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This page is informational only. It is a copy of a letter/questionnaire
used in the Earnings Reconciliation Process. No action is needed by the
viewer.
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Social Security Administration
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RETIREMENT SURVIVORS AND DISABILITY INSURANCE
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Important Information, Immediate Reply Required
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SECOND REQUEST
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Date : MM/DD/YY
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EIN : 99-9999999
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COMPANY NAME
ADDRESS 1
ADDRESS 2
CITY, ST 99999-9999
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We informed you earlier that
the wage reports we have for your employees may not be correct. We asked you
for information to help us correct them, but we have not heard from you. It is
important that we receive this information promptly.
NOTE: Effective January, 2008 SSA will no longer accept magnetic media submissions. We encourage you to file your wage reports electronically,
using Business Services Online (BSO). Additional information on wage reporting can be obtained by accessing our employer reporting
website at: www.socialsecurity.gov/employer.
What We Found
The Form W-2 wage totals on our records and the wage totals on your
IRS Forms 941, 943, 944 or Schedule H do not match for the year shown
on the enclosed questionnaire. There may be several reasons why these
totals do not match. We may not have received all the Forms W-2 that
are due or you may have reported smaller W-2 wage amounts to us than
you reported to IRS.
What You Should Do
Please check your records to make sure you have correctly
reported your employees' wages or to see if there is any other reason
for the different wage totals. Then, fill out the enclosed questionnaire
and return it with the requested information within 45 days.
Enclosure(s): Return Envelope
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See Next Page |
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SSA-L-94-SM(11-07) |
999999999-04-MMDDYY FORM APPROVED OMB NO. 0960-0432
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About the Questionnaire |
Page 2 of 5 |
If the questionnaire shows only IRS wage totals,
it means we do not have copies of any Form W-2 wage reports for your
employees for that year. Otherwise, it shows that the Form W-2 wage
totals we have in our records are less than those on the Forms 941,
943, 944 or Schedule H returns you filed with IRS.
We've also enclosed a self-addressed envelope. If you cannot use the
envelope, please mail the completed questionnaire and requested information
only to:
Social Security Administration
Metro West
P.O. Box 33021
Baltimore, Maryland 21290-3021
We cannot correct your employees' wage records unless
you give us the information that we requested. This information is important
because it could affect your employees' rights to future Social Security
benefits and the amount of those benefits. Please make sure that the information
you give us will resolve the problem. You should keep your wage records
for the tax year in question for the next four years.
If We Do Not Receive This Information
If you do not send the requested information to correct
your employees’ wage records or contact us within 45 days, we
must refer this matter to IRS. If the IRS finds that you made a reporting
error, IRS may charge penalties of up to $100 per missing Form W-2 or
10 percent of the amount of income reported, whichever is greater.
If You Have Any Questions
If you have any questions,
please write to us at the above address or call us at 1-800-772-6270 between
7:00 A.M. and 7:00 P.M., Eastern time, Monday through Friday.
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Carolyn L. Simmons
Associate Commissioner for
Central Operations
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SSA-L-94-SM(11-07) |
999999999-04-MMDDYY FORM APPROVED OMB NO. 0960-0432
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Page 3 of 5 |
PRIVACY/PAPERWORK ACT NOTICE
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We are allowed to collect facts about your employees
under section 205(c)(2)(A) of the Social Security Act (42 U.S.C.) (405)(C)(2)(A).
Your help will allow us to properly credit the earnings records for
your employees. You do not have to give us these facts, but, if you
do not, we will refer your case to IRS.
We may also use the information you give us when
we match records by computer. Matching programs compare our records with
those of other Federal, State, or local government agencies. Many agencies
may use matching programs to find or prove that a person qualifies for
benefits paid by the Federal government. The law allows us to do this
even if you do not agree to it.
Explanations about these and other reasons why information
you provide us may be used or given out are available in Social Security
offices. If you want to learn more about this, contact any Social Security
office.
Paperwork Reduction Act Statement - This information
collection meets the requirements of 44 U.S.C. § 3507, as amended
by section 2 of the Paperwork Reduction Act of 1995. You do not need to
answer these questions unless we display a valid Office of Management
and Budget control number. We estimate that it will take about 30 minutes
to read the instructions, gather the facts, and answer the questions.
You may send comments on our time estimate above to: SSA, 6401 Security
Blvd, Baltimore, MD 21235-6401. Send only comments relating
to our time estimate to this address, not the completed form.
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SSA-L-94-SM(11-07) |
999999999-04-MMDDYY FORM APPROVED OMB NO. 0960-0432 Date : MM/DD/YYY
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Page 4 of 5 |
SECOND REQUEST
EMPLOYER QUESTIONNAIRE
SSA HAS NO RECORD OF EMPLOYER REPORT
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IRS records show that you paid taxes on the wages that appear below. However, SSA does not
have a record of processing 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 |
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EIN: 99-9999999 |
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Employer Name: Employer Name |
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Employee Soc. Security Wage Totals: |
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$999,999.00 |
Employee Soc. Security Tip Totals: |
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$999,999.00 |
Employee Medicare Wage/Tip Totals: |
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$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.
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SSA-L-95-SM(11-07) |
999999999-04-MMDDYY
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Page 5 of 5 |
4. |
![c"heck](templateimages/box.gif) |
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.)
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5. |
![c"heck](templateimages/box.gif) |
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.)
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6. |
![c"heck](templateimages/box.gif) |
Other ___________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
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___________________________________________ |
( ) ____________________ |
Your Name and Title |
Daytime Phone, with area code |
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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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SSA-L-95-SM(11-07) |
999999999-04-MMDDYY |
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