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Form W-4P

Department of the Treasury

Internal Revenue Service

Withholding Certificate for

Pension or Annuity Payments

OMB No. 1545-0074

2019

Future developments. For the latest information about any

future developments related to Form W‐4P, such as legislation

enacted after it was published, go to www.irs.gov/FormW4P.

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 for payments to U.S. citizens to

be 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 2 and 3. Your previously filed Form W‐4P will remain in

effect if you don’t file a Form W‐4P for 2019.

General Instructions

Section references are to the Internal Revenue Code.

Follow these instructions to determine the number of

withholding allowances you should claim for pension or annuity

payment withholding for 2019 and any additional amount of tax

to have withheld. Complete the worksheet(s) using the taxable

amount of the payments.

If you don’t 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.

You can also use the calculator at www.irs.gov/W4App to

determine your tax withholding more accurately. Consider using

this calculator if you have a more complicated tax situation, such

as if you have more than one pension or annuity, a working

spouse, or a large amount of income outside of your pensions.

After your Form W‐4P takes effect, you can also use this calculator

to see how the amount of tax you’re having withheld compares to

your projected total tax for 2019. If you use the calculator, you

don’t need to complete any of the worksheets for Form W‐4P.

Note that if you have too much tax withheld, you will receive a

refund when you file your tax return. If you have too little tax

withheld, you will owe tax when you file your tax return, and you

might owe a penalty.

Filers with multiple pensions or more than one income. If

you have more than one source of income subject to

withholding (such as more than one pension or a pension and a

job, or you’re married filing jointly and your spouse is working),

read all of the instructions, including the instructions for the

Multiple Pensions/More‐Than‐One‐Income Worksheet, before

beginning.

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. Otherwise, you

might owe additional tax. See Pub. 505, Tax Withholding and

Estimated Tax, for more information. Get Form 1040‐ES and

Pub. 505 at www.irs.gov/FormsPubs. Or, you can use the

Deductions, Adjustments, and Additional Income Worksheet on

page 5 or the calculator at www.irs.gov/W4App to make sure

you have enough tax withheld from your payments. If you have

income from wages, see Pub. 505 or use the calculator at

www.irs.gov/W4App 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 to be

delivered outside the United States or its possessions; and

nonresident alien beneficiary, or a foreign estate. Qualified

distributions from a Roth IRA are nontaxable and, therefore, not

subject to withholding. See page 3 for special withholding rules

that apply to payments to be delivered outside the United

States and payments to foreign persons.

Separate here and give Form W-4P to the payer of your pension or annuity. Keep the worksheet(s) for your records.

Form W-4P

Department of the Treasury

Internal Revenue Service

Withholding Certificate for

Pension or Annuity Payments

▶

For Privacy Act and Paperwork Reduction Act Notice, see page 6.

OMB No. 1545-0074

2019

Your first name and middle initial Last name Your social security number

Home address (number and street or rural route)

City or town, state, and ZIP code

Claim or identification number

(if any) of your pension or

annuity contract

Complete the following applicable lines.

Check here if you do not want any federal income tax withheld from your pension or annuity. (Don’t complete line 2 or 3.)

▶

Total number of allowances and marital status you’re claiming for withholding from each periodic pension or

annuity payment. (You also may designate an additional dollar amount on line 3.) . . . . . . . . . . .

▶

(Enter number

of allowances.)

Marital status:

Single Married Married, but withhold at higher Single rate.

Additional amount, if any, you want withheld from each pension or annuity payment. (Note: For periodic payments,

you can’t enter an amount here without entering the number (including zero) of allowances on line 2.)

. . . .

▶

Your signature

▶

Date

▶

Cat. No. 10225T

Form W-4P (2019)

Page 2

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

below.

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. You can’t designate a specific dollar amount to

be withheld. However, you can designate an additional amount

to be withheld on line 3.

If you don’t 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 To Be Delivered Outside the

United States on page 3.

Caution: If you don’t submit Form W-4P to your payer, the

payer must withhold on periodic payments as if you’re married

claiming three withholding allowances. Generally, this means

that tax will be withheld if the taxable amount of your pension or

annuity is at least $2,033 a month.

If you submit a Form W-4P that doesn’t contain your correct

social security number (SSN), the payer must withhold as if

you’re 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

can’t use Form W-4P because they’re 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 tax-exempt organizations’ deferred compensation

plans described in section 457. 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 the taxable amount of

nonperiodic payments (but see Eligible rollover distribution—

20% withholding below) 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. However, see Payments to Foreign Persons and

Payments To Be Delivered Outside the United States on page 3.

Generally, your choice not to have federal income tax withheld

will apply to any later payment from the same plan. You can’t

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 doesn’t contain your

correct SSN, the payer can’t honor your request not to have

income tax withheld and must withhold 10% of the payment for

federal income tax.

Eligible rollover distribution—20% withholding. Distributions

you receive from qualified pension or annuity 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 flat 20% federal withholding rate on the taxable amount of

the distribution. The 20% withholding rate is required, and you

can’t choose not to have income tax withheld from eligible

rollover distributions. Don’t give Form W-4P to your payer

unless you want an additional amount withheld. In that case,

complete line 3 of Form W-4P and submit the form to your

payer.

Form W-4P (2019)

Page 3

Note: The payer won’t 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 401(k) plan, qualified pension

plan, governmental section 457(b) plan, section 403(b) contract,

or tax-sheltered annuity.

Distributions that are (a) required by federal law, (b) one of a

specified series of equal payments, or (c) qualifying “hardship”

distributions are not “eligible rollover distributions” and aren’t

subject to the mandatory 20% federal income tax withholding.

See Pub. 505 for details. See also Nonperiodic payments—10%

withholding on page 2.

Tax relief for victims of terrorist attacks. For tax years ending

after September 10, 2001, disability payments for injuries

incurred as a direct result of a terrorist attack directed against the

United States (or its allies), whether outside or within the United

States, aren’t included in income. You may check the box on line

1 of Form W-4P and submit the form to your payer to have no

federal income tax withheld from these disability payments.

However, you must include in your income any amounts that you

received or you would’ve received in retirement had you not

become disabled as a result of a terrorist attack. See Pub. 3920,

Tax Relief for Victims of Terrorist Attacks, for more details.

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 2019 default rate (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

To Be Delivered Outside the United States

Unless you’re a nonresident alien, withholding (in the manner

described above) is required on any periodic or nonperiodic

payments that are to be delivered to you outside the United States

or its possessions. Don’t check the box 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 and Reporting, to the payer before

receiving any payments. The Form W-8BEN must contain the

foreign person’s taxpayer identification number (TIN).

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’re 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 16 of next year.

Specific Instructions

Personal Allowances Worksheet

Complete this worksheet on page 4 first to determine the

number of withholding allowances to claim.

Line C. Head of household please note: Generally, you can

claim head of household filing status on your tax return only if

you’re unmarried and pay more than 50% of the costs of

keeping up a home for yourself and a qualifying individual. See

Pub. 501 for more information about filing status.

Line E. Child tax credit. When you file your tax return, you may

be eligible to claim a child tax credit for each of your eligible

children. To qualify, the child must be under age 17 as of

December 31, must be your dependent who lives with you for

more than half the year, and must have a valid social security

number. To learn more about this credit, see Pub. 972, Child

Tax Credit. To reduce the tax withheld from your payments by

taking this credit into account, follow the instructions on line E

of the worksheet. On the worksheet you will be asked about

your total income. For this purpose, total income includes all of

your pensions, wages, and other income, including income

earned by a spouse, if you are filing a joint return.

Line F. Credit for other dependents. When you file your tax

return, you may be eligible to claim a credit for other

dependents for whom a child tax credit cannot be claimed, such

as a qualifying child who does not meet the age or social

security number requirement for the child tax credit, or a

qualifying relative. To learn more about this credit, see Pub. 972.

To reduce the tax withheld from your payments by taking this

credit into account, follow the instructions on line F of the

worksheet. On the worksheet, you will be asked about your total

income. For this purpose, total income includes all of your

pensions, wages, and other income, including income earned by

a spouse, if you are filing a joint return.

Line G. Other credits. You may be able to reduce the tax

withheld from your payments if you expect to claim other tax

credits, such as tax credits for education (see Pub. 970). If you

do so, your payments will be larger, but the amount of any

refund that you receive when you file your tax return will be

smaller. Follow the instructions for Worksheet 1‐6 in Pub. 505 if

you want to reduce your withholding to take these credits into

account. Enter “-0-” on lines E and F if you use Worksheet 1-6.

Deductions, Adjustments, and Additional

Income Worksheet

Complete this worksheet to determine if you’re able to reduce

the tax withheld from your pension or annuity payments to

account for your itemized deductions and other adjustments to

income, such as IRA contributions. If you do so, your refund at

the end of the year will be smaller, but your payments will be

larger. You’re not required to complete this worksheet or reduce

your withholding if you don’t wish to do so.

You can also use this worksheet to figure out how much to

increase the tax withheld from your payments if you have a large

amount of other income not subject to withholding, such as

interest, dividends, or capital gains.

Another option is to take these items into account and make

your withholding more accurate by using the calculator at

www.irs.gov/W4App. If you use the calculator, you don’t need

to complete any of the worksheets for Form W‐4P.

Multiple Pensions/More‐Than‐One‐Income

Worksheet

Complete this worksheet if you receive more than one pension,

if you have a pension and a job, or if you’re married filing jointly

and have a working spouse or a spouse who receives a

pension. If you don’t complete this worksheet, you might have

too little tax withheld. If so, you will owe tax when you file your

tax return and may be subject to a penalty.

Form W-4P (2019)

Page 4

Figure the total number of allowances you’re entitled to claim

and any additional amount of tax to withhold on all pensions

using worksheets from only one Form W‐4P. Claim all

allowances on the Form W‐4P that you or your spouse file for the

highest paying pension in your family and claim zero allowances

on Forms W‐4P filed for all other pensions. For example, if you

receive $60,000 from your pension per year and your spouse

receives $20,000 from a pension, you should complete the

worksheets to determine what to enter on lines 2 and 3 of your

Form W‐4P, and your spouse should enter zero (“‐0‐”) on lines 2

and 3 of his or her Form W‐4P. See Pub. 505 for details.

Another option is to use the calculator at www.irs.gov/W4App

to figure your withholding more precisely.

Personal Allowances Worksheet (Keep for your records.)

A Enter “1” for yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A

B Enter “1” if you will file as married filing jointly . . . . . . . . . . . . . . . . . . . . . . B

C Enter “1” if you will file as head of household . . . . . . . . . . . . . . . . . . . . . . . C

D Enter “1” if:

{

• You’re single, or married filing separately, and have only one pension; or

• You’re married filing jointly, have only one pension, and your spouse 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) are $1,500 or less.

}

. . . . . D

E Child tax credit. See Pub. 972, Child Tax Credit, for more information.

• If your total income will be less than $71,201 ($103,351 if married filing jointly), enter “4” for each eligible child.

• If your total income will be from $71,201 to $179,050 ($103,351 to $345,850 if married filing jointly), enter “2”

for each eligible child.

• If your total income will be from $179,051 to $200,000 ($345,851 to $400,000 if married filing jointly), enter “1”

for each eligible child.

• If your total income will be higher than $200,000 ($400,000 if married filing jointly), enter “-0-” . . . . . . E

F Credit for other dependents. See Pub. 972, Child Tax Credit, for more information.

• If your total income will be less than $71,201 ($103,351 if married filing jointly), enter “1” for each eligible

dependent.

• If your total income will be from $71,201 to $179,050 ($103,351 to $345,850 if married filing jointly), enter “1”

for every two dependents (for example, “-0-” for one dependent, “1” if you have two or three dependents, and

“2” if you have four dependents).

• If your total income will be higher than $179,050 ($345,850 if married filing jointly), enter “-0-” . . . . . . F

Other credits. If you have other credits, see Worksheet 1-6 of Pub. 505 and enter the amount from that

worksheet here. If you use Worksheet 1-6, enter “-0-” on lines E and F . . . . . . . . . . . . . . G

H Add lines A through G and enter the total here . . . . . . . . . . . . . . . . . . . . .

▶

For accuracy,

complete all

worksheets

that apply.

{

• If you plan to itemize or claim adjustments to income and want to reduce your withholding,

or if you have a large amount of other income not subject to withholding and want to increase

your withholding, see the Deductions, Adjustments, and Additional Income Worksheet, later.

• If you have more than one source of income subject to withholding or are married filing

jointly and you and your spouse both have income subject to withholding and your

combined income from all sources exceeds $53,000 ($24,450 if married filing jointly), see the

Multiple Pensions/More-Than-One-Income Worksheet on page 5 to avoid having too little

tax withheld.

• If neither of the above situations applies, stop here and enter the number from line H on line

2 of Form W-4P above.

Form W-4P (2019)

Page 5

Deductions, Adjustments, and Additional Income Worksheet

Note: Use this worksheet only if you plan to itemize deductions, claim certain adjustments to income, or have a large amount of

other income not subject to withholding.

Enter an estimate of your 2019 itemized deductions. These include qualifying home mortgage interest,

charitable contributions, state and local taxes (up to $10,000), and medical expenses in excess of 10%

of your income. See Pub. 505 for details . . . . . . . . . . . . . . . . . . . . . 1 $

2 Enter:

{

$24,400 if you’re married filing jointly or qualifying widow(er)

$18,350 if you’re head of household

$12,200 if you’re single or married filing separately

}

. . . . . . . . . . 2 $

3 Subtract line 2 from line 1. If zero or less, enter “-0-” . . . . . . . . . . . . . . . . . 3

Enter an estimate of your 2019 adjustments to income, qualified business income deduction, and any

additional standard deduction for age or blindness (see Pub. 505 for information about these items) . 4

5 Add lines 3 and 4 and enter the total . . . . . . . . . . . . . . . . . . . . . . 5

Enter an estimate of your 2019 other income not subject to withholding (such as dividends, interest, or capital gains)

6 $

7 Subtract line 6 from line 5. If zero, enter “-0-”. If less than zero, enter the amount in parentheses . . 7

Divide the amount on line 7 by $4,200 and enter the result here. If a negative amount, enter in

parentheses. Drop any fraction . . . . . . . . . . . . . . . . . . . . . . . . 8

9 Enter the number from the Personal Allowances Worksheet, line H, page 4 . . . . . . . . . 9

Add lines 8 and 9 and enter the total here. If zero or less, enter “-0-”. If you plan to 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 . . . . . . . . . . . . . . . .

Multiple Pensions/More-Than-One-Income Worksheet

Note: Use this worksheet only if the instructions under line H from the Personal Allowances Worksheet 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).

Enter the number from the Personal Allowances Worksheet, line H, page 4 (or from line 10 above if

you used the Deductions, Adjustments, and Additional Income Worksheet) . . . . . . . . 1

Find the number in Table 1 below that applies to the LOWEST paying pension or job and enter it here.

However, if you’re married filing jointly and the amount from the highest paying pension or job is $75,000 or

less and the combined amounts for you and your spouse are $107,000 or less, do not enter more than “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

Divide line 8 by the number of payments remaining in 2019. For example, divide by 8 if you’re paid

every month and you complete this form in April 2019. Enter the result here and on Form W-4P, line 3,

page 1. This is the additional amount to be withheld from each payment . . . . . . . . . .

Table 1

Married Filing Jointly

If wages from LOWEST

paying job or pension are—

Enter on

line 2 above

$0 - $5,000

5,001 - 9,500

9,501 - 19,500

19,501 - 35,000

35,001 - 40,000

40,001 - 46,000

46,001 - 55,000

55,001 - 60,000

60,001 - 70,000

70,001 - 75,000

75,001 - 85,000

85,001 - 95,000

95,001 - 125,000

125,001 - 155,000

155,001 - 165,000

165,001 - 175,000

175,001 - 180,000

180,001 - 195,000

195,001 - 205,000

205,001

and over

All Others

If wages from LOWEST

paying job or pension are—

Enter on

line 2 above

$0 - $7,000 0

7,001 - 13,000 1

13,001 - 27,500 2

27,501 - 32,000 3

32,001 - 40,000 4

40,001 - 60,000 5

60,001 - 75,000 6

75,001 - 85,000 7

85,001 - 95,000 8

95,001 - 100,000 9

100,001 - 110,000 10

110,001 - 115,000 11

115,001 - 125,000 12

125,001 - 135,000 13

135,001 - 145,000 14

145,001 - 160,000 15

160,001 - 180,000 16

180,001 and over 17

Table 2

Married Filing Jointly

If wages from HIGHEST

paying job or pension are—

Enter on

line 7 above

$0 - $24,900 $420

24,901 - 84,450 500

84,451 - 173,900 910

173,901 - 326,950 1,000

326,951 - 413,700 1,330

413,701 - 617,850 1,450

617,851

and over

1,540

All Others

If wages from HIGHEST

paying job or pension are—

Enter on

line 7 above

$0 - $7,200 $420

7,201 - 36,975 500

36,976 - 81,700 910

81,701 - 158,225 1,000

158,226 - 201,600 1,330

201,601 - 507,800

1,450

507,801 and over 1,540

Form W-4P (2019)

Page 6

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’re 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’re 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’re 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.

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