1042-T Annual Summary and Transmittal of Forms 1042-S

DO NOT STAPLE

Form

1042-T

Annual Summary and Transmittal of
Forms 1042-S

Department of the Treasury
Internal Revenue Service

OMB No. 1545-0096

2022

Go to www.irs.gov/Form1042T for the latest information.

Ch. 4 Status Code
Ch. 3 Status Code

Name of withholding agent

Employer identification number

Number, street, and room or suite no.
City or town, state or province, country, and ZIP or foreign postal code

1

Type of paper Forms 1042‐S attached:
a

Choose only one:

Chapter 4 or Chapter 3 (enter 4 or 3)

b Check only one box:
c

Original

Amended

Check if pro rata

d Enter the number of paper Forms 1042‐S attached
e

Check if you are a partnership reporting withholding that occurred in the subsequent year (see instructions)

2

Total gross income reported on all paper Forms 1042-S (box 2) attached .

3

Total federal tax withheld on all paper Forms 1042-S attached:

a

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.

Total federal tax withheld under Chapter 4 .

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. $

b Total federal tax withheld under Chapter 3 .

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. $

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. $

Caution: If you have already filed a Form 1042 and an attached Form 1042-S causes the gross income or tax withheld information
shown on your previously filed Form 1042 to change, you must file an amended Form 1042. See the instructions on page 2.
If this is your FINAL return, enter an “X” here (see instructions)

Please return this entire page to the Internal Revenue Service.

Sign
Here

Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and
belief, they are true, correct, and complete.
Your signature

Title

For more information and the Privacy Act and Paperwork Reduction Act Notice, see Form 1042-S.

Date

Cat. No. 28848W

Daytime phone number

Form 1042-T (2022)

Form 1042-T (2022)

Instructions
Future Developments
For the latest information about developments related to Form
1042-T and its instructions, such as legislation enacted after
they were published, go to www.irs.gov/Form1042T.

Purpose of Form
Use this form to transmit paper Forms 1042-S, Foreign Person’s
U.S. Source Income Subject to Withholding, to the Internal
Revenue Service. Use a separate Form 1042-T to transmit each
type of Form 1042-S (see the instructions for line 1 below).

!
▲
CAUTION

Do not use Form 1042-T if you submit Forms 1042-S
electronically. See the instructions for Form 1042-S
for the electronic filing requirements for Form 1042-S.

Filing Forms 1042 and 1042-S
Use of this form to transmit paper Forms 1042-S does not affect
your obligation to file Form 1042, Annual Withholding Tax
Return for U.S. Source Income of Foreign Persons.
If you have not yet filed a Form 1042 for 2022, you may send
in more than one Form 1042-T to submit paper Forms 1042-S
prior to filing your Form 1042. You may submit amended Forms
1042-S even though changes reflect differences in gross
income and tax withheld information of Forms 1042-S
previously submitted with a Form 1042-T.
If you have already filed a Form 1042 for 2022 and an
attached Form 1042-S caused the gross income or tax withheld
information previously reported on line 62c or 63e of your Form
1042 to change, you must file an amended Form 1042.

Where and When To File
File Form 1042-T (and Copy A of the paper Forms 1042-S being
transmitted) with the Ogden Service Center, P.O. Box 409101,
Ogden, UT 84409, by March 15, 2023. Send the forms in a flat
mailing (not folded).

Line Instructions
Identifying information at top of form. The name, address,
EIN, and chapter 4 and chapter 3 status codes of the
withholding agent named on this form must be the same as
those you enter on Forms 1042 and 1042-S. See the
Instructions for Form 1042 for the definition of withholding
agent. See the Instructions for Form 1042-S for the withholding
agent codes for the chapter 4 and chapter 3 status codes. You
must enter both a chapter 4 and a chapter 3 withholding agent
status code regardless of the type of payment being made.
Line 1. You must file a separate Form 1042‐T for each type of
paper Form 1042‐S you are transmitting.
Line 1a. Withholding agents are not permitted to file a single
Form 1042‐T to transmit both chapter 4 and chapter 3 amounts.
Withholding agents must indicate either chapter 4 or chapter 3
to designate the chapter for which they are filing a given Form
1042‐T. The chapter you designate on this form must be the
same as that on all attached Forms 1042‐S. See Chapter
indicator in the Form 1042‐S instructions for additional
information.

Page 2

Line 1b. Check either the Original or Amended box (but not
both).
Line 1c. Check the box on this line 1c if you are filing pro rata
Forms 1042‐S (see the Form 1042‐S instructions).
Line 1e. Check the box on line 1e if you are a partnership
reporting withholding that occurred in the subsequent year with
respect to a foreign partner’s share of undistributed income for
the prior year. The attached Form(s) 1042-S should have the
checkbox checked in box 7c.
As a result of the above rules, there are sixteen possible types
of Form 1042‐S that may be transmitted, and each type requires
a separate Form 1042‐T.
• Chapter 4, original, pro rata.
• Chapter 4, original, non‐pro rata.
• Chapter 4, amended, pro rata.
• Chapter 4, amended, non‐pro rata.
• Chapter 4, original, pro rata, partnership.
• Chapter 4, original, non-pro rata, partnership.
• Chapter 4, amended, pro rata, partnership.
• Chapter 4, amended, non-pro rata, partnership.
• Chapter 3, original, pro rata.
• Chapter 3, original, non‐pro rata.
• Chapter 3, amended, pro rata.
• Chapter 3, amended, non‐pro rata.
• Chapter 3, original, pro rata, partnership.
• Chapter 3, original, non-pro rata, partnership.
• Chapter 3, amended, pro rata, partnership.
• Chapter 3, amended, non-pro rata, partnership.
Each type must be transmitted with a separate Form 1042-T.
For example, you must transmit only Chapter 3, original, pro
rata Forms 1042-S with one Form 1042-T.
Line 2. Enter the total of the gross income amounts shown on
the Forms 1042-S (box 2) being transmitted with this Form
1042-T.
Line 3. Enter the total of the federal tax withheld amounts
shown on all Forms 1042-S (total of amounts reported in boxes
10 and 11) being transmitted with this Form 1042-T. On this
Form 1042-T, complete either line 3a or line 3b, but not both. If
you indicated “Chapter 4” on line 1a, complete line 3a to report
the total amounts withheld pursuant to chapter 4. If you
indicated “Chapter 3” on line 1a, complete line 3b to report the
total amounts withheld pursuant to chapter 3.
Final return. If you will not be required to file additional Forms
1042-S, including amended Forms 1042-S for the 2022 year (on
paper or electronically), enter an “X” in the FINAL return box.
Paperwork Reduction Act Notice. The time needed to
complete and file this form will vary depending on individual
circumstances. The estimated average time is 12 minutes.