SSA-95-SmM- 2nd Request: -Employer Questionnaire- SSA has no record of employer report (current)

Date:

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SECOND REQUEST

EMPLOYER QUESTIONNAIRE

SSA HAS NO RECORD OF EMPLOYER REPORT

IRS records show that you paid taxes on the wages that appear below. However, SSA does not have a
record ofprocessing your Forms W·2 and W-3 for these wages. IRS requires you to send Forms W·2 to
SSA.

IRS Data (Forms, 941, 943, 944 or Schedule H) for Tax Year: YYYY
EIN: 99-9999999
Employer Name: Employer Name
Employee Soc. Security Wage Totals:
Employee Soc. Security Tip Totals:
Employee Medicare WagelTip Totals:

$999,999.00
$999,999.00
$999,999.00

CHECK AND COMPLETE
Check and complete any items that apply to your wage report for the tax year shown above. If you send a
wage report that shows a different total from the amount shown above, please explain why in number 6.

1. () I did not file Forms W-2 with SSA. I am now taking the following action (check one):
() Enclosing the original Copy A of Forms W-2 and W-3, or
() Sending SSA an electronic file.
2. () I filed Forms W-2 under the EIN shown above. I am now taking the following action for the wages I
previously reported (check one):
() Enclosing legible copies of Forms W-2 and W-3, or

() Sending SSA an electronic file.

3. () I filed Forms W -2 under EIN _ _ _---.J' rather than the EIN shown above. (Attach legible copies
of Forms W-2 and W-3.)

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4. () I filed but cannot locate my copies of Forms W-2 and W-3. (Attach an explanation of why you
cannot locate the records and a list of all names, total wage amounts and Social Security numbers
for your employees for the year shown above.)
5. () I was not required to file Forms W-2 with SSA, as I was self-employed. (Attach a legible copy of

Form 1099 or 1040 with a Schedule SE or Schedule C that shows SE tax.)

6.() Other ________________________________________________________

Your Name

(

)--=---~----~

Daytime Phone, with area code

INFORMATION ABOUT THE DATA YOU SEND SSA
The name, Social Security number and wage amounts on the Forms W-2 must be readable and complete. If
we cannot read all information on the documents you submit, or if any of these items are missing, we
cannot add the wages to the employee's wage record. If you need blank: copies of the Forms W-2 or W-3,
call IRS at 1-800-829-3676. If your copies of the Forms W-2 are illegible, please prepare duplicates on
blank: copies of the Forms W-2. Make sure the Forms W-2 show the year for which the wages are being
reported.
Note: If you send 250 or more wage items to us, you must file your wage reports electronically in
accordance with Publication 42-007: Specifications for Filing Forms W-2 Electronically (EFW2). To get
more information, go to our website at www.socialsecurity.gov/employer or call SSA's Employer
Reporting Branch at 1-800-772-6270 from 7:00 A.M. to 7:00 P.M., Eastern time, Monday through Friday.
RETURN THIS QUESTIONNAIRE
Please send all requested information to:
Social Security Administration, Metro West
P.O. Box 33021
Baltimore, Maryland 21290-3021

Do not send cash, checks or money orders to SSA. Tax payments are payable to the Internal Revenue
Service.

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