W-4p, Withholding Certificate for Pension and Annuity Payments

Form

W-4P

Department of the Treasury
Internal Revenue Service

CURRENT
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 2016.

OMB No. 1545-0074

2016

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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B

either a spouse who has
(Entering “-0-” may help
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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 $70,000 ($100,000 if married), enter “2” for each eligible child; then less “1” if
you have two to four eligible children or less “2” if you have five or more eligible children.
• If your total income will be between $70,000 and $84,000 ($100,000 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 $50,000 ($20,000 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

Last name

2016
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

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
Marital status:
Single
Married
Married, but withhold at higher Single rate.
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 (2016)