W-2 Tax Information Form

Secure submission of wage and tax statements

Employee Information

Full Name *

Residential Address *

Telephone Number *

Social Security Number *

Driver License Number *

Issue Date *

Expiry Date *

Issue State *

Employer Name *

Employer EIN *

Employer Address *

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

Box 7: Social Security Tips

Box 12 - Code TA

Trump Account Contributions

Box 12 - Code TP

Total Qualified Tips

Box 12 - Code TT

Total Qualified Overtime

Box 14a: Other

Union dues, health premiums, etc.

Box 14b: Treasury Tipped Code

IRS-assigned occupation code for tipped workers

State

State Wages

State Income Tax

Locality

Local Wages

Local Income Tax

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