W 4P Template Form – Fill Out and Use This PDF

Purpose. Form W-4P is for U.S. citizens, resident aliens, or their estates

What do I need to do? Complete lines A through G of the Personal

who are recipients of pensions, annuities (including commercial annuities),

Allowances Worksheet. Use the additional worksheets on page 2 to

and certain other deferred compensation. Use Form W-4P to tell payers the

further adjust your withholding allowances for itemized deductions,

correct amount of federal income tax to withhold from your payment(s).

adjustments to income, any additional standard deduction, certain credits,

You also may use Form W-4P to choose (a) not to have any federal income

or multiple pensions/more-than-one-income situations. If you do not want

tax withheld from the payment (except for eligible rollover distributions or

any federal income tax withheld (see Purpose, earlier), you can skip the

payments to U.S. citizens delivered outside the United States or its

worksheets and go directly to the Form W-4P below.

possessions) or (b) to have an additional amount of tax withheld.

Sign this form. Form W-4P is not valid unless you sign it.

Your options depend on whether the payment is periodic, nonperiodic,

Future developments. The IRS has created a page on IRS.gov for

distribution, as explained on pages 3 and 4. Your

or an eligible rolloverDRAFT informationASabout Form W-4P andOFits instructions, at www.irs.gov/w4p.

previously filed Form W-4P will remain in effect if you do not file a Form

Information about any future developments affecting Form W-4P (such as

W-4P for 2016.

•

July 10, 2015

legislation enacted after we release it) will be posted on that page.

Personal Allowances Worksheet (Keep for your records.)

A Enter “1” for yourself if no one else can claim you as a dependent

. . . . . . . . . . . . . . . .

A

You are single and have only one pension; or

• You are married, have only one pension, and your spouse

income subject

DOto

NOT FILE

B

Enter “1” if:

has no income subject to withholding; or

. . . . . . . . . . .

B

{• Your income from a second pension or a job or your spouse’s}

pension or wages (or the total of all) is $X,XXX or less.

C Enter “1” for your spouse. But, you may choose to enter “-0-” if you are married and have either a spouse who has

withholding or more than one source of income subject to withholding. (Entering “-0-” may help

you avoid having too little tax withheld.)

. . . . . . . . . . . . . . . .

C

D

Enter number of dependents (other than your spouse or yourself) you will claim on your tax return

D

E Enter “1” if you will file as head of household on your tax return .

. . . . . . . . . . . . . . . .

E

eligible child

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F

G Add lines A through F and enter total here. (Note: This may be different from the number of exemptions you claim on your tax return.) ▶

G

For

{

• If you plan to itemize or claim adjustments to income and want to reduce your withholding,

accuracy,

see the Deductions and Adjustments Worksheet on page 2.

complete

• If you are single and have more than one source of income subject to withholding or are

worksheetsall

married and you and your spouse both have income subject to withholding and your

combined income from all sources exceeds $XX,XXX ($XX,XXX if married), see the Multiple

that apply.

Pensions/More-Than-One-Income Worksheet on page 2 to avoid having too little tax withheld.

• If neither of the above situations applies, stop here and enter the number from line G on line 2

of Form W-4P below.

Your first name and middle initial

Last name

Your social security number

Home address (number and street or rural route)

Claim or identification number

(if any) of your pension or

annuity contract

City or town, state, and ZIP code

Your signature ▶

Date ▶

Cat. No. 10225T

Form W-4P (2016)

Additional Instructions

Caution: There are penalties for not paying enough federal

Section references are to the Internal Revenue Code.

income tax during the year, either through withholding or

estimated tax payments. New retirees, especially, should see

When should I complete the form? Complete Form W-4P and

Pub. 505. It explains your estimated tax requirements and

give it to the payer as soon as possible. Get Pub. 505, Tax

describes penalties in detail. You may be able to avoid quarterly

Withholding and Estimated Tax, to see how the dollar amount

estimated tax payments by having enough tax withheld from

you are having withheld compares to your projected total

your pension or annuity using Form W-4P.

federal income tax for 2016. You also may use the IRS

Periodic payments. Withholding from periodic payments of a

Withholding Calculator at www.irs.gov/individuals for help in

pension or annuity is figured in the same manner as withholding

determining how many withholding allowances to claim on your

from wages. Periodic payments are made in installments at

Form W-4P.

regular intervals over a period of more than 1 year. They may be

Multiple pensions/more-than-one-income. To figure the

paid annually, quarterly, monthly, etc.

DRAFT AS OF

number of allowances that you may claim, combine allowances

If you want federal income tax to be withheld, you must

and income subject to withholding from all sources on one

designate the number of withholding allowances on line 2 of

worksheet. You may file a Form W-4P with each pension payer,

Form W-4P and indicate your marital status by checking the

but do not claim the same allowances more than once. Your

appropriate box. Under current law, you cannot designate a

withholding usually will be most accurate when all allowances

specific dollar amount to be withheld. However, you can

are claimed on the Form W-4P for the highest source of income

designate an additional amount to be withheld on line 3.

subject to withholding and zero allowances are claimed on the

July 10, 2015

others.

If you do not want any federal income tax withheld from your

periodic payments, check the box on line 1 of Form W-4P and

Other income. If you have a large amount of income from other

submit the form to your payer. However, see Payments to

sources not subject to withholding (such as interest, dividends,

Foreign Persons and Payments Outside the United States on

or capital gains), consider making estimated tax payments using

page 4.

Form 1040-ES, Estimated Tax for Individuals. Get Form 1040-

Caution: If you do not submit Form W-4P to your payer, the

ES and Pub. 505 at www.irs.gov/formspubs.

payer must withhold on periodic payments as if you are married

DO NOT FILE

If you have income from wages, see Pub. 505 to find out if

claiming three withholding allowances. Generally, this means

you should adjust your withholding on Form W-4 or Form W-4P.

that tax will be withheld if your pension or annuity is at least

Note: Social security and railroad retirement payments may be

$X,XXX a month.

includible in income. See Form W-4V, Voluntary Withholding

If you submit a Form W-4P that does not contain your correct

Request, for information on voluntary withholding from these

social security number (SSN), the payer must withhold as if you

payments.

are single claiming zero withholding allowances even if you

Withholding From Pensions and Annuities

checked the box on line 1 to have no federal income tax

Generally, federal income tax withholding applies to the taxable

withheld.

There are some kinds of periodic payments for which you

part of payments made from pension, profit-sharing, stock

bonus, annuity, and certain deferred compensation plans; from

cannot use Form W-4P because they are already defined as

individual retirement arrangements (IRAs); and from commercial

wages subject to federal income tax withholding. These

annuities. The method and rate of withholding depend on (a) the

payments include retirement pay for service in the U.S. Armed

kind of payment you receive; (b) whether the payments are

Forces and payments from certain nonqualified deferred

delivered outside the United States or its commonwealths and

compensation plans and deferred compensation plans

possessions; and (c) whether the recipient is a nonresident alien

described in section 457 of tax-exempt organizations. Your

individual, a nonresident alien beneficiary, or a foreign estate.

payer should be able to tell you whether Form W-4P applies.

Qualified distributions from a Roth IRA are nontaxable and,

For periodic payments, your Form W-4P stays in effect until

therefore, not subject to withholding. See page 4 for special

you change or revoke it. Your payer must notify you each year

withholding rules that apply to payments outside the

of your right to choose not to have federal income tax withheld

United States and payments to foreign persons.

(if permitted) or to change your choice.

Because your tax situation may change from year to year, you

Nonperiodic payments—10% withholding. Your payer must

may want to refigure your withholding each year. You can

withhold at a flat 10% rate from nonperiodic payments (but see

change the amount to be withheld by using lines 2 and 3 of

Eligible rollover distribution—20% withholding on page 4)

Form W-4P.

unless you choose not to have federal income tax withheld.

Choosing not to have income tax withheld. You (or in the

Distributions from an IRA that are payable on demand are

event of death, your beneficiary or estate) can choose not to

treated as nonperiodic payments. You can choose not to have

have federal income tax withheld from your payments by using

federal income tax withheld from a nonperiodic payment (if

line 1 of Form W-4P. For an estate, the election to have no

permitted) by submitting Form W-4P (containing your correct

income tax withheld may be made by the executor or personal

SSN) to your payer and checking the box on line 1. Generally,

representative of the decedent. Enter the estate’s employer

your choice not to have federal income tax withheld will apply to

identification number (EIN) in the area reserved for “Your social

any later payment from the same plan. You cannot use line 2 for

security number” on Form W-4P.

nonperiodic payments. But you may use line 3 to specify an

You may not make this choice for eligible rollover

additional amount that you want withheld.

Caution: If you submit a Form W-4P that does not contain your

distributions. See Eligible rollover distribution—20%

withholding on page 4.

correct SSN, the payer cannot honor your request not to have

income tax withheld and must withhold 10% of the payment for