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similar to the official IRS form. Do not file copy A with the SSA. The official
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You may file Forms W-2 and W-3 electronically on the SSA’s website at
Employer Reporting Instructions & Information. You can create fill-in versions of
Forms W-2 and W-3 for filing with SSA. You may also print out copies for filing
with state or local governments, distribution to your employees, and for your
See IRS Publications 1141, 1167, 1179 and other IRS resources for information
about printing these tax forms.
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Notice, see the separate instructions.
Copy A For Social Security Administration—Send this entire page with Copy A of
Form W-3SS to the Social Security Administration; photocopies are not acceptable.
Department of the Treasury—Internal Revenue Service
Do Not Cut, Fold, or Staple Forms on This Page — Do Not Cut, Fold, or Staple Forms on This Page
Cat. No. 10140H
W-2AS American Samoa
Wage and Tax Statement 2 0
Employee’s social security number
Employer’s name, address, and ZIP code
Wages, tips, other compensation
Samoa income tax withheld
Social security tax withheld
Social security wages
Employer identification number (EIN)
Medicare wages and tips
Social security tips
Employee’s first name and initial
Medicare tax withheld
Employee’s address and ZIP code
See the separate instructions
OMB No. 1545-0008