Form W-2 Hidden
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Form W-2 Select Tax Year* 2024 2023 2022 2021
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Contact Info Email*
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Employer Info Employer Name*
Employer Address*
Employer's Tax Id*
Employer's State Id
Employee Info Employee Name*
First
Last
Employee Address*
SSN*
Employee Marital Status* Single Married
Enter the amount paid to the employee – not including tips.Annual income* Hidden
Wages, tips, other compensation Federal Income Tax*
State Income Tax*
Social Security Tax*
Medicare Tax*
Hidden
Show More First Employee Additional Information Additional Info
The following fields are not very common and are only necessary to complete if you meet the requirements. Please read description for each field carefully.
Control Number
Dependent Care Benefits
Social Security Tips Allocated Tips Hidden
Other (14)
Hidden
Other (Amount) Other (14) Statutory Employee Retirement Plan Third-Party Sick Pay Tax Code (12A) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12A)
Tax Code (12B) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12B)
Tax Code (12C) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12C)
Tax Code (12D) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12D)
Local Wages, Tips, etc.
Local Income Tax
Locality Name
Hidden
Section Break Second Employee Info Employee Name*
First
Last
Employee Address*
SSN*
Employee Marital Status* Single Married
Enter the amount paid to the employee – not including tips.Annual Income* Hidden
Wages, tips, other compensation Federal Income Tax*
State Income Tax*
Social Security Tax*
Medicare Tax*
Hidden
Show More Second Employee Additional Information Additional Info
The following fields are not very common and are only necessary to complete if you meet the requirements. Please read description for each field carefully.
Control Number
Dependent Care Benefits
Social Security Tips Allocated Tips Hidden
Other (14)
Hidden
Other (Amount) Other (14) Statutory Employee Retirement Plan Third-Party Sick Pay Tax Code (12A) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12A)
Tax Code (12B) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12B)
Tax Code (12C) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12C)
Tax Code (12D) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12D)
Local Wages, Tips, etc.
Local Income Tax
Locality Name
Hidden
Section Break Third Employee Info Employee Name*
First
Last
Employee Address*
SSN*
Employee Marital Status* Single Married
Enter the amount paid to the employee – not including tips.Annual Income* Hidden
Wages, tips, other compensation Federal Income Tax*
State Income Tax*
Social Security Tax*
Medicare Tax*
Hidden
Show More Third Employee Additional Information Additional Info
The following fields are not very common and are only necessary to complete if you meet the requirements. Please read description for each field carefully.
Control Number
Dependent Care Benefits
Social Security Tips Allocated Tips Hidden
Other (14)
Hidden
Other (Amount) Other (14) Statutory Employee Retirement Plan Third-Party Sick Pay Tax Code (12A) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12A)
Tax Code (12B) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12B)
Tax Code (12C) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12C)
Tax Code (12D) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12D)
Local Wages, Tips, etc.
Local Income Tax
Locality Name
Hidden
Section Break Fourth Employee Info Employee Name*
First
Last
Employee Address*
SSN*
Employee Marital Status* Single Married
Enter the amount paid to the employee – not including tips.Annual Income* Hidden
Wages, tips, other compensation Federal Income Tax*
State Income Tax*
Social Security Tax*
Medicare Tax*
Hidden
Show More Fourth Employee Additional Information Additional Info
The following fields are not very common and are only necessary to complete if you meet the requirements. Please read description for each field carefully.
Control Number
Dependent Care Benefits
Social Security Tips Allocated Tips Hidden
Other (14)
Hidden
Other (Amount) Other (14) Statutory Employee Retirement Plan Third-Party Sick Pay Tax Code (12A) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12A)
Tax Code (12B) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12B)
Tax Code (12C) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12C)
Tax Code (12D) Code A—Uncollected social security or RRTA tax on tips Code B—Uncollected Medicare tax on tips Code C—Taxable cost of group-term life insurance over $50,000 Code D—Elective deferrals under a section 401(k) cash or deferred arrangement (plan) Code E—Elective deferrals under a section 403(b) salary reduction agreement Code F—Elective deferrals under a section 408(k)(6) salary reduction SEP Code G—Elective deferrals and employer contributions (including nonelective deferrals) to any governmental or nongovernmental section 457(b) deferred compensation plan Code H—Elective deferrals under section 501(c)(18)(D) tax-exempt organization plan Code J—Nontaxable sick pay Code K—20% excise tax on excess golden parachute payments (not applicable to Forms W-2AS, W-2CM, W-2GU, or W-2VI) Code L—Substantiated employee business expense reimbursements Code M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (for former employees) Code P—Excludable moving expense reimbursements paid directly to employee Code Q—Nontaxable combat pay Code R—Employer contributions to an Archer MSA Code S—Employee salary reduction contributions under a section 408(p) SIMPLE plan Code T—Adoption benefits Code V—Income from the exercise of nonstatutory stock option(s) Code W—Employer contributions to a health savings account (HSA) Code Y—Deferrals under a section 409A nonqualified deferred compensation plan Code Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A Code AA—Designated Roth contributions under a section 401(k) plan Code BB—Designated Roth contributions under a section 403(b) plan Code CC—HIRE exempt wages and tips (2010 only) Code DD—Cost of employer-sponsored health coverage Code EE—Designated Roth contributions under a governmental section 457(b) plan Code FF—Permitted benefits under a qualified small employer health reimbursement arrangement
Amount (12D)
Local Wages, Tips, etc.
Local Income Tax
Locality Name