Form 13920 Directed Withholding and Deposit Verification

OMB No. 1545-2102
Department of the Treasury – Internal Revenue Service

Form 13920
(March 2013)

Directed Withholding and Deposit Verification

Withholding
Agent:

«Venue_Name»

Athlete /
Entertainer:

«Artists»

Performance date:

«Text_Performance_Date»

Withholding Agent: Please provide the following information and return this Form to the Internal
Revenue Service:

Settlement Amount:

($)

Amount Withheld:

($)

Deposit date (mmddyyyy):
Withholding Agent’s EIN

(Completed by IRS)
Firm Name

«Venue_Name»

Name of Contact

«Venue_Contact»

Address 1

«Venue_Addr1»

Address 2

«Venue_Addr2»

City, State Zip Code

«Venue_CityStZip»

Telephone Number

«Voice_Phone»

Fax Number

«Fax»
Return to:
By Mail:

By Fax:

(Please provide any corrections or additions to
your contact information in the space below

Internal Revenue Service
Attn: «Emp_Name»
«Emp_Addr1»
«Emp_Addr2»
«Emp_CSZ»
«Emp_Fax»

See “Deposit Requirements” in the instructions for Form 1042, Annual Withholding Tax Return
for U.S. Source Income of Foreign Persons, at http://www.irs.gov/pub/irs-pdf/f1042.pdf.
Privacy Act and Paperwork Reduction Act Notice:
We ask for the information on this form to carry out the Internal Revenue laws of the United States. Section 1441 requires withholding agents to report and pay
over to the IRS taxes withheld from certain U.S. source income of foreign persons; Form 1042 is used to report the amount of withholding that must be paid over.
Form 13920 is used to verify the deposit of the withheld amount; its use is voluntary. Section 6109 and its regulations require you to show your identifying number
on what you file. Not providing the information requested on this form in a timely manner may delay our ability to properly credit your deposit; providing false or
fraudulent information may subject you to penalties.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control
number. Books or records relating to a form or its instruction must be retained as long as their contents may become relevant in the administration of any Internal
Revenue law. Generally, tax returns and return information are confidential, as required by section 6103. However, we may give the information to the Department
of Justice for civil or criminal litigation, and to other Federal agencies, as provided by law. We may give it to cities, states, the District of Columbia, and U.S.
commonwealths or possessions to administer their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state
agencies to enforce federal nontax criminal laws, and to federal law enforcement and intelligence agencies to combat terrorism.
The time needed to complete the form will vary depending on individual circumstances. The estimated average time for completing this form is 20 minutes. If you
have comments concerning the accuracy of this time estimate or suggestions for making this form simpler, we would be happy to hear from you. You can write to
the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave., NW, IR 6526, Washington, DC 20224

Catalog Number 50904H

DRAFT

www.irs.gov

Form 13920 (3-2013)