W-4R Withholding Certificate for Nonperiodic Payments and Eli

Version A, Cycle 3

Form

W-4R

Withholding Certificate for Nonperiodic Payments and
Eligible Rollover Distributions

Department of the Treasury
Internal Revenue Service

OMB No. 1545-0074

2023

Give Form W-4R to the payer of your retirement payments.

1a First name and middle initial

1b Social security number

Last name

Address
City or town, state, and ZIP code

Your withholding rate is determined by the type of payment you will receive.
• For nonperiodic payments, the default withholding rate is 10%. You can choose to have a different rate by entering a rate between
0% and 100% on line 2. Generally, you can’t choose less than 10% for payments to be delivered outside the United States and its
territories.
• For an eligible rollover distribution, the default withholding rate is 20%. You can choose a rate greater than 20% by entering the rate
on line 2. You may not choose a rate less than 20%.
See page 2 for more information.
2

Complete this line if you would like a rate of withholding that is different from the default withholding
rate. See the instructions on page 2 and the Marginal Rate Tables below for additional information.
Enter the rate as a whole number (no decimals) . . . . . . . . . . . . . . . . . .

Sign
Here

2

%

INTERNAL USE ONLY
DRAFT AS OF
November 15, 2022
Your signature (This form is not valid unless you sign it.)

General Instructions

Section references are to the Internal Revenue Code.
Future developments. For the latest information about any
future developments related to Form W-4R, such as
legislation enacted after it was published, go to
www.irs.gov/FormW4R.
Purpose of form. Complete Form W-4R to have payers
withhold the correct amount of federal income tax from your
nonperiodic payment or eligible rollover distribution from an
employer retirement plan, annuity (including a commercial
annuity), or individual retirement arrangement (IRA). See
page 2 for the rules and options that are available for each
type of payment. Don’t use Form W-4R for periodic
payments (payments made in installments at regular

Date

intervals over a period of more than 1 year) from these plans
or arrangements. Instead, use Form W-4P, Withholding
Certificate for Periodic Pension or Annuity Payments. For
more information on withholding, see Pub. 505, Tax
Withholding and Estimated Tax.
Caution: If you have too little tax withheld, you will generally
owe tax when you file your tax return and may owe a penalty
unless you make timely payments of estimated tax. If too
much tax is withheld, you will generally be due a refund
when you file your tax return. Your withholding choice (or an
election not to have withholding on a nonperiodic payment)
will generally apply to any future payment from the same
plan or IRA. Submit a new Form W-4R if you want to change
your election.

2023 Marginal Rate Tables
You may use these tables to help you select the appropriate withholding rate for this payment or distribution. Add your income
from all sources and use the column that matches your filing status to find the corresponding rate of withholding. See page 2
for more information on how to use this table.

Single
or
Married filing separately
Total income
over—

Tax rate for every
dollar more

Married filing jointly
or
Qualifying surviving spouse
Total income
over—

Tax rate for every
dollar more

Head of household
Total income
over—

Tax rate for every
dollar more

$0

0%

$0

0%

$0

0%

13,850

10%

27,700

10%

20,800

10%

24,850

12%

49,700

12%

36,500

12%

58,575

22%

117,150

22%

80,650

22%

109,225

24%

218,450

24%

116,150

24%

195,950

32%

391,900

32%

202,900

32%

245,100

35%

490,200

35%

252,050

35%

591,975*

37%

721,450

37%

598,900

37%

* If married filing separately, use $360,725 instead for this 37% rate.
For Privacy Act and Paperwork Reduction Act Notice, see page 3.

Cat. No. 75085T

Form W-4R (2023)

Version A, Cycle 3
Form W-4R (2023)

General Instructions (continued)
Nonperiodic payments—10% withholding. Your payer
must withhold at a default 10% rate from the taxable amount
of nonperiodic payments unless you enter a different rate on
line 2. Distributions from an IRA that are payable on demand
are treated as nonperiodic payments. Note that the default
rate of withholding may not be appropriate for your tax
situation. You may choose to have no federal income tax
withheld by entering “-0-” on line 2. See the specific
instructions below for more information. Generally, you are
not permitted to elect to have federal income tax withheld at
a rate of less than 10% (including “-0-”) on any payments to
be delivered outside the United States and its territories.
Note: If you don’t give Form W-4R to your payer, you
don’t provide an SSN, or the IRS notifies the payer that you
gave an incorrect SSN, then the payer must withhold 10% of
the payment for federal income tax and can’t honor requests
to have a lower (or no) amount withheld. Generally, for
payments that began before 2023, your current withholding
election (or your default rate) remains in effect unless you
submit a Form W-4R.
Eligible rollover distributions—20% withholding.
Distributions you receive from qualified retirement plans (for
example, 401(k) plans and section 457(b) plans maintained
by a governmental employer) or tax-sheltered annuities that
are eligible to be rolled over to an IRA or qualified plan are
subject to a 20% default rate of withholding on the taxable
amount of the distribution. You can’t choose withholding at a
rate of less than 20% (including “-0-”). Note that the default
rate of withholding may be too low for your tax situation. You
may choose to enter a rate higher than 20% on line 2. Don’t
give Form W-4R to your payer unless you want more than
20% withheld.
Note that the following payments are not eligible rollover
distributions: (a) qualifying “hardship” distributions, and (b)
distributions required by federal law, such as required
minimum distributions. See Pub. 505 for details. See also
Nonperiodic payments—10% withholding above.
Payments to nonresident aliens and foreign estates. Do
not use Form W-4R. See Pub. 515, Withholding of Tax on
Nonresident Aliens and Foreign Entities, and Pub. 519, U.S.
Tax Guide for Aliens, for more information.
Tax relief for victims of terrorist attacks. If your disability
payments for injuries incurred as a direct result of a terrorist
attack are not taxable, enter “-0-” on line 2. See Pub. 3920,
Tax Relief for Victims of Terrorist Attacks, for more details.

Page 2

Suggestion for determining withholding. Consider using
the Marginal Rate Tables on page 1 to help you select the
appropriate withholding rate for this payment or distribution.
The tables are most accurate if the appropriate amount of
tax on all other sources of income, deductions, and credits
has been paid through other withholding or estimated tax
payments. If the appropriate amount of tax on those sources
of income has not been paid through other withholding or
estimated tax payments, you can pay that tax through
withholding on this payment by entering a rate that is greater
than the rate in the Marginal Rate Tables.
The marginal tax rate is the rate of tax on each additional
dollar of income you receive above a particular amount of
income. You can use the table for your filing status as a
guide to find a rate of withholding for amounts above the
total income level in the table.
To determine the appropriate rate of withholding from the
table, do the following. Step 1: Find the rate that
corresponds with your total income not including the
payment. Step 2: Add your total income and the taxable
amount of the payment and find the corresponding rate.
If these two rates are the same, enter that rate on line 2.
(See Example 1 below.)
If the two rates differ, multiply (a) the amount in the lower
rate bracket by the rate for that bracket, and (b) the amount
in the higher rate bracket by the rate for that bracket. Add
these two numbers; this is the expected tax for this payment.
To get the rate to have withheld, divide this amount by the
taxable amount of the payment. Round up to the next whole
number and enter that rate on line 2. (See Example 2 below.)
If you prefer a simpler approach (but one that may lead to
overwithholding), find the rate that corresponds to your total
income including the payment and enter that rate on line 2.
Examples. Assume the following facts for Examples 1 and 2.
Your filing status is single. You expect the taxable amount of
your payment to be $20,000. Appropriate amounts have
been withheld for all other sources of income and any
deductions or credits.
Example 1. You expect your total income to be $60,000
without the payment. Step 1: Because your total income
without the payment, $60,000, is greater than $58,575 but
less than $109,225, the corresponding rate is 22%. Step 2:
Because your total income with the payment, $80,000, is
greater than $58,575 but less than $109,225, the
corresponding rate is 22%. Because these two rates are the
same, enter “22” on line 2.
Example 2. You expect your total income to be $42,500
without the payment. Step 1: Because your total income
without the payment, $42,500, is greater than $24,850 but
less than $58,575, the corresponding rate is 12%. Step 2:
Because your total income with the payment, $62,500, is
greater than $58,575 but less than $109,225, the
corresponding rate is 22%. The two rates differ. $16,075 of
the $20,000 payment is in the lower bracket ($58,575 less
your total income of $42,500 without the payment), and
$3,925 is in the higher bracket ($20,000 less the $16,075 that
is in the lower bracket). Multiply $16,075 by 12% to get
$1,929. Multiply $3,925 by 22% to get $863.50. The sum of
these two amounts is $2,792.50. This is the estimated tax on
your payment. This amount corresponds to 14% of the
$20,000 payment ($2,792.50 divided by $20,000). Enter “14”
on line 2.

INTERNAL USE ONLY
DRAFT AS OF
November 15, 2022

Specific Instructions
Line 1b
For an estate, enter the estate’s employer identification
number (EIN) in the area reserved for “Social security
number.”

Line 2
More withholding. If you want more than the default rate
withheld from your payment, you may enter a higher rate on
line 2.
Less withholding (nonperiodic payments only). If
permitted, you may enter a lower rate on line 2 (including
“-0-”) if you want less than the 10% default rate withheld
from your payment. If you have already paid, or plan to pay,
your tax on this payment through other withholding or
estimated tax payments, you may want to enter “-0-”.

Version A, Cycle 3
Form W-4R (2023)

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
additional federal income tax withholding from your
nonperiodic payment(s) or eligible rollover distribution(s); (b)
choose not to have federal income tax withheld from your
nonperiodic payment(s), when permitted; or (c) change a
previous Form W-4R (or a previous Form W-4P that you
completed with respect to your nonperiodic payments or
eligible rollover distributions). 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).
Failure to provide a properly completed form will result in
your payment(s) being subject to the default rate; providing
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.

Page 3

commonwealths and territories 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.

INTERNAL USE ONLY
DRAFT AS OF
November 15, 2022