Attention:

You may file Forms W-2 and W-3 electronically on the SSA’s Employer W-2
Filing Instructions and Information web page, which is also accessible at
www.socialsecurity.gov/employer. You can create fill-in versions of Forms
W-2 and W-3 for filing with SSA. You may also print out copies for filing with
state or local governments, distribution to your employees, and for your
records.
Note: Copy A of this form is provided for informational purposes only. Copy A appears in red,
similar to the official IRS form. The official printed version of this IRS form is scannable, but
the online version of it, printed from this website, is not. Do not print and file Copy A
downloaded from this website with the SSA; a penalty may be imposed for filing forms that
can’t be scanned. See the penalties section in the current General Instructions for Forms W-
2 and W-3, available at www.irs.gov/w2, for more information.
Please note that Copy B and other copies of this form, which appear in black, may be
downloaded, filled in, and printed and used to satisfy the requirement to provide the
information to the recipient.
To order official IRS information returns such as Forms W-2 and W-3, which include a
scannable Copy A for filing, go to IRS’ Online Ordering for Information Returns and
Employer Returns page, or visit www.irs.gov/orderforms and click on Employer and
Information returns. We’ll mail you the scannable forms and any other products you order.
See IRS Publications 1141, 1167, and 1179 for more information about printing these tax
forms.
 22222 VOID a Employee’s social security For Official Use Only ▶ OMB
number No. 1545-0008

b Employer identification number (EIN) 1 Wages, tips, other 2 VI income tax withheld
compensation

c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld

5 Medicare wages and tips 6 Medicare tax withheld

7 Social security tips 8

d Control number 9 1
0

e Employee’s first name and Last name Suff 11 Nonqualified plans 12a See instructions for
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initial . o
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f Employee’s address and ZIP code 13 Statutory employeeRetirement plan Third-party 12b
sick pay C
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14 Other 12c
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W-2VI U.S. Virgin Islands 2022 Department of the Treasury—Internal Revenue Service

Form
Wage and Tax Statement For Privacy Act and Paperwork Reduction Act
Notice, see the separate instructions.
Copy A—For Social Security Administration. Send this entire page with Copy A of
Form W-3SS to the Social Security Administration; photocopies are not acceptable. Cat. No. 49977C
 Do Not Cut, Fold, or Staple Forms on This Page
a Employee’s social security number
22222 VOID
OMB No. 1545-0008
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 VI income tax withheld

c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld

5 Medicare wages and tips 6 Medicare tax withheld

7 Social security tips 8

d Control number 9 10

e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a
C
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13 Statutory employeeRetirement plan Third-party 12b

sick pay C
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14 Other 12c
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f Employee’s address and ZIP code d
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12d
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W-2VI U.S. Virgin Islands 2022 Department of the Treasury—Internal Revenue Service

Form Wage and Tax Statement

Copy 1—For VI Bureau of Internal Revenue
 a Employee’s social security number
OMB No. 1545-0008
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 VI income tax withheld

c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld

5 Medicare wages and tips 6 Medicare tax withheld

7 Social security tips 8

d Control number 9 10

e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a See instructions for box
C
o
12
d
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13 Statutory employeeRetirement plan Third-party 12b

sick pay C
o
d
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14 Other 12c
C
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f Employee’s address and ZIP code d
e

12d
C
o
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W-2VI U.S. Virgin Islands

Form Wage and Tax Statement
Copy B—To Be Filed With Employee’s VI Tax Return

2022 Department of the Treasury—Internal Revenue Service

This information is being furnished to the

V.I. Bureau of Internal Revenue.
Notice to Employee
Do you have to file? Refer to the Form 1040 instructions to determine if you are
required to file a tax return. Even if you don’t have to file a tax return, you may be
eligible for a refund if box 2 shows an amount or if you are eligible for any credit.
Copies B and C; corrections. File Copy B of this form with your 2022 U.S. Virgin
Islands income tax return. Keep Copy C for your records. If your name, social
security number (SSN), or address is incorrect, correct Copies B and C and ask
your employer to correct your employment record. Be sure to ask your employer to
file Form W-2c, Corrected Wage and Tax Statement, with the Social Security
Administration (SSA) to correct any name, amount, or SSN error reported to the
SSA. Be sure to get your copies of Form W-2c from your employer for all
corrections made so you may file them with your tax return.
Estimated tax. If you expect to owe $1,000 or more in tax for 2023, you may have
to make estimated tax payments to your local territory tax department. You may
also have to make estimated tax payments to the U.S. Internal Revenue Service if
you are subject to self-employment taxes. See Pub. 570, Tax Guide for Individuals
With Income From U.S. Possessions, for additional information.
Employee’s social security number (SSN). For your protection, this form may
show only the last four digits of your SSN. However, your employer has reported
your complete SSN to the V.I. Bureau of Internal Revenue and the SSA.
Clergy and religious workers. If you aren’t subject to social security and Medicare
taxes, see Pub. 517, Social Security and Other Information for Members of the
Clergy and Religious Workers.
Cost of employer-sponsored health coverage (if such cost is provided by the
employer). The reporting in box 12, using code DD, of the cost of
employersponsored health coverage is for your information only. The amount
reported with code DD is not taxable.
Credit for excess social security tax. If one employer paid you wages during
2022 and more than $9,114 in social security tax was withheld, you can claim a
refund of the excess by filing Form 1040 or 1040-SR with the V.I. Bureau of Internal
Revenue, 6115 Estate Smith Bay, Suite 225, St. Thomas, VI 00802.
If you had more than one employer in 2022 and more than $9,114 in social
security tax was withheld, you can have the excess refunded by filing Form 843,
Claim for Refund and Request for Abatement, with the Department of the Treasury,
Internal Revenue Service Center, Austin, TX 73301-0215, USA. However, if you are
required to file Form 1040 or 1040-SR with the United States, you must claim the
excess tax as a credit on Form 1040 or 1040-SR.
Unreported tip income. You must file Form 4137, Social Security and Medicare
Tax on Unreported Tip Income, with your income tax return to figure the social
security and Medicare tax owed on tips you didn’t report to your employer. Enter
this amount on the wages line of your tax return. (Form 1040-SS filers, see the
instructions for Form 1040-SS, Part I, line 6.) By filing this form, your social security
tips will be credited to your social security record (used to figure your benefits).
(See also the Instructions for Employee on this page and the back of Copy C.)

Instructions for Employee

(See also Notice to Employee on this page.)
Box 5. You may be required to report this amount on Form 8959, Additional
Medicare Tax. See the Form 1040 instructions to determine if you are required to
complete Form 8959.
Box 6. This amount includes the 1.45% Medicare Tax withheld on all Medicare
wages and tips shown in box 5, as well as the 0.9% Additional Medicare Tax on
any of those Medicare wages and tips above $200,000.
Box 11. This amount is (a) reported in box 1 if it is a distribution made to you from a
nonqualified deferred compensation or nongovernmental section 457(b) plan, or (b)
included in box 3 and/or box 5 if it is a prior year deferral under a nonqualified or
section 457(b) plan that became taxable for social security and Medicare taxes this
year because there is no longer a substantial risk of forfeiture of your right to the
deferred amount. This box shouldn’t be used if you had a deferral and a distribution
in the same calendar year. If you made a deferral and received a distribution in the
same calendar year, and you are or will be age 62 by the end of the calendar year,
your employer should file Form SSA-131, Employer Report of Special Wage
Payments, with the Social Security Administration and give you a copy.
Box 12. The following list explains the codes shown in box 12. You may need this
information to complete your tax return. Elective deferrals (codes D, E, F, and S)
and designated Roth contributions (codes AA, BB, and EE) under all plans are
generally limited to a total of $20,500 ($14,000 if you have only SIMPLE plans;
$23,500 for section 403(b) plans if you qualify for the 15-year rule explained in Pub.
571). Deferrals under code G are limited to $20,500. Deferrals under code H are
limited to $7,000.
(continued on back of Copy C)
 a Employee’s social security number
OMB No. 1545-0008
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 VI income tax withheld

c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld

5 Medicare wages and tips 6 Medicare tax withheld

7 Social security tips 8

d Control number 9 10

e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a See instructions for box 12
C
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d
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13 Statutory employeeRetirement plan Third-party 12b

sick pay C
o
d
e

14 Other 12c
C
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f Employee’s address and ZIP code d
e

12d
C
o
d
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W-2VI U.S. Virgin Islands

Form Wage and Tax Statement
Copy C—For EMPLOYEE’S RECORDS
(See Notice to Employee on the back of Copy B.)

2022 Department of the Treasury—Internal Revenue Service

This information is being furnished to the

V.I. Bureau of Internal Revenue.
 Note: Keep Copy C of Form W-2VI for at least 3 years after the due date for filing
Instructions for Employee (continued from back of your income tax return. However, to help protect your social security benefits,
Copy B) keep Copy C until you begin receiving social security benefits just in case there is a
question about your work record and/or earnings in a particular year.
Box 12 (continued)
However, if you were at least age 50 in 2022, your employer may have allowed
an additional deferral of up to $6,500 ($3,000 for section 401(k)(11) and 408(p)
SIMPLE plans). This additional deferral amount is not subject to the overall limit on
elective deferrals. For code G, the limit on elective deferrals may be higher for the
last 3 years before you reach retirement age. Contact your plan administrator for
more information. Amounts in excess of the overall elective deferral limit must be
included in income. See the “Wages, Salaries, Tips, etc.” line instructions for your
tax return.
Note: If a year follows code D through H, S, Y, AA, BB, or EE, you made a make-
up pension contribution for a prior year(s) when you were in military service. To
figure whether you made excess deferrals, consider these amounts for the year
shown, not the current year. If no year is shown, the contributions are for the
current year.
A—Uncollected social security tax on tips. Report on U.S. Form 1040 or 1040-SR.
Report on Form 1040-SS if not required to file Form 1040 or 1040-SR.
B—Uncollected Medicare tax on tips. Report on U.S. Form 1040 or 1040-SR.
Report on Form 1040-SS if not required to file Form 1040 or 1040-SR. C—
Taxable cost of group-term life insurance over $50,000 (included in boxes 1, 3 (up
to the social security wage base), and 5)
D—Elective deferrals to a section 401(k) cash or deferred arrangement. Also
includes deferrals under a SIMPLE retirement account that is part of a section
401(k) arrangement.
E—Elective deferrals under a section 403(b) salary reduction agreement
F—Elective deferrals under a section 408(k)(6) salary reduction SEP G—Elective
deferrals and employer contributions (including nonelective deferrals) to a section
457(b) deferred compensation plan
H—Elective deferrals to a section 501(c)(18)(D) tax-exempt organization plan. (You
may be able to deduct.)
J—Nontaxable sick pay (information only, not included in box 1, 3, or 5) M—
Uncollected social security tax on taxable cost of group-term life insurance over
$50,000 (former employees only). Report on U.S. Form 1040 or 1040-SR. Report
on Form 1040-SS if not required to file Form 1040 or 1040-SR.
N—Uncollected Medicare tax on taxable cost of group-term life insurance over
$50,000 (former employees only). Report on U.S. Form 1040 or 1040-SR. Report
on Form 1040-SS if not required to file Form 1040 or 1040-SR.
P—Excludable moving expense reimbursements paid directly to a member of the
U.S. Armed Forces (not included in box 1, 3, or 5)
Q—Nontaxable combat pay. See your tax return instructions for details on reporting
this amount.
R—Employer contributions to your Archer MSA. Report on Form 8853, Archer
MSAs and Long-Term Care Insurance Contracts.
S—Employee salary reduction contributions under a section 408(p) SIMPLE plan
(not included in box 1)
T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified
Adoption Expenses, to figure taxable and nontaxable amounts.
V—Income from exercise of nonstatutory stock option(s) (included in boxes 1, 3 (up
to the social security wage base), and 5). See Pub. 525, Taxable and Nontaxable
Income, for reporting requirements.
W—Employer contributions (including amounts the employee elected to contribute
using a section 125 (cafeteria) plan) to your health savings account (HSA). Report
on Form 8889, Health Savings Accounts (HSAs).
Y—Deferrals under a section 409A nonqualified deferred compensation plan Z—
Income under a nonqualified deferred compensation plan that fails to satisfy section
409A. This amount is also included in box 1. It is subject to an additional 20% tax
plus interest. See “Other Taxes” in the instructions for your tax return.
AA—Designated Roth contributions under a section 401(k) plan
BB—Designated Roth contributions under a section 403(b) plan DD—Cost of
employer-sponsored health coverage. The amount reported with code DD is
not taxable.
EE—Designated Roth contributions under a governmental section 457(b) plan. This
amount does not apply to contributions under a tax-exempt organization section
457(b) plan.
FF—Permitted benefits under a qualified small employer health reimbursement
arrangement
GG—Income from qualified equity grants under section 83(i) HH—Aggregate
deferrals under section 83(i) elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked, special limits may apply to the
amount of traditional IRA contributions that you may deduct. See Pub. 590-A,
Contributions to Individual Retirement Arrangements (IRAs).
 a Employee’s social security number
VOID
OMB No. 1545-0008
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 VI income tax withheld

c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld

5 Medicare wages and tips 6 Medicare tax withheld

7 Social security tips 8

d Control number 9 10

e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a See instructions for box 12
C
o
d
e

13 Statutory employeeRetirement plan Third-party 12b

sick pay C
o
d
e

14 Other 12c
C
o
f Employee’s address and ZIP code d
e

12d
C
o
d
e

W-2VI U.S. Virgin Islands

Form Wage and Tax Statement
Copy D—For Employer

2022 Department of the Treasury—Internal Revenue Service

This information is being furnished to the

V.I. Bureau of Internal Revenue.
Employers, Please Note—
Specific information needed to complete Form W-2VI is
available in a separate booklet titled the 2022 General
Instructions for Forms W-2 and W-3. Also, see Pub. 80, Federal
Tax Guide for Employers in the U.S. Virgin Islands, Guam,
American Samoa, and the Commonwealth of the Northern
Mariana Islands, for employment-related information for
employers with territory employees. You can order these
instructions and additional forms at www.irs.gov/OrderForms.
Caution: Do not send the SSA any Forms W-2VI and W-3SS
that you have printed from IRS.gov. The SSA is unable to
process these forms. Instead, you can create and submit them
online. See E-filing, later.
Due dates. By January 31, 2023, furnish Copies B and C to
each person who was your employee during 2022. Mail or
electronically file Copy A of Form(s) W-2VI and W-3SS with the
SSA by January 31, 2023. See the separate instructions.
Need help? If you have questions about reporting on Form W-
2VI, call the information reporting customer service site toll free
at 866-455-7438 or 304-263-8700 (not toll free). For TTY/ TDD
equipment for persons who are deaf, hard of hearing, or have a
speech disability, call 304-579-4827 (not toll free).
E-filing. See the 2022 General Instructions for Forms W-2 and
W-3 for information on when you’re required to file
electronically. Even if you aren’t required to file electronically,
doing so can save you time and effort. Employers may now use
the SSA’s W-2 Online service to create, save, print, and submit
up to 50 Form(s) W-2VI at a time over the Internet. When you e-
file with the SSA, no separate Form W-3SS filing is required. An
electronic Form W-3SS will be created for you by the W-2
Online service. For information, visit the SSA’s Employer W-2
Filing Instructions & Information website at www.SSA.gov/
employer or contact your Employer Services Liaison Officer
(ESLO) at 212-264-3865 (not toll free) or
NY.RO.CDPS.ESLO@ssa.gov.
Future developments. Information about any future
developments affecting Form W-2VI and its instructions (such
as legislation enacted after we release them) will be posted at
www.irs.gov/FormW2VI.