mm) from one edge to the other. |
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Porosity: Average, not less |
10 |
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Finish (smoothness): Average, each |
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(for information only) the Sheffield equivalent— |
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units |
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Dirt: Average, each side, not to |
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million |
8 |
Note. Reclaimed fiber in any percentage is permitted, provided the requirements of this standard are met.
.03 All printing of
•Identifying number “22222” for Forms
•Tax year at the bottom of the forms.
•The four (4) corner register marks on the forms.
•The form identification number
•All the instructions below Form
.04 The vertical and horizontal spacing for all federal payment and data boxes on Forms
.05 The official
7
official Forms
.06 The top, left, and right margins for the Form
.07 The identifying numbers are “22222” for Form
Note. The identifying number must be printed in nonreflective black ink in
.08 The depth of the individual scannable image on a page must be the same as that on the official IRS forms. The depth from the top line to the bottom line of an individual Form
.09
.10 Box 12 of Form
.11 The checkboxes in box 13 of Form
Note. More than 50% of an applicable checkbox must be covered by an “X.”
.12 All substitute Forms
.13 The words “For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.” must be printed in Flint red OCR dropout ink in the same
8
location as on the official Form
.14 The Office of Management and Budget (OMB) Number must be printed on substitute Forms
.15 All substitute Forms
.16 The back of substitute Form
.17 All copies must be clearly legible. Fading must be minimized to assure legibility.
.18 Chemical transfer paper is permitted for Form
•Only chemically backed paper is acceptable for Form
•Chemically transferred images must be black.
•
.19 The Government Printing Office (GPO) symbol and the Catalog Number (Cat. No.) must be deleted from substitute Form
Section 2.2 – Specifications for Substitute
.01 Specifications for the
1.Forms must be printed on 8.5 x
2.All forms and data must be printed in nonreflective black ink only.
3.The data and forms must be programmed to print simultaneously. Forms cannot be produced separately from wage data entries.
4.The forms must not contain corner register marks.
5.The forms must not contain any shaded areas, including those boxes that are entirely shaded on the
6.Identifying numbers on both Form
9
7.The form numbers
8.No part of the box titles or the data printed on the forms may touch any of the vertical or horizontal lines, nor should any of the data intermingle with the box titles. The data should be centered in the boxes.
9.Do not print any information in the margins of the substitute
10.The word “Code” must not appear in box 12 on Form
11.A
12.Do not print Catalog Numbers (Cat. No.) on either Form
13.Do not print the checkboxes in:
•Box 13 of Form
14.Do not print dollar signs. If there are no money amounts being reported, the entire field should be left blank.
15.The space between the two Forms
.02 You must submit samples of your substitute
.03 You will be required to send one set of blank and one set of
10
.04 To receive approval, you may first contact the SSA via email at copy.a.forms@ssa.gov to obtain a template and further instructions. Send your 2021 sample substitute
Social Security Administration Direct Operations Center
Attn: Substitute
Send your sample forms via private mail carrier or certified mail in order to verify their receipt. You can expect approval (or disapproval) by the SSA within 30 days of receipt of your sample forms.
.05 Vendor codes from the National Association of Computerized Tax Processors (NACTP) are required by those companies producing the
.06 The
A)and Forms
.07 If you use forms produced by a vendor and have questions concerning approval, do not send the forms to the SSA for approval. Instead, you may contact the software vendor to obtain a copy of SSA’s dated approval notice supplied to that vendor.
.08 In response to feedback from the user community, the SSA (and the IRS) have added a
Note. The data contained in the barcode must not differ from the data displayed on the form. If they differ, the data in the barcode will be ignored and the data displayed on the form will be considered the submission. This also occurs when the barcode is not read correctly. The information on the form needs to be manually keyed into the database.
To get the barcode information:
•See the SSA’s BSO website at www.ssa.gov/bso,
11
•Request the PDF version of the specifications by emailing copy.a.forms@ssa.gov, and
•Download the substitute W3/W2
If you are using a form produced by another vendor that contains a
Section 2.3 – Requirements for Substitute Forms Furnished to Employees (Copies B, C, and 2 of Form
Note. Rules in Section 2.3 apply only to employee copies of Form
.01 All employers (including those who file electronically) must furnish employees with at least two copies of Form
The dimensions of these copies (Copies B, C, and 2), but not Copy A, may differ from the dimensions of the official IRS form to allow space for reporting additional information, including additional entries such as withholding for health insurance, union dues, bonds, or charity in box 14. The limitation of a maximum of four items in box 12 of Form
Note. Employee copies (Copies B, C, and 2 of Form
.02 The minimum dimensions for employee copies only (not Copy A) of Form
Note. The maximum and minimum size specifications in this document are for tax year 2021 only and may change in future years.
.03 Either horizontal or vertical format is permitted (see Exhibit F).
.04 The paper for all copies must be white and printed in black ink. The substitute Copy B, which employees are instructed to attach to their federal income tax returns, should be at least
.05 Employee copies of Form
12
separation is to provide perforations between the individual copies. Whatever method of separation is used, each copy should be easily distinguished.
Note. Perforation does not apply to printouts of copies of Forms
.06 Interleaved carbon and chemical transfer paper employee copies must be clearly legible. Fading must be minimized to assure legibility.
.07 The electronic tax logo on the IRS official employee copies is not required on any of the substitute form copies. To avoid confusion and questions by employees, employers are encouraged to delete the identifying number (“22222”) from the employee copies of Form
.08 All substitute employee copies must contain boxes, box numbers, and box titles that match the official IRS Form
•The core boxes must be printed in the exact order shown on the official IRS form. The items and box numbers that constitute the core data are:
Box 1 — Wages, tips, other compensation
Box 2 — Federal income tax withheld
Box 3 — Social security wages
Box 4 — Social security tax withheld
Box 5 — Medicare wages and tips
Box 6 — Medicare tax withheld
•The core data boxes (1 through 6) must be placed in the upper right of the form. Substitute
•The form title, number, or copy designation (B, C, or 2) may be at the top of the form. Also, a reversed or
•Boxes 1 through 6 must each be a minimum of 11/8 inches wide x 1/4 inch deep.
•Other required boxes are:
a)Employee’s social security number
b)Employer identification number (EIN)
c)Employer’s name, address, and ZIP code
e)Employee’s name
13
f) Employee’s address and ZIP code
Identifying items must be present on the form and be in boxes similar to those on the official IRS form. However, they may be placed in any location other than the top or upper right. You do not need to use the lettering system
f)used on the official IRS form. The employer identification number (EIN) may be included with the employer’s name and address and not in a separate box.
Note. Box d (“Control number”) is not required.
.09 All copies of Form
.10 If the substitute employee copies are labeled, the forms must contain the applicable description.
•“Copy B, To Be Filed With Employee’s FEDERAL Tax Return.”
•“Copy C, For EMPLOYEE’S RECORDS.”
•“Copy 2, To Be Filed With Employee’s State, City, or Local Income Tax Return.”
It is recommended (but not required) that these be located on the lower left of Form
.11 The tax year (for example, 2021) must be clearly printed on all copies of substitute Form
.12 Boxes 1 and 2 (if applicable) on Copy B must be outlined in bold
Note. Boxes 8 and 9 may be omitted if not applicable.
.13 If employers are required to withhold and report state or local income tax, the applicable boxes are also considered core information and must be placed at the bottom of the form. State information is included in:
•Box 15 (State, Employer’s state ID number)
•Box 16 (State wages, tips, etc.)
•Box 17 (State income tax)
14
Local information is included in:
•Box 18 (Local wages, tips, etc.)
•Box 19 (Local income tax)
•Box 20 (Locality name)
.14 Boxes 7 through 14 may be omitted from substitute employee copies unless the employer must report any of that information to the employee. For example, if an employee did not have “Social security tips” (box 7), the form could be printed without that box. But, if an employer provided dependent care benefits, the amount must be reported separately, shown in box 10, and labeled “Dependent care benefits.”
.15 Employers may enter more than four codes in box 12 of substitute Copies B, C, and 2 (and 1 and D) of Form
.16 If an employer has employees in any of the three categories in box 13, all checkbox headings must be shown and the proper checkmark made, when applicable.
.17 Employers may use box 14 for any other information that they wish to give to their employees. Each item must be labeled. (See the instructions for box 14 in the 2021 General Instructions for Forms
.18 The front of Copy C of a substitute Form
.19 Instructions similar to those contained on the back of Copies B, C, and 2 of the official IRS Form
.20 Employers must notify their employees who have no income tax withheld that they may be able to claim a tax refund because of the earned income credit (EIC). They will meet this notification requirement if they furnish a substitute Form
Note. An employer does not have to notify any employee who claimed exemption from withholding on Form
15
Section 2.4 – Electronic Delivery of Form
.01 If you are required to furnish a Form
If you meet the requirements listed below, you are treated as furnishing the statement timely.
.02 The recipient must consent in the affirmative and not have withdrawn the consent before the statement is furnished. The consent by the recipient must be made electronically in a way that shows that he or she can access the statement in the electronic format in which it will be furnished.
You must notify the recipient of any hardware or software changes prior to furnishing the statement. A new consent to receive the statement electronically is required after any new hardware or software is put into service.
To furnish Forms
•The employee must be informed that he or she will receive a paper Form
•The employee must be informed of the scope and duration of the consent.
•The employee must be informed of any procedure for obtaining a paper copy of his or her Form
•The employee must be notified about how to withdraw a consent and the effective date and manner by which the employer will confirm the withdrawn consent.
•The employee must also be notified that the withdrawn consent doesn't apply to the previously issued Forms
•The employee must be informed about any conditions under which electronic Forms
•The employee must be informed of any procedures for updating his or her contact information that enables the employer to provide electronic Forms
•The employer must notify the employee of any changes to the employer's contact information.
.03 Additionally, you must:
•Ensure the electronic format complies with the guidelines in this document and contains all the required information described in the 2021 General Instructions for Forms
16
•If posting the statement on a website, post it for the recipient to access on or before the January 31 due date through October 15 of that year.
•Inform the recipient in person, electronically, or by mail, of the posting and how to access and print the statement.
Part 3
Additional Instructions
Section 3.1 – Additional Instructions for Form Printers
.01 If paper copies are used for filing with the SSA, the substitute copies of Forms
.02 The substitute form to be filed by the employer with the SSA must carry the designation “Copy A.”
Note. Electronic filers do not submit either
.03 Employers must retain a copy of Forms
.04 Except for copies in the official assembly, described in Section 3.1.01 above, no additional copies that may be prepared by employers should be placed ahead of Form
.05 You must provide instructions similar to those contained on the back of Copies B, C, and 2 of the official IRS Form
17
Section 3.2 – Instructions for Employers
.01 Only originals of Form
.02 Employers should type or
Note.
.03 Form
.04 The employer must provide a
Note. Do not print Forms
.05 Any printing in box d (Control number) on Form
.06 The filer’s employer identification number (EIN) must be entered in box b of Form
.07 The employer’s name, address, and EIN may be preprinted.
Section 3.3 – OMB Requirements for Both
.01 The Paperwork Reduction Act (the Act) of 1995 (Public Law
•The Office of Management and Budget (OMB) approves all IRS tax forms that are subject to the Act.
•Each IRS form contains (in or near the upper right corner) the OMB approval number, if assigned. (The official OMB numbers may be found on the official IRS printed forms and are also shown on the forms in the Exhibits in Section 3.6.)
18
•Each IRS form (or its instructions) states:
1.Why the IRS needs the information,
2.How it will be used, and
3.Whether or not the information is required to be furnished to the IRS.
.02 This information must be provided to any users of official or substitute IRS forms or instructions.
.03 The OMB requirements for substitute IRS Form
•Any substitute form or substitute statement to a recipient must show the OMB number as it appears on the official IRS form.
•The OMB number for both Form
•For any copy of Form
1.OMB No.
2.OMB #
.04 Any substitute Form
Section 3.4 – Order Forms and Instructions
.01 You can order IRS Forms
.02 Copies of Form
Section 3.5 – Effect on Other Documents
.01 Revenue Procedure
19
Section 3.6 – Exhibits
Exhibits A through F provide the general measurements for Forms
Exhibit A — Form
Exhibit B — Form
Exhibit C — Form
Exhibit D — Form
Exhibit E — Form
Exhibit F — Form
Horizontal and Vertical Formats)
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EXHIBIT A
Form
.50 in
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22222 |
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a Employee’s social security number For Official Use Only |
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b Employer identification number (EIN) |
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1 Wages, tips, other compensation |
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c Employer’s name, address, and ZIP code |
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Social security wages |
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15 State |
Employer’s state ID number |
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Wage and Tax Statement |
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c Employer’s name, address, and ZIP code |
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3 |
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Social security wages |
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4 Social security tax withheld |
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5 Medicare wages and tips |
6 |
Medicare tax withheld |
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7 |
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Social security tips |
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8 |
Allocated tips |
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d Control number |
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9 |
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10 |
Dependent care benefits |
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e Employee’s first name and initial |
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Last name |
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Suff. |
11 |
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Nonqualified plans |
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12a See instructions for box 12 |
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2.20 in |
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13 |
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Statutory |
Retirement |
12b |
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employee |
plan |
sick pay |
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14 Other |
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12c |
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d .50 in |
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e |
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f Employee’s address and ZIP code |
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15 State Employer’s state ID number |
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16 State wages, tips, etc. |
17 State income tax |
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18 Local wages, tips, etc. |
19 Local income tax |
20 Locality name |
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2.20 in |
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1.20 in |
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1.10 in |
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1.20 in |
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1.10 in |
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.40 in |
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Form |
2021 |
Copy
Form
Department of the
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
21
EXHIBIT B
Form
|
|
a |
Employee’s social security number |
|
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Safe, accurate, |
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|
Visit the IRS website at |
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OMB No. |
FAST! Use |
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www.irs.gov/efile |
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b Employer identification number (EIN) |
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1 Wages, tips, other compensation |
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2 Federal income tax withheld |
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|||||||||||
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|||
c Employer’s name, address, and ZIP code |
|
3 |
Social security wages |
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|
4 Social security tax withheld |
|||||||||||
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5 Medicare wages and tips |
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6 |
Medicare tax withheld |
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7 |
Social security tips |
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8 |
Allocated tips |
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||||
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d Control number |
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9 |
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10 |
Dependent care benefits |
|||||
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||
e Employee’s first name and initial |
Last name |
Suff. |
11 |
Nonqualified plans |
|
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12a See instructions for box 12 |
||||||||||
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C |
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d |
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e |
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13 |
Statutory |
Retirement |
|
12b |
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||||
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employee |
plan |
sick pay |
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C |
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d |
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14 Other |
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12c |
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d |
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12d |
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f Employee’s address and ZIP code |
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15 State Employer’s state ID number |
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16 State wages, tips, etc. |
17 State income tax |
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18 Local wages, tips, etc. |
19 Local income tax |
20 Locality name |
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Form |
2021 |
Copy |
0000/ |
This information is being furnished to the Internal Revenue Service.
Department of the
22
EXHIBIT C
Form
7.50 in
DO NOT STAPLE
.50 in
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33333 |
a |
Control number |
For Official Use Only ▶ |
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5.00 in |
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OMB No. |
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.85 in |
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1.65 in |
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b |
▲ |
941 |
Military |
943 .36 in 944 |
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▲ |
None apply |
501c |
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1.20 in |
Kind |
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Kind |
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sick pay |
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of |
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of |
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Hshld. |
Medicare |
State/local |
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(Check if |
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.50 in |
Payer |
govt. emp. |
Employer |
State/local 501c |
Federal govt. |
applicable) |
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(Check one) |
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(Check one) |
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c Total number of Forms |
d Establishment number |
1 Wages, tips, other compensation |
2 Federal income tax withheld |
.50 in |
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.14 in |
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1.60 in |
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1.60 in |
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e Employer identification number (EIN) |
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3 Social security wages |
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4 Social security tax withheld |
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f Employer’s name |
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4.67 in |
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5 Medicare wages and tips |
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6 Medicare tax withheld |
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7 Social security tips |
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8 Allocated tips |
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2.15 in |
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9 |
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10 Dependent care benefits |
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11 Nonqualified plans |
12a Deferred compensation |
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g Employer’s address and ZIP code |
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h Other EIN used this year |
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13 For |
12b |
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15 State |
Employer’s state ID number |
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14 Income tax withheld by payer of |
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16 State wages, tips, etc. |
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17 State income tax |
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18 Local wages, tips, etc. |
19 Local income tax |
.33 in |
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Employer's contact person |
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Employer's telephone number |
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For Official Use Only |
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Employer's fax number |
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Employer's email address |
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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 ▶
Form |
2021 |
Department of the Treasury |
Internal Revenue Service |
Send this entire page with the entire Copy A page of Form(s)
Photocopies are not acceptable. Do not send Form
Do not send any payment (cash, checks, money orders, etc.) with Forms
Reminder
Separate instructions. See the 2021 General Instructions for Forms
Purpose of Form |
|
|
Complete a Form |
5.33 in |
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||
Form(s) |
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paper forms must comply with IRS standards and be machine readable. |
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Photocopies are not acceptable. Use a Form |
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paper Form |
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Form(s) |
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Number (EIN). Make a copy of this form and keep it with Copy D (For |
|
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Employer) of Form(s) |
When To File Paper Forms |
|
retaining copies of these forms for 4 years. |
||
Mail Form |
||
The SSA strongly suggests employers report Form |
Where To File Paper Forms |
|
Copy A electronically instead of on paper. The SSA provides two free |
Send this entire page with the entire Copy A page of Form(s) |
|
|
||
Social Security Administration |
||
50 Forms |
Direct Operations Center |
|
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 |
Note: If you use “Certified Mail” to file, change the ZIP code to |
|
Specifications for Filing Forms |
||
|
||
“ATTN: |
||
January 31, 2022. For more information, go to www.SSA.gov/bso. First- |
the ZIP code to |
|
time filers, select “Register”; returning filers select “Log In.” |
Guide, for a list of |
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
23
EXHIBIT D
Form
.90 in |
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.70 in |
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1.80 in |
.50 in
.50 in
22222 |
VOID |
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a Employee’s social security number |
For Official Use Only ▶ |
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OMB No. |
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b Employer identification number (EIN) |
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1 Wages, tips, other compensation |
2 |
Federal income tax withheld |
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c Employer’s name, address, and ZIP code |
3 |
Social security wages |
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4 |
Social security tax withheld |
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5 |
Medicare wages and tips |
6 |
Medicare tax withheld |
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7 |
Social security tips |
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8 |
Allocated tips |
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d Control number |
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9 |
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4.17 in |
10 |
Dependent care benefits |
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e Employee’s first name and initial |
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Last name |
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Suff. 11 |
Nonqualified plans |
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12a See instructions for box 12 |
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13 |
Statutory |
Retirement |
12b |
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employee |
plan |
sick pay |
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14 Other |
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12c |
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12d |
fEmployee’s address and ZIP code
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 |
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.40 in |
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1.80 in |
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1.20 in |
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1.10 in |
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1.20 in |
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1.10 in |
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.70 in |
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.50 in
Form |
2021 |
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Department |
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of the |
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For Privacy Act and Paperwork Reduction |
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Copy |
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1.33 in |
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Act Notice, see the separate instructions. |
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Form |
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.83 in |
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Do Not Cut, Fold, or Staple Forms on |
This Page |
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.50 in |
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22222 |
VOID |
a Employee’s social security number |
For Official Use Only ▶ |
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OMB No. |
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b Employer identification number (EIN) |
1 |
Wages, tips, other compensation |
2 Federal income tax withheld |
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c Employer’s name, address, and ZIP code |
3 |
Social security wages |
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4 Social security tax withheld |
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5 |
Medicare wages and tips |
6 |
Medicare tax withheld |
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7 |
Social security tips |
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8 |
Allocated tips |
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d Control number |
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9 |
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10 |
Dependent care benefits |
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e Employee’s first name and initial |
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Last name |
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Suff. 11 |
Nonqualified plans |
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12a See instructions for box 12 |
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13 |
Statutory |
Retirement |
12b |
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employee |
plan |
sick pay |
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14 Other |
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12d |
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fEmployee’s address and ZIP code
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 |
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Form |
2021 |
Copy |
0000/ |
Form
Department of the
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
24
EXHIBIT E |
Form |
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.50 in |
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33333 |
a Control number |
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For Official Use Only ▶ |
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.67 in |
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OMB No. |
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b |
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941 |
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Military |
943 |
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944 |
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None apply |
501c |
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1.20 in |
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Kind |
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.36 in |
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.36 in |
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.36 in |
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.36 in |
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Kind 1.40 in |
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.55 in |
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1.25 in |
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sick pay |
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of |
▲ |
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(Check if |
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Hshld. |
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Medicare |
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State/local |
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Payer |
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Employer |
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applicable) |
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emp. |
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govt. emp. |
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State/local 501c |
Federal govt. |
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(Check one) |
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(Check one) |
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.66 in |
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c Total number of Forms |
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d Establishment number |
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1 Wages, tips, other compensation |
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2 Federal income tax withheld |
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e Employer identification number (EIN) |
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3 Social security wages |
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4 Social security tax withheld |
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f Employer’s name |
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5 Medicare wages and tips |
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6 Medicare tax withheld |
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7 Social security tips |
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8 Allocated tips |
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1.00 in |
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9 |
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10 Dependent care benefits |
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11 Nonqualified plans |
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12a Deferred compensation |
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g Employer’s address and ZIP code |
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h Other EIN used this year |
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13 For |
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12b |
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15 State |
Employer’s state ID number |
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14 Income tax withheld by payer of |
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16 State wages, tips, etc. |
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17 State income tax |
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18 Local wages, tips, etc. |
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19 Local income tax |
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Employer’s contact person |
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Employer’s telephone number |
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For Official Use Only |
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3.20 in |
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2.15 in |
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.33 in |
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0000/ |
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Employer’s fax number |
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Employer’s email address |
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4.30 in |
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Under penalties of perjury, I declare that I have |
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examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and |
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complete. |
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.50 in |
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Signature ▶ |
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Title ▶ |
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Date ▶ |
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Form |
2021 |
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Department of the Treasury |
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Internal Revenue Service |
Send this entire page with the entire Copy A page of Form(s)
Do not send any payment (cash, checks, money orders, etc.) with Forms
Reminder
Separate instructions. See the 2021 General Instructions for Forms
.50 in
Purpose of Form
Complete a Form
The SSA strongly suggests employers report Form
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 for Filing Forms
When To File Paper Forms
Mail Form
Where To File Paper Forms
Send this entire page with the entire Copy A page of Form(s)
Social Security Administration
Direct Operations Center
Note: If you use “Certified Mail” to file, change the ZIP code to
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
25
EXHIBIT F |
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Form |
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a |
Employee’s social security number |
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Safe, accurate, |
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Visit the IRS website at |
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OMB No. |
FAST! Use |
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www.irs.gov/efile |
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b Employer identification number (EIN) |
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1 Wages, tips, other compensation |
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2 Federal income tax withheld |
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c Employer’s name, address, and ZIP code |
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3 |
Social security wages |
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4 Social security tax withheld |
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5 Medicare wages and tips |
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6 |
Medicare tax withheld |
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7 |
Social security tips |
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8 |
Allocated tips |
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d Control number |
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9 |
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10 |
Dependent care benefits |
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e Employee’s first name and initial |
Last name |
Suff. |
11 |
Nonqualified plans |
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12a See instructions for box 12 |
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C |
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13 |
Statutory |
Retirement |
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12b |
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employee |
plan |
sick pay |
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14 Other |
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12c |
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e |
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f Employee’s address and ZIP code |
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15 State Employer’s state ID number |
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16 State wages, tips, etc. |
17 State income tax |
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18 Local wages, tips, etc. |
19 Local income tax |
20 Locality name |
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Wage and Tax |
2021 |
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Department of the |
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Statement |
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Copy |
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This information is being furnished to the Internal Revenue Service.
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OMB No. |
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1 |
Wages, tips, other compensation |
2 |
Federal income tax withheld |
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3 |
Social security wages |
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Social security tax withheld |
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5 |
Medicare wages and tips |
6 |
Medicare tax withheld |
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Employee’s social security number
Employer identification number (EIN)
Employer’s name, address, and ZIP code
Note: Exhibit F displays examples of how Form
Although employee copies can be manipulated, Section 2.3 has specific requirements for core data boxes that must be present on substitute employee copies.
Employee’s name
Employee’s address and ZIP code
15 State Employer’s state ID number |
18 Local wages, tips, etc. |
16State wages, tips, etc.
19Local income tax
17 State income tax
20 Locality name
Copy B To Be Filed With Employee’s FEDERAL Tax Return.
FORM |
2021 |
Wage and Tax |
Statement |
0000/ |
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Department of the Treasury— Internal Revenue Service
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