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                                  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  , and1179 for more information about printing these tax 
forms.



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                                     a  Employee’s social security number
     22222          VOID                                                 For Official Use Only  
                                                                         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                12aCdoe See instructions for box 12
                                                                                      13  Statutory Retirement  Third-party  
                                                                                          employee  plan        sick pay
                                                                                                                             12bCdoe
                                                                                      14  Other
                                                                                                                             12cCdoe
                                                                                                                             12dCo 
f  Employee’s address and ZIP code                                                                                           de

                          U.S. Virgin Islands                                                            Department of the Treasury—Internal Revenue Service
Form W-2VI                Wage and Tax Statement                         2022                                   For Privacy Act and Paperwork Reduction Act 
Copy A—For Social Security Administration. Send this entire page with Copy A of                                               Notice, see the separate instructions.
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 



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                                     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 Cdoe
                                                                                13  Statutory Retirement  Third-party  
                                                                                    employee  plan        sick pay
                                                                                                                       12bCdoe
                                                                                14  Other
                                                                                                                       12cCdoe
                                                                                                                       12dCo 
f  Employee’s address and ZIP code                                                                                     de

                          U.S. Virgin Islands                                                      Department of the Treasury—Internal Revenue Service
Form W-2VI                Wage and Tax Statement                         2022
Copy 1—For VI Bureau of Internal Revenue



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                                     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                12aCdoe   See instructions for box 12
                                                                                13  Statutory Retirement  Third-party  
                                                                                    employee  plan        sick pay
                                                                                                                       12bCdoe
                                                                                14  Other
                                                                                                                       12cCdoe
                                                                                                                       12dCo 
f  Employee’s address and ZIP code                                                                                     de

                          U.S. Virgin Islands                                                      Department of the Treasury—Internal Revenue Service 
Form W-2VI                Wage and Tax Statement                         2022                                     This information is being furnished to the 
Copy B—To Be Filed With Employee’s VI Tax Return                                                                               V.I. Bureau of Internal Revenue. 



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Notice to Employee                                                                     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 
Do you have to file? Refer to the Form 1040 instructions to determine if you are       security and Medicare tax owed on tips you didn’t report to your employer. Enter 
required to file a tax return. Even if you don’t have to file a tax return, you may be this amount on the wages line of your tax return. (Form 1040-SS filers, see the 
eligible for a refund if box 2 shows an amount or if you are eligible for any credit.  instructions for Form 1040-SS, Part I, line 6.) By filing this form, your social 
Copies B and C; corrections. File Copy B of this form with your 2022 U.S. Virgin       security tips will be credited to your social security record (used to figure your 
Islands income tax return. Keep Copy C for your records. If your name, social          benefits).  
security number (SSN), or address is incorrect, correct Copies B and C and ask         (See also the Instructions for Employee on this page and the back of Copy C.)
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         Instructions for Employee
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.                            (See also Notice to Employee on this page.)
Estimated tax. If you expect to owe $1,000 or more in tax for 2023, you may have       Box 5. You may be required to report this amount on Form 8959, Additional 
to make estimated tax payments to your local territory tax department. You may         Medicare Tax. See the Form 1040 instructions to determine if you are required to 
also have to make estimated tax payments to the U.S. Internal Revenue Service if       complete Form 8959.
you are subject to self-employment taxes. See Pub. 570, Tax Guide for Individuals      Box 6. This amount includes the 1.45% Medicare Tax withheld on all Medicare 
With Income From U.S. Possessions, for additional information.                         wages and tips shown in box 5, as well as the 0.9% Additional Medicare Tax on 
Employee’s social security number (SSN). For your protection, this form may            any of those Medicare wages and tips above $200,000. 
show only the last four digits of your SSN. However, your employer has reported        Box 11. This amount is (a) reported in box 1 if it is a distribution made to you from 
your complete SSN to the V.I. Bureau of Internal Revenue and the SSA.                  a nonqualified deferred compensation or nongovernmental section 457(b) plan, or 
Clergy and religious workers. If you aren’t subject to social security and             (b) included in box 3 and/or box 5 if it is a prior year deferral under a nonqualified 
Medicare taxes, see Pub. 517, Social Security and Other Information for Members        or section 457(b) plan that became taxable for social security and Medicare taxes 
of the Clergy and Religious Workers.                                                   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 
Cost of employer-sponsored health coverage (if such cost is provided by the            distribution in the same calendar year. If you made a deferral and received a 
employer). The reporting in box 12, using code DD, of the cost of employer-            distribution in the same calendar year, and you are or will be age 62 by the end of 
sponsored health coverage is for your information only. The amount reported            the calendar year, your employer should file Form SSA-131, Employer Report of 
with code DD is not taxable.                                                           Special Wage Payments, with the Social Security Administration and give you a 
Credit for excess social security tax. If one employer paid you wages during           copy.
2022 and more than $9,114 in social security tax was withheld, you can claim a         Box 12. The following list explains the codes shown in box 12. You may need this 
refund of the excess by filing Form 1040 or 1040-SR with the V.I. Bureau of            information to complete your tax return. Elective deferrals (codes D, E, F, and S) 
Internal Revenue, 6115 Estate Smith Bay, Suite 225, St. Thomas, VI 00802.              and designated Roth contributions (codes AA, BB, and EE) under all plans are 
If you had more than one employer in 2022 and more than $9,114 in social               generally limited to a total of $20,500 ($14,000 if you have only SIMPLE plans; 
security tax was withheld, you can have the excess refunded by filing Form 843,        $23,500 for section 403(b) plans if you qualify for the 15-year rule explained in 
Claim for Refund and Request for Abatement, with the Department of the                 Pub. 571). Deferrals under code G are limited to $20,500. Deferrals under code H 
Treasury, Internal Revenue Service Center, Austin, TX 73301-0215, USA. However,        are limited to $7,000. 
if you are required to file Form 1040 or 1040-SR with the United States, you must                                                 (continued on back of Copy C)
claim the excess tax as a credit on Form 1040 or 1040-SR. 



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                                     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                12aCdoe   See instructions for box 12
                                                                                13  Statutory Retirement  Third-party  
                                                                                    employee  plan        sick pay
                                                                                                                       12bCdoe
                                                                                14  Other
                                                                                                                       12cCdoe
                                                                                                                       12dCo 
f  Employee’s address and ZIP code                                                                                     de

                          U.S. Virgin Islands                                                      Department of the Treasury—Internal Revenue Service 
Form W-2VI                Wage and Tax Statement                         2022                                     This information is being furnished to the 
Copy C—For EMPLOYEE’S RECORDS                                                                                                  V.I. Bureau of Internal Revenue. 
(See Notice to Employee on the back of Copy B.)



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Instructions for Employee (continued from back of                                       Q—Nontaxable combat pay. See your tax return instructions for details on 
                                                                                        reporting this amount.
Copy B)                                                                                 R—Employer contributions to your Archer MSA. Report on Form 8853, Archer 
Box 12 (continued)                                                                      MSAs and Long-Term Care Insurance Contracts.
However, if you were at least age 50 in 2022, your employer may have allowed an         S—Employee salary reduction contributions under a section 408(p) SIMPLE plan 
additional deferral of up to $6,500 ($3,000 for section 401(k)(11) and 408(p) SIMPLE    (not included in box 1)
plans). This additional deferral amount is not subject to the overall limit on elective T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified 
deferrals. For code G, the limit on elective deferrals may be higher for the last 3     Adoption Expenses, to figure taxable and nontaxable amounts.
years before you reach retirement age. Contact your plan administrator for more         V—Income from exercise of nonstatutory stock option(s) (included in boxes 1, 3 
information. Amounts in excess of the overall elective deferral limit must be included  (up to the social security wage base), and 5). See Pub. 525, Taxable and 
in income. See the “Wages, Salaries, Tips, etc.” line instructions for your tax return. Nontaxable Income, for reporting requirements.
Note: If a year follows code D through H, S, Y, AA, BB, or EE, you made a make-up       W—Employer contributions (including amounts the employee elected to contribute 
pension contribution for a prior year(s) when you were in military service. To figure   using a section 125 (cafeteria) plan) to your health savings account (HSA). Report 
whether you made excess deferrals, consider these amounts for the year shown,           on Form 8889, Health Savings Accounts (HSAs).
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.         Y—Deferrals under a section 409A nonqualified deferred compensation plan
Report on Form 1040-SS if not required to file Form 1040 or 1040-SR.                    Z—Income under a nonqualified deferred compensation plan that fails to satisfy 
B—Uncollected Medicare tax on tips. Report on U.S. Form 1040 or 1040-SR.                section 409A. This amount is also included in box 1. It is subject to an additional 
Report on Form 1040-SS if not required to file Form 1040 or 1040-SR.                    20% tax plus interest. See “Other Taxes” in the instructions for your tax return.
C—Taxable cost of group-term life insurance over $50,000 (included in boxes 1, 3        AA—Designated Roth contributions under a section 401(k) plan
(up to the social security wage base), and 5)                                           BB—Designated Roth contributions under a section 403(b) plan
D—Elective deferrals to a section 401(k) cash or deferred arrangement. Also             DD—Cost of employer-sponsored health coverage.The amount reported with 
includes deferrals under a SIMPLE retirement account that is part of a section          code DD is not taxable.
401(k) arrangement.                                                                     EE—Designated Roth contributions under a governmental section 457(b) plan. 
E—Elective deferrals under a section 403(b) salary reduction agreement                  This amount does not apply to contributions under a tax-exempt organization 
F—Elective deferrals under a section 408(k)(6) salary reduction SEP                     section 457(b) plan.
G—Elective deferrals and employer contributions (including nonelective deferrals)       FF—Permitted benefits under a qualified small employer health reimbursement 
to a section 457(b) deferred compensation plan                                          arrangement
H—Elective deferrals to a section 501(c)(18)(D) tax-exempt organization plan. (You      GG—Income from qualified equity grants under section 83(i)
may be able to deduct.)                                                                 HH—Aggregate deferrals under section 83(i) elections as of the close of the 
J—Nontaxable sick pay (information only, not included in box 1, 3, or 5)                calendar year
M—Uncollected social security tax on taxable cost of group-term life insurance          Box 13. If the “Retirement plan” box is checked, special limits may apply to the 
over $50,000 (former employees only). Report on U.S. Form 1040 or 1040-SR.              amount of traditional IRA contributions that you may deduct. See Pub. 590-A, 
Report on Form 1040-SS if not required to file Form 1040 or 1040-SR.                    Contributions to Individual Retirement Arrangements (IRAs).
N—Uncollected Medicare tax on taxable cost of group-term life insurance over            Note: Keep Copy C of Form W-2VI for at least 3 years after the due date for filing 
$50,000 (former employees only). Report on U.S. Form 1040 or 1040-SR. Report            your income tax return. However, to help protect your social security benefits, 
on Form 1040-SS if not required to file Form 1040 or 1040-SR.                           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.  
P—Excludable moving expense reimbursements paid directly to a member of the 
U.S. Armed Forces (not included in box 1, 3, or 5)



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                                     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                12aCdoe   See instructions for box 12
                                                                                13  Statutory Retirement  Third-party  
                                                                                    employee  plan        sick pay
                                                                                                                       12bCdoe
                                                                                14  Other
                                                                                                                       12cCdoe
                                                                                                                       12dCo 
f  Employee’s address and ZIP code                                                                                     de

                          U.S. Virgin Islands                                                      Department of the Treasury—Internal Revenue Service 
Form W-2VI                Wage and Tax Statement                         2022                                     This information is being furnished to the 
Copy D—For Employer                                                                                                            V.I. Bureau of Internal Revenue. 



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






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