Form W--4 P Withholding Certificate for Pension or Annuity Payments

Form

W-4P

Department of the Treasury
Internal Revenue Service

OMB No. 1545-0074

Withholding Certificate for
Pension or Annuity Payments

Purpose. Form W-4P is for U.S. citizens, resident aliens, or their estates who
are recipients of pensions, annuities (including commercial annuities), and
certain other deferred compensation. Use Form W-4P to tell payers the correct
amount of federal income tax to withhold from your payment(s). You also may
use Form W-4P to choose (a) not to have any federal income tax withheld from
the payment (except for eligible rollover distributions or payments to U.S.
citizens delivered outside the United States or its possessions) or (b) to have an
additional amount of tax withheld.
Your options depend on whether the payment is periodic,
nonperiodic, or an eligible rollover distribution, as explained on pages 3
and 4. Your previously filed Form W-4P will remain in effect if you do not
file a Form W-4P for 2012.

2012

What do I need to do? Complete lines A through G of the Personal
Allowances Worksheet. Use the additional worksheets on page 2 to further
adjust your withholding allowances for itemized deductions, adjustments to
income, any additional standard deduction, certain credits, or multiple pensions/
more-than-one-income situations. If you do not want any federal income tax
withheld (see Purpose, earlier), you can skip the worksheets and go directly to
the Form W-4P below.
Sign this form. Form W-4P is not valid unless you sign it.
Future developments. The IRS has created a page on IRS.gov for information
about Form W-4P and its instructions, at www.irs.gov/w4p. Information about
any future developments affecting Form W-4P (such as 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 . . . . . . . .
• You are single and have only one pension; or
• You are married, have only one pension, and your spouse
B Enter “1” if: has no income subject to withholding; or
. . .
• Your income from a second pension or a job or your spouse’s
pension or wages (or the total of all) is $1,500 or less.
C Enter “1” for your spouse. But, you may choose to enter “-0-” if you are married and have
income subject to withholding or more than one source of income subject to withholding.
you avoid having too little tax withheld.) . . . . . . . . . . . . . . . . .

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A

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B

either a spouse who has
(Entering “-0-” may help
. . . . . . . .

D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . .
E Enter “1” if you will file as head of household on your tax return . . . . . . . . . . . . . . . . .
F Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information.
• If your total income will be less than $61,000 ($90,000 if married), enter “2” for each eligible child; then less “1” if
you have three to seven eligible children or less “2” if you have eight or more eligible children.
• If your total income will be between $61,000 and $84,000 ($90,000 and $119,000 if married), enter “1” for each
eligible child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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.) ▶
For
accuracy,
complete
all
worksheets
that apply.

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C
D
E

F
G

• If you plan to itemize or claim adjustments to income and want to reduce your withholding,
see the Deductions and Adjustments Worksheet on page 2.
• If you are single and have more than one source of income subject to withholding or are
married and you and your spouse both have income subject to withholding and your
combined income from all sources exceeds $40,000 ($10,000 if married), see the Multiple
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.

Separate here and give Form W-4P to the payer of your pension or annuity. Keep the top part for your records.
Form

W-4P

Department of the Treasury
Internal Revenue Service

OMB No. 1545-0074

Withholding Certificate for
Pension or Annuity Payments
▶ For Privacy Act and Paperwork Reduction Act Notice, see page 4.

Your first name and middle initial

2012
Your social security number

Last name

Claim or identification number
(if any) of your pension or
annuity contract

Home address (number and street or rural route)
City or town, state, and ZIP code

Complete the following applicable lines.
1 Check here if you do not want any federal income tax withheld from your pension or annuity. (Do not complete line 2 or 3.) ▶
2 Total number of allowances and marital status you are claiming for withholding from each periodic pension or
annuity payment. (You also may designate an additional dollar amount on line 3.) . . . . . . . . . . . ▶
(Enter number
Single
Married
Married, but withhold at higher Single rate
Marital status:
of allowances.)
3 Additional amount, if any, you want withheld from each pension or annuity payment. (Note. For periodic payments,
you cannot enter an amount here without entering the number (including zero) of allowances on line 2.) . . . . ▶ $
Your signature ▶

Date
Cat. No. 10225T

▶

Form W-4P (2012)

Page 2

Form W-4P (2012)

Deductions and Adjustments Worksheet
Note. Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income.
1 Enter an estimate of your 2012 itemized deductions. These include qualifying home mortgage interest,
charitable contributions, state and local taxes, medical expenses in excess of 7.5% of your income, and
miscellaneous deductions . . . . . . . . . . . . . . . . . . . . . . . . . .
1
$11,900 if married filing jointly or qualifying widow(er)
$8,700 if head of household
. . . . . . . . . . . .
2
2 Enter:
$5,950 if single or married filing separately
3 Subtract line 2 from line 1. If zero or less, enter “-0-” . . . . . . . . . . . . . . . . .
3
4 Enter an estimate of your 2012 adjustments to income and any additional standard deduction (see
Pub. 505) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
5 Add lines 3 and 4 and enter the total. (Include any credit amounts from the Converting Credits to
Withholding Allowances for 2012 Form W-4 worksheet in Pub. 505.) . . . . . . . . . . . .
5
6 Enter an estimate of your 2012 income not subject to withholding (such as dividends or interest)
. .
6
7 Subtract line 6 from line 5. If zero or less, enter “-0-” . . . . . . . . . . . . . . . . .
7
8 Divide the amount on line 7 by $3,800 and enter the result here. Drop any fraction . . . . . . .
8
9 Enter the number from the Personal Allowances Worksheet, line G, page 1 . . . . . . . . .
9
10 Add lines 8 and 9 and enter the total here. If you use the Multiple Pensions/More-Than-One-Income
Worksheet, also enter this total on line 1 below. Otherwise, stop here and enter this total on Form
W-4P, line 2, page 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10

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$
$
$
$
$
$

Multiple Pensions/More-Than-One-Income Worksheet
Note. Complete only if the instructions under line G, page 1, direct you here. This applies if you (and your spouse if married filing jointly) have more than
one source of income subject to withholding (such as more than one pension, or a pension and a job, or you have a pension and your spouse works).
1 Enter the number from line G, page 1 (or from line 10 above if you used the Deductions and
Adjustments Worksheet) . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Find the number in Table 1 below that applies to the LOWEST paying pension or job and enter it here.
However, if you are married filing jointly and the amount from the highest paying pension or job is
$65,000 or less, do not enter more than “3” . . . . . . . . . . . . . . . . . . . .

1

2
3 If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter
“-0-”) and on Form W-4P, line 2, page 1. Do not use the rest of this worksheet . . . . . . . .
3
Note. If line 1 is less than line 2, enter “-0-” on Form W-4P, line 2, page 1. Complete lines 4 through 9 below to figure the
additional withholding amount necessary to avoid a year-end tax bill.
4 Enter the number from line 2 of this worksheet . . . . . . . . . .
4
5 Enter the number from line 1 of this worksheet . . . . . . . . . .
5
6 Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7 Find the amount in Table 2 below that applies to the HIGHEST paying pension or job and enter it here
7 $
8 Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed . .
8 $
9 Divide line 8 by the number of pay periods remaining in 2012. For example, divide by 12 if you are paid
every month and you complete this form in December 2011. Enter the result here and on Form W-4P,
line 3, page 1. This is the additional amount to be withheld from each payment . . . . . . . .
9 $

Table 1

Table 2

Married Filing Jointly

All Others

If wages from LOWEST
Enter on
paying job or pension are— line 2 above

If wages from LOWEST
Enter on
paying job or pension are— line 2 above

$0 - $5,000
5,001 - 12,000
12,001 - 22,000
22,001 - 25,000
25,001 - 30,000
30,001 - 40,000
40,001 - 48,000
48,001 - 55,000
55,001 - 65,000
65,001 - 72,000
72,001 - 85,000
85,001 - 97,000
97,001 - 110,000
110,001 - 120,000
120,001 - 135,000
135,001 and over

0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

$0 - $8,000
8,001 - 15,000
15,001 - 25,000
25,001 - 30,000
30,001 - 40,000
40,001 - 50,000
50,001 - 65,000
65,001 - 80,000
80,001 - 95,000
95,001 - 120,000
120,001 and over

Married Filing Jointly

0
1
2
3
4
5
6
7
8
9
10

If wages from HIGHEST
paying job or pension are—
$0 - $70,000
70,001 - 125,000
125,001 - 190,000
190,001 - 340,000
340,001 and over

Enter on
line 7 above
$570
950
1,060
1,250
1,330

All Others
If wages from HIGHEST
paying job or pension are—
$0 - $35,000
35,001 - 90,000
90,001 - 170,000
170,001 - 375,000
375,001 and over

Enter on
line 7 above
$570
950
1,060
1,250
1,330

Form W-4P (2012)

Additional Instructions
Section references are to the Internal Revenue Code.
When should I complete the form? Complete Form W-4P and
give it to the payer as soon as possible. Get Pub. 505, Tax
Withholding and Estimated Tax, to see how the dollar amount
you are having withheld compares to your projected total
federal income tax for 2012. You also may use the IRS
Withholding Calculator at www.irs.gov/individuals for help in
determining how many withholding allowances to claim on your
Form W-4P.
Multiple pensions/more-than-one income. To figure the
number of allowances that you may claim, combine allowances
and income subject to withholding from all sources on one
worksheet. You may file a Form W-4P with each pension payer,
but do not claim the same allowances more than once. Your
withholding usually will be most accurate when all allowances
are claimed on the Form W-4P for the highest source of income
subject to withholding and zero allowances are claimed on the
others.
Other income. If you have a large amount of income from other
sources not subject to withholding (such as interest, dividends,
or capital gains), consider making estimated tax payments using
Form 1040-ES, Estimated Tax for Individuals. Call
1-800-TAX-FORM (1-800-829-3676) to get Form 1040-ES and
Pub. 505. You also can get forms and publications at
www.irs.gov/formspubs.
If you have income from wages, see Pub. 505 to find out if
you should adjust your withholding on Form W-4 or Form W-4P.
Note. Social security and railroad retirement payments may be
includible in income. See Form W-4V, Voluntary Withholding
Request, for information on voluntary withholding from these
payments.

Withholding From Pensions and Annuities
Generally, federal income tax withholding applies to the taxable
part of payments made from pension, profit-sharing, stock
bonus, annuity, and certain deferred compensation plans; from
individual retirement arrangements (IRAs); and from commercial
annuities. The method and rate of withholding depend on (a) the
kind of payment you receive; (b) whether the payments are
delivered outside the United States or its commonwealths and
possessions; and (c) whether the recipient is a nonresident alien
individual, a nonresident alien beneficiary, or a foreign estate.
Qualified distributions from a Roth IRA are nontaxable and,
therefore, not subject to withholding. See page 4 for special
withholding rules that apply to payments outside the United
States and payments to foreign persons.
Because your tax situation may change from year to year, you
may want to refigure your withholding each year. You can
change the amount to be withheld by using lines 2 and 3 of
Form W-4P.
Choosing not to have income tax withheld. You (or in the
event of death, your beneficiary or estate) can choose not to
have federal income tax withheld from your payments by using
line 1 of Form W-4P. For an estate, the election to have no
income tax withheld may be made by the executor or personal
representative of the decedent. Enter the estate’s employer
identification number (EIN) in the area reserved for “Your social
security number” on Form W-4P.
You may not make this choice for eligible rollover
distributions. See Eligible rollover distribution—20%
withholding on page 4.

Page 3

Caution. There are penalties for not paying enough federal
income tax during the year, either through withholding or
estimated tax payments. New retirees, especially, should see
Pub. 505. It explains your estimated tax requirements and
describes penalties in detail. You may be able to avoid quarterly
estimated tax payments by having enough tax withheld from
your pension or annuity using Form W-4P.
Periodic payments. Withholding from periodic payments of a
pension or annuity is figured in the same manner as withholding
from wages. Periodic payments are made in installments at
regular intervals over a period of more than 1 year. They may be
paid annually, quarterly, monthly, etc.
If you want federal income tax to be withheld, you must
designate the number of withholding allowances on line 2 of
Form W-4P and indicate your marital status by checking the
appropriate box. Under current law, you cannot designate a
specific dollar amount to be withheld. However, you can
designate an additional amount to be withheld on line 3.
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
submit the form to your payer. However, see Payments to
Foreign Persons and Payments Outside the United States on
page 4.
Caution. If you do not submit Form W-4P to your payer, the
payer must withhold on periodic payments as if you are married
claiming three withholding allowances. Generally, this means
that tax will be withheld if your pension or annuity is at least
$1,640 a month.
If you submit a Form W-4P that does not contain your correct
social security number (SSN), the payer must withhold as if you
are single claiming zero withholding allowances even if you
checked the box on line 1 to have no federal income tax
withheld.
There are some kinds of periodic payments for which you
cannot use Form W-4P because they are already defined as
wages subject to federal income tax withholding. These
payments include retirement pay for service in the U.S. Armed
Forces and payments from certain nonqualified deferred
compensation plans and deferred compensation plans
described in section 457 of tax-exempt organizations. Your
payer should be able to tell you whether Form W-4P applies.
For periodic payments, your Form W-4P stays in effect until
you change or revoke it. Your payer must notify you each year
of your right to choose not to have federal income tax withheld
(if permitted) or to change your choice.
Nonperiodic payments—10% withholding. Your payer must
withhold at a flat 10% rate from nonperiodic payments (but see
Eligible rollover distribution—20% withholding on page 4)
unless you choose not to have federal income tax withheld.
Distributions from an IRA that are payable on demand are
treated as nonperiodic payments. You can choose not to have
federal income tax withheld from a nonperiodic payment (if
permitted) by submitting Form W-4P (containing your correct
SSN) to your payer and checking the box on line 1. Generally,
your choice not to have federal income tax withheld will apply to
any later payment from the same plan. You cannot use line 2 for
nonperiodic payments. But you may use line 3 to specify an
additional amount that you want withheld.
Caution. If you submit a Form W-4P that does not contain your
correct SSN, the payer cannot honor your request not to have
income tax withheld and must withhold 10% of the payment for
federal income tax.

Form W-4P (2012)

Eligible rollover distribution—20% withholding. Distributions
you receive from qualified pension or annuity plans (for
example, 401(k) pension plans and section 457(b) plans
maintained by a governmental employer) or tax-sheltered
annuities that are eligible to be rolled over tax free to an IRA or
qualified plan are subject to a flat 20% federal withholding rate.
The 20% withholding rate is required, and you cannot choose
not to have income tax withheld from eligible rollover
distributions. Do not give Form W-4P to your payer unless you
want an additional amount withheld. Then, complete line 3 of
Form W-4P and submit the form to your payer.
Note. The payer will not withhold federal income tax if the entire
distribution is transferred by the plan administrator in a direct
rollover to a traditional IRA or another eligible retirement plan (if
allowed by the plan), such as a qualified pension plan,
governmental section 457(b) plan, section 403(b) contract, or
tax-sheltered annuity.
Distributions that are (a) required by law, (b) one of a specified
series of equal payments, or (c) qualifying “hardship”
distributions are not “eligible rollover distributions” and are not
subject to the mandatory 20% federal income tax withholding.
See Pub. 505 for details. See also Nonperiodic payments—10%
withholding on page 3.

Changing Your “No Withholding” Choice
Periodic payments. If you previously chose not to have federal
income tax withheld and you now want withholding, complete
another Form W-4P and submit it to your payer. If you want
federal income tax withheld at the rate set by law (married with
three allowances), write “Revoked” next to the checkbox on line
1 of the form. If you want tax withheld at any different rate,
complete line 2 on the form.
Nonperiodic payments. If you previously chose not to have
federal income tax withheld and you now want withholding,
write “Revoked” next to the checkbox on line 1 and submit
Form W-4P to your payer.

Payments to Foreign Persons and Payments
Outside the United States
Unless you are a nonresident alien, withholding (in the manner
described above) is required on any periodic or nonperiodic
payments that are delivered to you outside the United States or
its possessions. You cannot choose not to have federal income
tax withheld on line 1 of Form W-4P. See Pub. 505 for details.
In the absence of a tax treaty exemption, nonresident aliens,
nonresident alien beneficiaries, and foreign estates generally are
subject to a 30% federal withholding tax under section 1441 on
the taxable portion of a periodic or nonperiodic pension or
annuity payment that is from U.S. sources. However, most tax
treaties provide that private pensions and annuities are exempt
from withholding and tax. Also, payments from certain pension
plans are exempt from withholding even if no tax treaty applies.
See Pub. 515, Withholding of Tax on Nonresident Aliens and
Foreign Entities, and Pub. 519, U.S. Tax Guide for Aliens, for
details. A foreign person should submit Form W-8BEN,
Certificate of Foreign Status of Beneficial Owner for United
States Tax Withholding, to the payer before receiving any
payments. The Form W-8BEN must contain the foreign person’s
taxpayer identification number (TIN).

Page 4

Statement of Federal Income Tax Withheld
From Your Pension or Annuity
By January 31 of next year, your payer will furnish a statement
to you on Form 1099-R, Distributions From Pensions, Annuities,
Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts,
etc., showing the total amount of your pension or annuity
payments and the total federal income tax withheld during the
year. If you are a foreign person who has provided your payer
with Form W-8BEN, your payer instead will furnish a statement
to you on Form 1042-S, Foreign Person’s U.S. Source Income
Subject to Withholding, by March 15 of next year.

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. You are required to provide
this information only if you want to (a) request federal income
tax withholding from periodic pension or annuity payments
based on your withholding allowances and marital status, (b)
request additional federal income tax withholding from your
pension or annuity, (c) choose not to have federal income tax
withheld, when permitted, or (d) change or revoke a previous
Form W-4P. To do any of the aforementioned, you are required
by sections 3405(e) and 6109 and their regulations to provide
the information requested on this form. Failure to provide this
information may result in inaccurate withholding on your
payment(s). Providing false or fraudulent information may
subject you to penalties.
Routine uses of this information include giving it to the
Department of Justice for civil and criminal litigation, and to
cities, states, the District of Columbia, and U.S. commonwealths
and possessions for use in administering 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, or to federal law enforcement and intelligence
agencies to combat terrorism.
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
section 6103.
The average time and expenses required to complete and file
this form will vary depending on individual circumstances. For
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.