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Employer-requested 2021 Wage Tax refund template

Employers can use this template to request a 2021 Philadelphia Wage Tax refund on behalf of their non-resident employees. This form should not be used for employees with bonus pay, severance, or stock options (employees with bonus pay, etc., will need to complete an individual long form). To submit the request, you should:

  1. Select the Excel (xlsx) spreadsheet below. The file downloads to your computer automatically.
  2. Open the file. Add your company name, address, EIN, and the preparer’s name and contact information.
  3. Provide accurate and complete information for each employee who is eligible for a refund.
  4. Save the file, renaming it with your company’s name.
  5. Before uploading the completed template, you should go to the Philadelphia Tax Center to submit employees’ W-2s. Employers must first submit each eligible employee’s W-2s before uploading their bulk templates.
  6. Upload the completed template to the Department of Revenue’s eFile/ePay website.

Select “Wage Tax Refund Request” from the bottom of the left menu on the homepage. Follow the on-screen prompts to submit.

The Department of Revenue will mail refunds to the addresses you provide in the template. Missing information could delay the petition.

Name Description Released Format
2021 Employer-requested refund template xlsx Use this form to complete a 2021 Wage Tax Refund Petition for your employee(s). March 15, 2022

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