Pa 78 Form – Fill Out and Use This PDF

The Pa 78 Form is an essential document for state tax offices across the nation. It serves as an application, record of credits and payments, and personal information to taxpayers that utilize state tax structures. It helps standardize processes across all states, ensuring everyone pays their appropriate taxes slowly and securely. This form is also incredibly crucial for anyone who makes a pay or earnings in Pennsylvania — everyone from temporary workers to movie stars must fill out and submit this document. Through the Pa 78 Form, taxpayers can remain on budget with the IRS, protecting their tax investigations, expected payment updates, deadlines, changes in rates and more. Consequently, staying organized and up-to-date with their documents are necessary steps to avoid audits or having critical information fall through the cracks.

Pa 78 Form PDF Details

Understanding government forms, like the Pa 78 form, can seem complicated and overwhelming. If you need help completing the Pennsylvania Form 76 or learning more about it, this blog is here to give you all the information you'll need! We’ll explain what type of application needs to be done and answer common questions regarding submitting materials correctly. With a better understanding of how the process works, this post will make filing for your form easier and faster. Read on for more details about completing your Pa 78 form properly.

Question	Answer
Form Name	Pa 78 Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	form pa 78, pa 78 form online, pa 78, erie cao form pa78a

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REQUEST FOR EMPLOYMENT/EARNINGS INFORMATION

CO	RECORD	DIST	CASE LOAD

	CAO DISC		DATE OF NOTICE

	WORKER NAME

TELEPHONE NUMBER			FAX NUMBER

PLEASE FAX OR RETURN TO ADDRESS SHOWN ON BACK OF THIS FORM

IMPORTANT

62 PS 487 (B) REQUIRES, UNDER PENALTY OF LAW,* THAT YOU COMPLETE THIS FORM UPON REQUEST AND RETURN IT WITHIN 30 DAYS TO THE ADDRESS ON THE BACK OF THIS FORM. EVERY EMPLOYER IS REQUIRED, WHEN REQUESTED IN WRITING FROM THE DEPARTMENT, TO DISCLOSE ANY MONEY IN SALARY, WAGES, COMPENSATION, AND THE AMOUNTS AND DATES OF SUCH SALARY. THE DEPARTMENT CERTIFIES THAT THE EMPLOYEE BELOW IS APPLYING FOR, RECEIVING OR DID RECEIVE PUBLIC ASSISTANCE, OR IS ALEGALLY RESPONSIBLE RELATIVE OF THE EMPLOYEE.

					*AFINE NOT TO EXCEED $1,000

				SUBJECT OF INQUIRY
EMPLOYEE’S NAME					SOCIALSECURITYNUMBER

COMMENT:					LASTKNOWN ADDRESS:

				EMPLOYER INFORMATION

EMPLOYEE TELEPHONE NUMBER					EARNED INCOME TAX CREDIT(EIC) RECEIVED
(	)				YES	NO
					YES	NO

IS INDIVIDUALCURRENTLYEMPLOYED		YES		NO	IF NO, REASON FOR TERMINATION

			EMPLOYER MEDICALINFORMATION
MEDICALINSURANCE COMPANY				MEDICALINSURANCE COMPANYADDRESS

DATES OF COVERAGE		TYPE OF COVERAGE			POLICY/CONTRACTNUMBER		GROUPNAME/NUMBER
FROM	TO


	Please provide earnings information by DATE of PAY
	as indicated ON REVERSE SIDE
							PA78A-X 7/09

PROVIDE EARNINGS INFORMATION BY PAY PERIOD FROM ___________________ TO PRESENT. PLEASE DO NOT

USE QUARTERLY OR YEARLY AMOUNTS. A COMPUTER PRINTOUT OF THE EARNINGS DATA MAY BE SUBSTITUTED IF IT CONTAINS ALLOF THE REQUESTED INFORMATION. ACTUALDATES OF PAYMUST BE INCLUDED, NOT MERELY “PAYPERIOD ENDING” OR “WEEK ENDING” INFORMATION. PLEASE PRINT OR TYPEAND SIGN YOUR NAME BELOW.

DATE OF PAY	GROSSAMOUNT	ADVANCED EIC

DATE OF PAY	GROSSAMOUNT	ADVANCED EIC

USE THIS SPACE FOR ADDITIONALCOMMENTS:

EMPLOYER’S REPRESENTATIVE

TITLE

SIGNATURE

PHONE NUMBER

DATE

(PLEASE PRINT)

FIRST-CLASS MAILPERMITNO 9314 HARRISBURG PA

POSTAGE WILLBE PAID BYADDRESSEE

PA78A-X 7/09

How to Edit Pa 78 Form Online for Free

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1. Start completing your pa 78a form with a number of necessary blanks. Gather all of the necessary information and make certain not a single thing missed!

Guidelines on how to complete pa78a stage 1

2. Immediately after the first section is done, go to enter the suitable information in these: EMPLOYEES NAME, COMMENT, SUBJECT OF INQUIRY, SOCIAL SECURITY NUMBER, LAST KNOWN ADDRESS, COMPLETE THE INFORMATION REQUESTED, IF THE PERSON IS OR WAS EVER IN, EMPLOYER INFORMATION, EMPLOYEE TELEPHONE NUMBER, EARNED INCOME TAX CREDIT EIC, YES, IS INDIVIDUAL CURRENTLY EMPLOYED, YES, IF NO REASON FOR TERMINATION, and MEDICAL INSURANCE COMPANY.

Always be very attentive while completing COMMENT and SOCIAL SECURITY NUMBER, since this is the section where many people make a few mistakes.

3. This stage is straightforward - fill in every one of the form fields in PROVIDE EARNINGS INFORMATION BY, DATE OF PAY, GROSS AMOUNT, PRETAX, DEDUCTIONS, DATE OF PAY, GROSS AMOUNT, PRETAX, and DEDUCTIONS in order to complete this part.

pa78a writing process detailed (portion 3)

4. To go forward, this step will require filling out a few empty form fields. Examples include USE THIS SPACE FOR ADDITIONAL, EMPLOYERS REPRESENTATIVE, TITLE, SIGNATURE, PHONE NUMBER, DATE, and PLEASE PRINT, which are fundamental to going forward with this particular document.

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Pa 78 Form – Fill Out and Use This PDF

Pa 78 Form PDF Details

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