US Internal Revenue Service: fw2as--2001

8/14/2019 US Internal Revenue Service: fw2as--2001

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For Privacy Act and Paperwork ReductioNotice and instructions, see Form W

opy A For Social Security AdministrationSend this entireage with Copy A of Form W-3SS to the Social Securitydministration; photocopies are not acceptable.

Department of the TreasuryInternal Revenue S

Do Not Cut, Fold, or Staple Forms on This Page Do Not Cut, Fold, or Staple Forms on This Page

orm

Cat. No. 10140H

W-2ASAmerican SamoaWage and Tax Statement 2 00 1

1

Control number

Retirementplan

Third-partysick pay

Statutoryemployee

6

2

Employers name, address, and ZIP code

7 8

109

Wages, tips, other compensation Samoa income tax withheld

Social security tax withheldSocial security wages

12a11

43

Employer identification number

Medicare wages and tips

Social security tips

13

5

Employees social security number

Employees first name and initial Nonqualified plans

Medicare tax withheld

14 Other

Employees address and ZIP code

See Form W-3SS instructions

a

b

c

d

e

Void22222OMB No. 1545-0008

For Official Use Only

Last name

$

$

$

$

$

$

$

$

Code

12bCode

12cCode

$

$

$12dCode $


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opy 1For American Samoa Treasurer


orm W-2ASAmerican SamoaWage and Tax Statement 2001

1

Control number

Retirementplan

Third-partysick pay

Statutoryemployee

6

2


7 8

109



12a11

43




13

5




14 Other


a

b

c

d

e

Void22222OMB No. 1545-0008

Last nameCode

12bCode

12cCode

12dCode


4/12


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opy 1For American Samoa Treasurer



1

Control number

Retirementplan

Third-partysick pay

Statutoryemployee

6

2


7 8

109



12a11

43




13

5




14 Other


a

b

c

d

e

Void22222OMB No. 1545-0008

Last nameCode

12bCode

12cCode

12dCode


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opy BTo Be Filed With Employees American Samoa Tax Return



1

Control number

Retirementplan

Third-partysick pay

Statutoryemployee

6

2


7

Nonqualified plans

8

109



12a11

43




13

5


Employees first name and initial


14 Other


a

b

c

d

e

OMB No. 1545-0008

Last nameCode

12bCode

12cCode

12dCode

See instructions on back of Cop

This information is being furnished to thDepartment, American Samoa Govern


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opy CFor EMPLOYEES RECORDS



This information is being furnished to thDepartment, American Samoa Governm

1

Control number

Retirementplan

Third-partysick pay

Statutoryemployee

6

2


7 8

109



12a11

43




13

5




14 Other


a

b

c

d

e

OMB No. 1545-0008

Last nameCode

12bCode

12cCode

12dCode

See instructions on back


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Notice to Employeee Copy B of this form with your 2001 American Samoa income tax return.

eep Copy C for your records. If your name, social security number (SSN), orddress is incorrect, correct Copies B and C, and ask the employer to correctur employment record. Be sure to ask your employer to file Form W-2c,

orrected Wage and Tax Statement, with the Social Security AdministrationSA) to correct any name, amount, or SSN error reported to the SSA.

Credit for excess social security tax. If you had more than one employer i2001 and more than $4,984.80 in social security tax was withheld, you may the excess refunded by filing Form 843, Claim for Refund and Request forAbatement, with the Internal Revenue Service Center in Philadelphia. If you file Form 1040 with the United States, claim the excess tax as a credit on

Form 1040.

QMilitary employee basic housing, subsistence, and combat zonecompensation

Uncollected social security tax on tips

Uncollected Medicare tax on tips

Cost of group-term life insurance over $50,000 (included in boxes 1, 3 (up tocial security wage base), and 5)

Elective deferrals to a section 401(k) cash or deferred arrangement. Alsocludes deferrals under a SIMPLE retirement account that is part of a section01(k) arrangement.

JNontaxable sick pay (not included in boxes 1, 3, or 5)

MUncollected social security tax on cost of group-term life insurance over$50,000 (former employees only)

NUncollected Medicare tax on cost of group-term life insurance over $50,(former employees only)

ox 11. This amount is (a) reported in box 1 if it is a distribution from aonqualified deferred compensation or section 457 plan or (b) included in box 3nd/or 5 if it is a prior year deferral under a nonqualified or section 457 plan thatecame taxable for social security and Medicare taxes this year because there iso longer a substantial risk of forfeiture of your right to the deferred amount.

Elective deferrals under a section 403(b) salary reduction agreement

Elective deferrals under a section 408(k)(6) salary reduction SEP

Elective deferrals and employer contributions (including nonelective deferrals)a section 457(b) deferred compensation plan

Elective deferrals to a section 501(c)(18)(D) tax-exempt organization planou may be able to deduct.)

PExcludable moving expense reimbursements paid directly to employee (nincluded in boxes 1, 3, or 5)

Box 13. If the Retirement plan checkbox is marked, special limits may appthe amount of traditional IRA contributions you may deduct. Also, the electivdeferrals in box 12 (codes D, E, F, G, H, and S) (for all employers, and for allsuch plans to which you belong) are generally limited to $10,500. Electivedeferrals for section 403(b) contracts are limited to $10,500 ($13,500 in somcases; see Pub. 571). Section 457(b) plans are limited to $8,500. Amounts othese limits must be included in income.

ox 12. The following list explains any codes shown in box 12. You may needs information to complete your tax return.

REmployer contributions to your medical savings account (MSA)

SEmployee salary reduction contributions under a section 408(p) SIMPLE included in box 1)

TAdoption benefits (not included in box 1)

If you expect to owe self-employment tax of $1,000 or more for 2002, youay have to make estimated tax payments to the U.S. Internal Revenue Service.se Form 1040-ES, Estimated Tax for Individuals.

Note: Keep Copy C of Form W-2AS for at least 3 years after the due date fofiling your income tax return. However, to help protect your social securitybenefits, keep Copy C until you begin receiving social security benefits, just case there is a question about your work record and/or earnings in a particulyear. Review the information shown on your annual (for workers over 25) SocSecurity Statement.

VIncome from exercise of nonstatutory stock option(s) (included in boxes (up to social security wage base), and 5)


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opy DFor Employer



For Privacy Act and Paperwork Reduction Act Nand instructions, see Form W

1

Control number

Retirementplan

Third-partysick pay

Statutoryemployee

6

2


7 8

109



12a11

43




13

5




14 Other


a

b

c

d

e

VoidOMB No. 1545-0008

Last nameCode

12bCode

12cCode

12dCode

See Form W-3SS instructions


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nstructions forPreparing Form W-2AS

ote: A minimum income tax of 2% must be withheld on wagesnd other compensation.

Who must file. File Form W-2AS for each employee fromhom American Samoa income tax or U.S. social security andedicare taxes were withheld or required to be withheld during

001.

istribution of copies. By January 31, 2002, furnish Copies B

nd C to each person who was your employee during 2001. Fornyone who stopped working for you before the end of 2001,ou may furnish Copies B and C to them any time aftermployment ends but by January 31. If the employee asks fororm W-2AS, furnish the completed copies within 30 days ofe request or within 30 days of the final wage payment,hichever is later. You may also file Copy A and

See Form W-3SS for more information on how tocomplete Form W-2AS.

When to file. By February 28, 2002, send Copy A of FormsW-2AS and W-3SS to the Social Security Administration.However, if you file electronically (not by magnetic media), thdue date is April 1, 2002. See Form W-3SS.

Note: If you terminate your business, see the rules onfurnishing and filing Forms W-2AS and W-3SS underTerminating a businessin the Form W-3SS instructions.

Reporting on magnetic media or electronically. If you mus

file 250 or more Forms W-2AS, you must file using magneticmedia or electronically. For information, contact your EmployService Liaison Officer (ESLO) at 510-970-8247.

Form W-3SS, Transmittal of Wage and Tax Statements, withthe Social Security Administration at the same time.

Documents

US Internal Revenue Service: fw2as--2001