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Get USCG CG-2016 2010

U.S. DEPARTMENT OF HOMELAND SECURITY U.S. Coast Guard CG -2016 Rev. 02-10 REQUEST FOR DUPLICATE OR REPLACEMENT IRS FORM W-2 1. Employee ID 2. Today s Date 3. Last Name 4. First Name 5. MI 6 Address Street RR Box Apt etc* 7 City 8. State 11. Fax Complete only if you would like us to fax 10. Daytime Phone a copy to you 12. Member Status select one 13. Tax Year Desired for W-2 e*g* 2010 2009 etc* Reserve Retired Note If you need a 1099R form from our Retired pay section please call 1-800-772-8724 for assistance. 14. Is the member deceased Complete only if the person signing in block 15 is not Separated 15. Signature Please note During the busy tax season Feb 15 thru April 15 there is no guarantee that PPC can fax a W2. You will receive your W2 in the mail within 10 working days. PRIVACY ACT STATEMENT IAW 5 USC Sec* 522a e 3 the following is provided when supplying personal information to the Active Duty 9. Zip Authority - 31 USC Section 3332. Principal Purpose - Used to identify member s pay account and provide distribution instructions for annual employee s wage and earnings statement. Routine Uses - Same. Disclosure - Disclosure of this information is voluntary but without disclosure member may not receive a replacement IRS Form W-2. DO NOT FAX OR MAIL WITHOUT A SIGNATURE 16. Printed Name First Middle Initial Last the same as person identified in blocks 1 through 5 Instructions Yes Complete the form print and fax the SIGNED completed LEGIBLE form to PPC SES-AA at 785-339-3784 or mail to Commanding Officer SES-AA Pay Personnel Center 444 SE Quincy St* Topeka KS 66683-3591 Note If filling out by hand please print legibly If we can t read your writing we will not be able process your request U*S* DEPT. Employee ID 2. Today s Date 3. Last Name 4. First Name 5. MI 6 Address Street RR Box Apt etc* 7 City 8. State 11. Fax Complete only if you would like us to fax 10. Daytime Phone a copy to you 12. Member Status select one 13. State 11. Fax Complete only if you would like us to fax 10. Daytime Phone a copy to you 12. Member Status select one 13. Tax Year Desired for W-2 e*g* 2010 2009 etc* Reserve Retired Note If you need a 1099R form from our Retired pay section please call 1-800-772-8724 for assistance. Tax Year Desired for W-2 e*g* 2010 2009 etc* Reserve Retired Note If you need a 1099R form from our Retired pay section please call 1-800-772-8724 for assistance. 14. Is the member deceased Complete only if the person signing in block 15 is not Separated 15. Signature Please note During the busy tax season Feb 15 thru April 15 there is no guarantee that PPC can fax a W2. 14. Is the member deceased Complete only if the person signing in block 15 is not Separated 15. Signature Please note During the busy tax season Feb 15 thru April 15 there is no guarantee that PPC can fax a W2. You will receive your W2 in the mail within 10 working days. PRIVACY ACT STATEMENT IAW 5 USC Sec* 522a e 3 the following is provided when supplying personal information to the Active Duty 9. .

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