CT-4852: Substitute for Forms W-2 and 1099-R (Revision 2023-12)
Connecticut · Connecticut DRS · Used for tax years 2024, 2025, 2026
Form CT-4852 is Connecticut’s substitute for a missing or incorrect Form W-2 or Form 1099-R. It records your best estimates of wages or payments and federal and Connecticut income taxes withheld, along with how you determined those amounts and your efforts to obtain the original
Who files this form
Complete Form CT-4852 if you cannot obtain a Form W-2 or Form 1099-R from your employer or payer, or you received an incorrect one, and you have notified the Internal Revenue Service.
Complete a separate Form CT-4852 for each missing or incorrect Form W-2 or Form 1099-R.
What you'll need
Have the following information ready:
- Your name, Social Security number, mailing address, and telephone number.
- The year the wages or payments relate to.
- Your employer’s or payer’s name and address, plus its Connecticut Tax Registration number and Federal Employer Identification number, if known.
- Your best estimates of wages or payments and federal and Connecticut income tax withheld, with an explanation of how you determined the amounts.
- The reason the employer or payer did not furnish Form W-2, Form 1099-R, or Form W-2C, if known, and an explanation of your efforts to get it.
If you received a Form W-2 showing federal wages and federal income tax withheld, attach a copy to CT-4852. If you did not receive a W-2 but file federal Form 4852 to report those amounts, attach a copy of federal Form 4852 instead.
How to file
Do not attach Form CT-4852 to your Connecticut income tax return. Keep it with your tax records. The Connecticut Department of Revenue Services (DRS) may ask you to provide a copy later.
Complete the applicable information, explain your estimates and your efforts to obtain the missing or corrected form, and sign and date the declaration.
Common mistakes
- Leaving out the year. Enter the year at the end of the statement in item 1.
- Combining missing or incorrect forms. Complete a separate CT-4852 for each missing or incorrect W-2 or 1099-R.
- Reporting compensation after deductions. Boxes 6 and 8 must include total wages, noncash payments, reported tips, and all other compensation before deductions for taxes, insurance, and similar items.
- Omitting a required copy. Attach the W-2 showing federal wages and withholding, or federal Form 4852 when the stated conditions apply.
- Attaching CT-4852 to your Connecticut return. Keep it with your records instead.
Questions people ask
Can I use CT-4852 for an incorrect form, not just a missing one?
Yes. It covers missing or incorrect Forms W-2 and 1099-R. The form’s purpose statement also says you must have notified the IRS.
Can I use estimated amounts?
Yes. The form asks for your best estimates of wages or payments and taxes withheld. In item 9, explain how you determined the amounts in Boxes 5 through 8.
What if I do not know the employer’s identification numbers?
The Connecticut Tax Registration number and Federal Employer Identification number are requested only if known.
Should I send CT-4852 with my Connecticut income tax return?
No. Keep it with your tax records. DRS may request a copy later.