Form 13920 Directed Withholding and Deposit Verification

Form

13920

(Rev. October 2013)

Department of the Treasury — Internal Revenue Service

Directed Withholding and Deposit Verification

Withholding Agent

OMB Number
1545-2102

Performance date (mmddyyyy)

Athlete/Entertainer
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:
(Please provide any corrections or additions to your
contact information in the space below)

(Completed by the IRS)
Firm Name
Name of Contact
Address 1
Address 2
City, State, ZIP Code
Telephone Number
Fax Number

Return to: Internal Revenue Service
Attn :

By Mail:

By 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

www.irs.gov

Form 13920 (Rev. 10-2013)