FORM W-2 CORRECTION WORKSHEET FOR 20 - New York …
AC 2674 (Rev. 6/17)
Agency Code Last Name
FORM W-2 CORRECTION WORKSHEET FOR 20_ _
Batch #
Separate Form Required for Each Employee
First Name, MI
NYS EMPLID
Wage Correction
Originally Reported
W-2
Corrected W-2
Difference (+ or -)
Gross Wage
Federal Tax
0.00
0.00
SS Wage
SS Tax
0.00
0.00
Med Wage
Med Tax
State Wage
State Tax
Local Wage
NYC / Yonkers Tax
0.00
0.00
0.00
0.00
0.00
0.00
Misc.
0.00
Name Correction
CHANGE TO: Last Name
First Name, MI
c Uncheck Retirement Checkbox c Check Retirement Checkbox
Reason: ___________________________________________________________________ ___________________________________________________________________
Reason Codes (check all that apply) c Salary Refunds (AC 230s processed after deadlines.) A copy of AC 230 is required. c Miscellaneous Codes:
UTA, EDA, PPL, CPA, FRB, IMP, TXP, EXP, 414H, WCX, IRC125, MNA, TPS For description of codes, refer to back of Form W-2 Statement. c SS/MED Refunds c Miscellaneous. Explanation required. ______________________________________ ____________________________________________________________________
Social Security Number Correction
CHANGE TO: Social Security Number
Special Notes: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________
Prepared by _________________________________ Date________________ Tele. # __(______)___________________ Fax # __(______)__________________ Email ____________________________________________________________
For OSC Use Only
Audited by___________________________________ Date________________
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