REV-1667R - W-2 Transmittal
DATE DAyTIME TElEPhOnE # EXT. TITlE SIGnATuRE
( )
REV-1667 R AS (10-15)
Part III fOR MEDIA REPORTInG
NUMBER OF CDs
BuSInESS nAME AnD ADDRESS
LEGAL NAME
TRADE NAME
ADDRESS
CITY, STATE, ZIP
DO nOT SEnD PAyMEnT WITh ThIS fORM.
Attach adding machine tape(s) or some acceptable listing
of tax withheld as reported on accompanying W-2 form(s)
to substantiate reported PA withholding.This tape or listing
applies only to paper W-2s, not media reporting.
✁
DETACh hERE BEfORE MAIlInG
PlEASE READ ThE InSTRuCTIOnS BEfORE COMPlETInG ThIS COuPOn.
InSTRuCTIOnS fOR ThE W-2 TRAnSMITTAl (REV-1667R)
A W-2 Transmittal (REV-1667) along with an individual Wage
and Tax Statement (W-2/1099-R) for each employee, must
be submitted annually on or before Jan. 31 following the year
in which wages were paid. Each employer submitting W-2
Wage and Tax Statements in paper form must attach adding
machine tapes, or some acceptable listing, to substantiate the
income tax withheld in the calendar year.
Electronic Reporting. Employers can file year-end employee
W-2 Wage and Tax Statements and W-2 Transmittals (REV-
1667) online through the e-TIDES business tax filing website.
Employers can also upload computer files containing W-2 data
to e-TIDES, eliminating the need to enter the data. Visit e-
TIDES at www.etides.state.pa.us for more information.
To Complete the W-2 Transmittal:
● Complete the following required fields: calendar year, Em-
ployer Account ID and Entity ID (federal EIN) in the
blocks at the top of the W-2 Transmittal. Enter the busi-
ness name and address in the area provided.
● Sign, date and include a daytime telephone number and
title on the W-2 Transmittal, which must accompany the
materials submitted.
Part I. W-2 Reconciliation
Line 1a. Enter the number of W-2 forms attached.
Line 1b. Enter the number of 1099 forms with PA
withholding.
Line 2. Enter the total compensation subject to PA withhold-
ing.
Line 3. Enter the total amount of PA personal income
tax withheld.
Part II. Annual Reconciliation
Enter the amount of wages subject to PA withholding and the
amount of PA tax withheld for each quarter. Add the amounts
for the four quarters and enter the total.
Part III. MEDIA reporting
Each employer submitting W-2 information must provide
their business name, address and the number of CD’s sub-
mitted.
Mail the W-2 Transmittal with the accompaniments to:
PA Department of Revenue, PO BOX 280412, Harrisburg, PA
17128-0412.
Additional information on employer withholding requirements
can be found on our website at www.revenue.pa.gov.
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ENTITY ID (EIN)EMPLOYER ACCOUNT ID
YEAR
DuE DATE
JAnuARy 31
W-2 TRAnSMITTAl
1a
Part I W-2 RECOnCIlIATIOn
Number of W-2 forms attached
1b Number of 1099 forms with PA withholding
2
Total compensation subject
to PA withholding
3 PA INCOME TAX WITHHELD
Part II AnnuAl RECOnCIlIATIOn
Wages paid subject to PA withholding PA tax withheld
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
TOTAl
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