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Currency [0]/Explanatory TextG5Explanatory Text %0 : Followed Hyperlink 1Good;Good  a%2 Heading 1G Heading 1 I}%O3 Heading 2G Heading 2 I}%?4 Heading 3G Heading 3 I}%235 Heading 49 Heading 4 I}%6( Hyperlink 7InputuInput ̙ ??v% 8 Linked CellK Linked Cell }% 9NeutralANeutral  e%"Normal :Noteb Note   ;OutputwOutput  ???%????????? ???<$Percent =Title1Title I}% >TotalMTotal %OO? Warning Text? Warning Text %XTableStyleMedium2PivotStyleLight16`v: Request Formh Instructions  ;2 S,,W-2c Request Form Name on W-2:Date of W-2c Issue:!Date Received in Central Payroll:Date Prepared:Requestor's Name/Contact #:City: Street:,REASON (and necessary adjustments) for W-2c: Apartment:State: Zip Code:GThe W-2c Request Form is to accompany all requests for W-2 corrections.Steps:>1. Enter the name of the employee needing the W-2 correction.Purpose:The purpose of the form is to have documentation on who sent the form, why they sent it and what corrections should be made. It is a beneficial document to make corrections quick and easy and it will be beneficial if the form is reviewed in later years. Other:It doesn't matter if this form is typed up on-line and then printed or printed off and filled in by hand. Just make sure it is legible.aIf the W-2c is resulting in a refund, my signature on this form authorizes the refund to be made..(signature of Payroll/HR Staff making request)?3. Explain the reason for the adjustment. Show the adjustment(s) that should be made. Also attach any necessary documents as backup. An example would be the VISA, I-94 and I-20 for a FICA refund based on F-1 VISA status; Copy of SS card for # change and name changes; Copy of CRR for overpayments; etcBOX 'SCorrectPreviousChangeEmplid: TAX YEAR:Email:_____________Mail:_______________ Select W-2c notification option:5. Fill in the address in which to send the W-2 if it is different than the address on the original W-2. The address on the W-2c will remain as the original address because the change is not required by the IRS.m6. Please provide your name and contact number in case the person preparing the W-2c has any questions.Revised: 03/01/2014,Address to mail W-2c, if different than W-2:4. Once processed the W-2c will be available electronically through myHR. Select how the employee should be notified. The email notification will only use University email addresses on file.Central Payroll Use OnlyBatch Number: IRS Date: Refunded:Voucher:%2. Enter the emplid of the employee.:7. 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