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Employer Information

Box b — Employer EIN*

Format: XX-XXXXXXX

Box c — Employer Name*

Address*

City*

State*

ZIP*

Employee Information

Box a — SSN*

Format: XXX-XX-XXXX

Box d — Control Number

Optional

Box e — First Name & MI*

Last Name*

Box f — Address*

City*

State*

ZIP*

Wages & Tax Withholding

Box 1 — Wages, Tips, Other Comp*

Box 2 — Federal Income Tax Withheld*

Box 3 — Social Security Wages

Box 4 — SS Tax Withheld

Auto: $0.00 (6.2% of Box 3)

Box 5 — Medicare Wages and Tips

Box 6 — Medicare Tax Withheld

Auto: $0.00 (1.45% of Box 5)

Box 7 — Social Security Tips

Optional

Box 8 — Allocated Tips

Optional

Box 10 — Dependent Care Benefits

Optional

Box 11 — Nonqualified Plans

Optional

Box 12 — Coded Deductions

Box 13 — Checkboxes

Statutory EmployeeRetirement PlanThird-Party Sick Pay

Box 14 — Other

State & Local Tax (Boxes 15–20)

Filing Information

Tax Year*

W-2 Copy Type

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W-2 Wage and Tax Statement

2026 • Copy B

PayStubVault

b Employer's EIN

a Employee's SSN

c Employer's name, address

Employer Name , ,

1 Wages, tips, other comp

$0.00

2 Federal income tax withheld

$0.00

d Control number

3 Social security wages

$0.00

4 Social security tax withheld

$0.00

e/f Employee's name, address

Employee Name , ,

5 Medicare wages and tips

$0.00

6 Medicare tax withheld

$0.00

7 Social security tips

$0.00

8 Allocated tips

$0.00

10 Dependent care benefits

$0.00

11 Nonqualified plans

$0.00

12a Code

12b Code

12c Code

12d Code

13 Checkboxes

☐ Statutory☐ Retirement☐ 3rd Party Sick

14 Other