IRS Form 8922 "Third-Party Sick Pay Recap"

What Is IRS Form 8922?

This is a tax form that was released by the Internal Revenue Service (IRS) - a subdivision of the U.S. Department of the Treasury. As of today, no separate filing guidelines for the form are provided by the IRS.

Form Details:

  • A 2-page form available for download in PDF;
  • Actual and valid for filing 2020 taxes;
  • Additional instructions and information can be found on page 1 of the document;
  • Editable, printable, and free;

Download a fillable version of IRS Form 8922 through the link below or browse more documents in our library of IRS Forms.

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Download IRS Form 8922 "Third-Party Sick Pay Recap"

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CORRECTED
8888
FILER’S name, street address, city or town, province or state, country, ZIP
Filer is an (check one):
OMB No. 1545-0123
Third-Party
or foreign postal code, and telephone no.
2019
Employer
Sick Pay
Recap
Insurer/Agent
8922
Form
FILER’S employer identification number
1 Sick pay subject to federal
2 Federal income tax withheld
OTHER PARTY’S name (see instructions before entering)
income tax
from sick pay
$
$
3 Sick pay subject to social
4 Social security tax withheld
security tax
from sick pay
$
$
OTHER PARTY’S employer identification number (see instructions before
5 Sick pay subject to
6 Medicare tax withheld from
entering)
Medicare tax
sick pay
$
$
Instructions for Form 8922
If your principal place of business is outside the United States, file
with the Internal Revenue Service, IRS SSA CAWR, Philadelphia, PA
Section references are to the Internal Revenue Code unless otherwise
19255-0533.
noted.
Private delivery services. Private delivery services can’t deliver to the
Future Developments
addresses shown above. If you choose to use a private delivery
For the latest information about developments related to Form 8922
service, send Form 8922 to the address shown below based on the
and its instructions, such as legislation enacted after they were
location of your principal business, office, or agency.
published, go to www.irs.gov/Form8922.
Internal Revenue Service
Mail Stop 4-G08 151
General Instructions
2970 Market St
Don’t send this form to the Social Security Administration.
Philadelphia, PA 19104
!
This form is processed solely by the IRS for third-party sick
Internal Revenue Service
pay reporting.
5333 Getwell Rd Stop 814 D6
CAUTION
Memphis, TN 38118
Go to www.irs.gov/PDS for the current list of designated services.
Purpose of Form
Form 8922 is filed to reconcile employment tax returns (for example,
Substitute Forms
Form 941) with Forms W-2 when third-party sick pay is paid. For more
The IRS accepts quality substitute tax forms that are consistent with
information, see Sick Pay Reporting in Pub. 15-A.
the official forms and have no adverse impact on our processing. The
Who Must File
official Form 8922 is the standard for substitute forms. Because a
substitute form is a variation from the official form, you should know
Generally, if the liability for the employer’s share of social security tax
the requirements of the official form for the year of use before you
and Medicare tax is reported on the employer’s employment tax
create a substitute version. For details on the requirements for
return, Form 8922 must be filed by:
substitute forms, see Pub. 1167.
• The employer, if sick pay is reported on Forms W-2 under the name
and EIN of the insurer or agent.
Specific Instructions
• The insurer or agent, if sick pay is reported on Forms W-2 under the
Check box for employer or insurer/agent. Check the appropriate
name and EIN of the employer.
box to state whether you’re the employer or the insurer/agent filing
For more information on who must file Form 8922, see Pub. 15-A.
Form 8922.
When To File
Filer’s name. If the Employer box is checked, the employer for whom
the sick pay was paid by the insurer or agent will complete the
File Form 8922 by March 2, 2020.
information with the employer’s name, address, and phone number.
Where To File
If the Insurer/Agent box is checked, the insurer or agent who paid
Send Form 8922 to the following:
the sick pay will complete the information with the insurer/agent’s
name, address, and phone number.
If your principal business, office,
Use the following
or agency is located in
address
Filer’s EIN. If the Employer box is checked, enter the EIN of the
employer.
If the Insurer/Agent box is checked, enter the EIN of the insurer or
Alabama, Alaska, Arizona, Arkansas,
Internal Revenue Service
agent.
Colorado, Florida, Georgia, Hawaii,
Memphis Service Center
Kansas, Louisiana, Mississippi, Missouri,
Other party’s name and EIN. If the Employer box is checked, the
P.O. Box 87 Mail Stop 814D6
Nevada, New Mexico, Oklahoma,
employer must provide the name and EIN of the insurer or agent. If the
Memphis, TN 38101-0087
Tennessee, Texas, Utah, Washington
employer has contracts with more than one insurer or agent, the
employer must file a separate Form 8922 for the wages and taxes
California, Connecticut, Delaware, District
related to each contract.
of Columbia, Idaho, Illinois, Indiana, Iowa,
Kentucky, Maine, Maryland,
If the Insurer/Agent box is checked, the insurer or agent may, but
Massachusetts, Michigan, Minnesota,
Internal Revenue Service
isn’t required to, provide the name and EIN of the employer. If it is
Montana, Nebraska, New Hampshire,
IRS SSA CAWR
providing this information, and if it has contracts with more than one
New Jersey, New York, North Carolina,
Philadelphia, PA 19255-0533
employer, it must file a separate Form 8922 for the wages and taxes
North Dakota, Ohio, Oregon,
related to each employer. Alternatively, it may file a separate Form
Pennsylvania, Rhode Island, South
8922 for the wages and taxes related to each employer for which it is
Carolina, South Dakota, Vermont, Virginia,
West Virginia, Wisconsin, Wyoming
8922
Form
Cat. No. 37734T
www.irs.gov/Form8922
Department of the Treasury - Internal Revenue Service
CORRECTED
8888
FILER’S name, street address, city or town, province or state, country, ZIP
Filer is an (check one):
OMB No. 1545-0123
Third-Party
or foreign postal code, and telephone no.
2019
Employer
Sick Pay
Recap
Insurer/Agent
8922
Form
FILER’S employer identification number
1 Sick pay subject to federal
2 Federal income tax withheld
OTHER PARTY’S name (see instructions before entering)
income tax
from sick pay
$
$
3 Sick pay subject to social
4 Social security tax withheld
security tax
from sick pay
$
$
OTHER PARTY’S employer identification number (see instructions before
5 Sick pay subject to
6 Medicare tax withheld from
entering)
Medicare tax
sick pay
$
$
Instructions for Form 8922
If your principal place of business is outside the United States, file
with the Internal Revenue Service, IRS SSA CAWR, Philadelphia, PA
Section references are to the Internal Revenue Code unless otherwise
19255-0533.
noted.
Private delivery services. Private delivery services can’t deliver to the
Future Developments
addresses shown above. If you choose to use a private delivery
For the latest information about developments related to Form 8922
service, send Form 8922 to the address shown below based on the
and its instructions, such as legislation enacted after they were
location of your principal business, office, or agency.
published, go to www.irs.gov/Form8922.
Internal Revenue Service
Mail Stop 4-G08 151
General Instructions
2970 Market St
Don’t send this form to the Social Security Administration.
Philadelphia, PA 19104
!
This form is processed solely by the IRS for third-party sick
Internal Revenue Service
pay reporting.
5333 Getwell Rd Stop 814 D6
CAUTION
Memphis, TN 38118
Go to www.irs.gov/PDS for the current list of designated services.
Purpose of Form
Form 8922 is filed to reconcile employment tax returns (for example,
Substitute Forms
Form 941) with Forms W-2 when third-party sick pay is paid. For more
The IRS accepts quality substitute tax forms that are consistent with
information, see Sick Pay Reporting in Pub. 15-A.
the official forms and have no adverse impact on our processing. The
Who Must File
official Form 8922 is the standard for substitute forms. Because a
substitute form is a variation from the official form, you should know
Generally, if the liability for the employer’s share of social security tax
the requirements of the official form for the year of use before you
and Medicare tax is reported on the employer’s employment tax
create a substitute version. For details on the requirements for
return, Form 8922 must be filed by:
substitute forms, see Pub. 1167.
• The employer, if sick pay is reported on Forms W-2 under the name
and EIN of the insurer or agent.
Specific Instructions
• The insurer or agent, if sick pay is reported on Forms W-2 under the
Check box for employer or insurer/agent. Check the appropriate
name and EIN of the employer.
box to state whether you’re the employer or the insurer/agent filing
For more information on who must file Form 8922, see Pub. 15-A.
Form 8922.
When To File
Filer’s name. If the Employer box is checked, the employer for whom
the sick pay was paid by the insurer or agent will complete the
File Form 8922 by March 2, 2020.
information with the employer’s name, address, and phone number.
Where To File
If the Insurer/Agent box is checked, the insurer or agent who paid
Send Form 8922 to the following:
the sick pay will complete the information with the insurer/agent’s
name, address, and phone number.
If your principal business, office,
Use the following
or agency is located in
address
Filer’s EIN. If the Employer box is checked, enter the EIN of the
employer.
If the Insurer/Agent box is checked, enter the EIN of the insurer or
Alabama, Alaska, Arizona, Arkansas,
Internal Revenue Service
agent.
Colorado, Florida, Georgia, Hawaii,
Memphis Service Center
Kansas, Louisiana, Mississippi, Missouri,
Other party’s name and EIN. If the Employer box is checked, the
P.O. Box 87 Mail Stop 814D6
Nevada, New Mexico, Oklahoma,
employer must provide the name and EIN of the insurer or agent. If the
Memphis, TN 38101-0087
Tennessee, Texas, Utah, Washington
employer has contracts with more than one insurer or agent, the
employer must file a separate Form 8922 for the wages and taxes
California, Connecticut, Delaware, District
related to each contract.
of Columbia, Idaho, Illinois, Indiana, Iowa,
Kentucky, Maine, Maryland,
If the Insurer/Agent box is checked, the insurer or agent may, but
Massachusetts, Michigan, Minnesota,
Internal Revenue Service
isn’t required to, provide the name and EIN of the employer. If it is
Montana, Nebraska, New Hampshire,
IRS SSA CAWR
providing this information, and if it has contracts with more than one
New Jersey, New York, North Carolina,
Philadelphia, PA 19255-0533
employer, it must file a separate Form 8922 for the wages and taxes
North Dakota, Ohio, Oregon,
related to each employer. Alternatively, it may file a separate Form
Pennsylvania, Rhode Island, South
8922 for the wages and taxes related to each employer for which it is
Carolina, South Dakota, Vermont, Virginia,
West Virginia, Wisconsin, Wyoming
8922
Form
Cat. No. 37734T
www.irs.gov/Form8922
Department of the Treasury - Internal Revenue Service
2
Form 8922 (2019)
Page
supplying the name and EIN, and then file one Form 8922 for the
Generally, tax returns and return information are confidential, as
wages and taxes related to the employers for which it isn’t supplying
required by section 6103. However, section 6103 allows or requires
the name and EIN.
the Internal Revenue Service to disclose or give the information shown
on your return to others as described in the Code. For example, we
Box 1. Enter the total amount of sick pay subject to federal income
may disclose your tax information to the Department of Justice for
tax.
civil and/or criminal litigation, and to cities, states, the District of
Box 2. Enter the total amount of federal income tax withheld from the
Columbia, and U.S. commonwealths and possessions for use in
sick pay.
administering their tax laws. We may also disclose this information to
Box 3. Enter the total amount of sick pay subject to social security
other countries under a tax treaty, to federal and state agencies to
tax.
enforce federal nontax criminal laws, or to federal law enforcement
Box 4. Enter the total amount of social security tax withheld from the
and intelligence agencies to combat terrorism.
sick pay.
You’re not required to provide the information requested on a form
Box 5. Enter the total amount of sick pay subject to Medicare tax.
that is subject to the Paperwork Reduction Act unless the form
Box 6. Enter the total amount of the Medicare tax (including Additional
displays a valid OMB control number. Books or records relating to a
Medicare Tax) withheld from the sick pay.
form or its instructions must be retained as long as their contents may
Corrected Form 8922. If you filed Form 8922 with the IRS and later
become material in the administration of any Internal Revenue law.
discover that you made an error on it, you must correct it as soon as
The time needed to complete and file this form will vary depending
possible. Complete all entries on Form 8922 when making a
on individual circumstances. The estimated burden for business
correction. Enter an “X” in the “CORRECTED” checkbox only when
taxpayers filing this form is approved under OMB control number
correcting a Form 8922 previously filed with the IRS.
1545-0123 and is included in the estimates shown in the instructions
Recordkeeping. Keep all records of employment taxes for at least 4
for their business income tax return.
years. These should be available for IRS review.
If you have comments concerning the accuracy of these time
estimates or suggestions for making Form 8922 simpler, we would be
Privacy Act and Paperwork Reduction Act Notice. We ask for the
happy to hear from you. You can send us comments from
information on this form to carry out the Internal Revenue laws of the
www.irs.gov/FormComments. Or you can send your comments to
United States. We need it to figure and collect the right amount of tax.
Internal Revenue Service, Tax Forms and Publications Division, 1111
Section 6051 and its regulations require you to furnish wage and tax
Constitution Ave. NW, IR-6526, Washington, DC 20224. Don’t send
statements to employees, the Social Security Administration, and the
Form 8922 to this address. Instead, see Where To File, earlier.
Internal Revenue Service. Section 6109 requires you to provide your
identification number. Failure to provide this information in a timely
manner or providing false or fraudulent information may subject you to
penalties.
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