Form 8891 Beneficiaries of Certain Canadian Registered Retirement

Form

8891

U.S. Information Return for Beneficiaries of
Certain Canadian Registered Retirement Plans

(Rev. December 2012)

▶

For calendar year 20

Department of the Treasury
Internal Revenue Service
Name as shown on Form 1040

▶

OMB No. 1545-0074

Attach to Form 1040.

, or tax year beginning

, 20

, and ending

, 20

.

Information about Form 8891 and its instructions is at www.irs.gov/form8891.

Attachment
Sequence No. 139

Identifying number (see instructions)

Address

1

Name of plan custodian

2

Account number of plan

3

Address of plan custodian

4

Type of plan (check one box):
Registered Retirement Savings Plan (RRSP)
Registered Retirement Income Fund (RRIF)

5

Check the applicable box for your status in the plan (see Definitions in the instructions):
Beneficiary
Annuitant (Complete only lines 7a, 7b, and 8.)

6a

Have you previously made an election under Article XVIII(7) of the U.S.-Canada income tax treaty to
defer U.S. income tax on the undistributed earnings of the plan? . . . . . . . . . . . ▶

b If “Yes,” enter the first year the election came into effect
c

7a

If you have not previously made the election described on line 6a above, you can make an irrevocable
election for this year and subsequent years by checking this box . . . . . . . . . . . ▶

7a

b Taxable distributions received from the plan during the year. Enter here and include on Form
1040, line 16b . . . . . . . . . . . . . . . . . . . . . . . . . . .

7b

9
10

No

and go to line 7a. If “No,” go to line 6c.

Distributions received from the plan during the year. Enter here and include on Form 1040, line
16a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8

Yes

Plan balance at the end of the year. If you checked the “Annuitant” box on line 5, the “Yes” box
on line 6a, or the box on line 6c, stop here. Do not complete the rest of the form . . . . .

8

Contributions to the plan during the year

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9

Interest income. Enter here and include on Form 1040, line 8a

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10a

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10b

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10c

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10d

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Undistributed earnings of the plan during the year:
a

b Total ordinary dividends. Enter here and include on Form 1040, line 9a
c

Qualified dividends. Enter here and include on Form 1040, line 9b .

d Capital gains. Enter here and include on Form 1040, line 13
e

.

.

.

Other income. Enter here and include on Form 1040, line 21. List type and amount ▶

10e
For Paperwork Reduction Act Notice, see instructions.

Cat. No. 37699X

Form 8891 (Rev. 12-2012)

Page 2

Form 8891 (Rev. 12-2012)

Section references are to the Internal Revenue Code.

Future Developments
For the latest information about developments related to Form
8891 and its instructions, such as legislation enacted after they
were published, go to www.irs.gov/form8891.

General Instructions
Purpose of Form
Form 8891 is used by U.S. citizens or residents (a) to report
contributions to Canadian registered retirement savings plans
(RRSPs) and registered retirement income funds (RRIFs), (b) to
report undistributed earnings in RRSPs and RRIFs, and (c) to
report distributions received from RRSPs and RRIFs. See
Notice 2003-75, which is available at IRS.gov.
Form 8891 also can be used to make an election pursuant to
Article XVIII(7) of the U.S.-Canada income tax treaty to defer
U.S. income tax on income earned by an RRSP or an RRIF that
has been accrued, but not distributed. Taxpayers who have not
previously made the election can make it on this form by
checking the box on line 6c.

Who Must File
Form 8891 must be completed and attached to Form 1040 by
any U.S. citizen or resident who is a beneficiary of an RRSP or
RRIF. Do not file Form 8891 by itself.
A U.S. citizen or resident who is an annuitant of an RRSP or
RRIF must file the form for any year in which he or she receives
a distribution from the RRSP or RRIF.
A separate Form 8891 must be filed for each RRSP or RRIF
for which there is a filing requirement. If you and your spouse
are both required to file Form 8891, each of you must complete
and attach a separate Form 8891 to Form 1040, even if you file
a joint return.

Definitions
Beneficiary. A beneficiary of an RRSP or RRIF is an individual
who is subject to current U.S. income taxation on income
accrued in the RRSP or RRIF or would be subject to current
income taxation had the individual not made the election under
Article XVIII(7) of the U.S.-Canada income tax treaty to defer
U.S. income taxation of income accrued in the RRSP or RRIF.
Annuitant. For purposes of this form, an annuitant of an RRSP
or RRIF is an individual who is designated pursuant to the RRSP
or RRIF as an annuitant and is not also a beneficiary as defined
above.

Record Retention
Taxpayers must retain supporting documentation relating to the
information reported on Form 8891, including Canadian forms
T4RSP, T4RIF, or NR4, and periodic or annual statements
issued by the custodian of the RRSP or RRIF.

Other Reporting Requirements
Pursuant to section 6048(d)(4), annuitants and beneficiaries
who are required to file Form 8891 will not be required to file
Form 3520 and will not be subject to the associated penalties
described in section 6677 on such RRSPs or RRIFs.
You may be required to file Form TD F 90-22.1, Report of
Foreign Bank and Financial Accounts. You may also be required
to file Form 8938, Statement of Specified Foreign Financial
Assets, for other Canadian assets not reported on this Form
8891. For more information, see the instructions for Schedule B
(Form 1040A or 1040) at www.irs.gov/form1040, and the
instructions for Form 8938 at www.irs.gov/form8938.

Specific Instructions
All amounts listed must be in U.S. dollars.

Name and Address
Enter your name and address as shown on Form 1040. Even if
you are filing a joint Form 1040 with your spouse, enter only
your name.

Identifying number
Enter your U.S. social security number (SSN) or individual
taxpayer identification number (ITIN). Do not enter a Canadian
identifying number.

Beneficiaries
A beneficiary who previously made the election to defer income
on the plan or is making it initially by checking the box on line 6c
must only complete lines 1 through 8 of the form.

Annuitants
If you are treated as an annuitant for purposes of this form (see
Definitions), you should complete only lines 1 through 5, 7a, 7b,
and 8.

Line 6(a)
If the election you made previously was made under Rev. Proc.
89-45, check the “No” box. If an election (other than an election
under Rev. Proc. 89-45) was made for an RRSP, and amounts
from the RRSP were rolled over tax-free to an RRIF or another
RRSP, the election is considered to have been made for the
plan which received the tax-free rollover.

Line 6(c)
If you did not make the election under Article XVIII to defer
income tax on income earned by an RRSP or an RRIF in a
previous year, you cannot make a late election on Form 8891.
However, you may be able to seek relief from the IRS for failure
to timely elect the deferral of income on Form 8891 in an earlier
year.

Line 7(b)
For information on figuring taxable distributions, see section 72
and Pub. 939, General Rule for Pensions and Annuities.

Paperwork Reduction Act Notice
We ask for the information on this form to carry out the Internal
Revenue laws of the United States. You are required to give us
the information. We need it to ensure that you are complying
with these laws and to allow us to figure and collect the right
amount of tax.
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 instructions must be retained as
long as their contents may become material in the
administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by
Internal Revenue Code section 6103.
The average time and expenses required to complete and file
this form will vary depending on individual circumstances. For
the estimated averages, see the instructions for your income tax
return.
If you have suggestions for making this form simpler, we
would be happy to hear from you. See the instructions for your
income tax return.