Keep these forms in the order in which they are printed. During the help
session, we will fitl them out in the order listed below. All pages, except the first
page, are numbered at the bottom.
o
.
o
Pages 1-8 are allthe forms needed for retirement
page 9 is a sample of TRS 25 which show annuity payments for a teacher
pages 10 and 11 are directions for how to fill our TRS 228A (Tax form)
Below is a list of the forms we will complete during the zoom session.
o
o
.
o
.
.
Direct Deposit TRS 278 (pages l and 2)
Application for Service Retirement TRS 30 (pages 3 and 4)
Service Retirement Estimate of Benefits TRS 25 (page 5) (This page gives
instructions for how to obtain your estimate of benefits (TRS 25) from the
TRS website (httpS:f,WwWlfS.tqxas.gqv) You will need TRS 25 in order to
complete your forms. lf you have trouble following the instructions on
page 5, call TRS at t-8OO-223-8778 for assistance)
Federal lncome Tax Certificate TRS 228A (page 6)
Notice of Final Deposit before Retirement TRS 7 (page7)
partial Lump Sun Option Election TRS 3OP (page 8) This form is rarely used.
Please complete the Direct Deposit form, TRS 278 (page 1 and 2), and the
Federal lncome Tax Certificate, TRS 228 A, (page 6) prior to the zoom session.
you have difficulty filling out these forms, you will have an opportunity to ask
questions during the session. ln addition, please fill out the personal
lf
information at the top of the forms if it is not already printed in the blanks.
One other thing to be mailed to Austin is proof of age. A copy of a driver's license
will be sufficient. lf you are selectingthe Standard Annuity, make a copyof your
driver's license only and include it with the forms being mailed to Austin' lf you
are leaving your annuity to someone, option s 1',2, or 5, include a copy of your
driver's license and the person's license who will receive your annuity.
Reminders:
The address is at the top left on each
like FedEx.
form. Consider using an overnight service
Remember the TRS 7 form is not mailed to Austin. Contact your school district
and ask how you should submit the TRS 7 form to the district.
ffi,,r,r
TEACil€n
flmnEtEflT SYSEI 0r
Direct Deposit Request
TRS278 (08-22)
[eS
1000 Red River Street
Austin, TX 78701-2698
(800) 223-8778
lilillH!ilfrthtff{ilt ii[lt,il,tlfillItfllflilll,lllllll[l
www.tE.texas.gov
$il
lll
TRS Participant lD or Social Security Number
Name
Mailing Address (city, state, and ZIP code)
Financial lnstitution Name
AccountType
Routing Number (9 digits)
Account Number (maximum 17 digits)
fficnecrinS
f,savings
Will these payments be forwarded to a financial institution outside the United States?
"YES," also complete the ACH (Direct Deposit) Payment Destination Confirmation on page
2.
I authorize the state agency that issues my state of Texas payments via the Texas Comptroller of Public Accounts to electronically
deposit my payments to my financial institution. I understand that any payments deposited in error to my account will be reversed
by the agency that issues my state of Texas payments via the Texas Comptroller of Public Accounts.
I further understand that the agency that issues my state of Texas payments and the Texas Comptroller of Public Accounts will
comply at all times with the National Automated Clearing House Association's rules. (For further information on these rules, please
contact your financial institution.)
Date
Signature
Teacher Retirement System of Texas
l
Page 1 of 2
Place a check mark
1
-./;
on the appropriate selection below to indicate your response.
I attest, under penalty of perjury, that the ACH payment(s) to be issued by the state of Texas and sent to my domestic financial
institution and account listed on page 1;
(a) ffi
l-J
(b) f
(c) f,
Wlt-l- be fonvarded in its entirety (100%) to a country outside the United States.
3ps6;1y the name of the country where '1 00% of payment(s) will be forwarded:
-
Wf
U- be forwarded, but less than 100%, to a country outside the United States.
WfLL NOT be forwarded to a country outside the United States.
I have read and understand the statements above and will notify the state agency that issues my state of Texas payments of any
change to the intended final destination of these payments.
Date
Signature
Add itional lnformation
TRS through the Texas Comptroller of Public Accounts has the ability to electronically deposit an annuitant's monthly benefit and
certain other payments to an authorized financial institution. ln order for TRS to deposit the annuitant's payments into a financial
institution, the annuitant must sign the TRS 278 Diecl Deposit Request form.
Payments may only be deposited to an account in which the TRS participant has an interest.
Any change to your direct deposit will apply to all eligible payments issued by TRS.
TRS recommends attaching a voided check in the space below. Please use tape. Do not staple or paper clip.
Teacher Retirement System of Texas
Page 2 of 2
FX**
\
Application for Service Retirement
ffiffi$kffi
TRS30 (02-20)
ffiffi#'
Austin, TX 78701-2698
(800) 223-8778
M.trs.texas.gov
month you want your retirement to be
This form must be received by TRS by the last day of the second calendar month following the
effective. lnitial any corrections to avoid possible disputes.
TRS Participant lD or
Social Security Number
Name
SECTION
I I
A.
SELECTION OF RETIREMENT DATE
I
l- I
I
I
I
RetirementDate(MM-yyyy)-yourretirementwillbeeffectiveonthelastdayofthemonth
your retirement effective date'
that you select. you must teiminate all employment with all rRS-covered employers no later than
with rRS-covered employers
The bnly exception to this requirement is if you select a May retirement date; then, all employment
must be terminated no later than June 15th.
SECTION
B.
SELECTION OF RETIREMENT ANNUITY PAYMENT PLAN
you the estimated gross dollar amount
Refer to the written retirement annuity estimates you received from TRS, which provide
plans:
following
payable under each plan. Check only ONE of
flstrnarrd
[OO,,on
my death'
Annuity Option - The maximum annuity payable throughout my life with these payments ceasing upon
reduced annuity shall
1 - A reduced annuity payable throughout my life with the provision that, upon my death the
primary beneficiary' I may
be continued throughout the life of and paid tJ the person designated on the reverse side as my
my annuity payment will
predeceases
me,
beneficiary
my
designated
lf
designate only one person as my Option 1 beneficiary.
increase to the Standard Annuity amount.
percent of the reduced
Oo,,on 2 - A reduced annuity payable throughout my life with the provision that, upon my death 50
my primary beneficiary'
as
side
reverse
on
the
person
designated
paio
the
io
annuity shall be continued throughoutihe life of a-nd
predeceases me, my annuity payment
beneficiary
my
designited
li
beneficiary.
2
p"r.o-n
option
as
my
only
on"
I may designate
will increase to the Standard Annuity amount.
ffi
t--J
a period of 60
3 - A reduced annuity payable throughout my life with the provision that, if my death occurs within
?fi6iltf,. after retirement, my beneficiary will receive the remainder of the 60 payments'
ffiOpgon
[*lgogon
ti6iltf,r
period of 120
4 - A reduced annuity payable throughout my life with the provision that, if my death occurs within a
after retirement, my beneficiary will receive the remainder of the 120 payments'
that, upon my death 75 percent of the reduced
t]go,,on 5 - A reduced annuity payable throughout my life with the provision
person
designated on the reverse side as mv primary
paid
the
to
ani
tifJ
of
the
throughtut
o"
-r*il;;,
lf
my designated beneficiary predeceases me, my
designate only-one person as my opiion 5 beneficiary.
oeneficiary. I may"ontinr"a
annuity payment will increase to the Standard Annuity amount.
Lump-Sum Option
lf you are eligible to elect a Partial Lump-Sum Option (PLSO), please review the TRS form 30P (Partial
permanently reduces
of
PLSo
Election
election.
this
for
eligible
packet
members
of
retirement
in
the
included
(pLso) Etection),
ihe monthly annuity payment available from each. of the payment plans listed above'
at TRS within 12 months
NoTE: This application will be void if all documents and forms required for retirement are not received
your earliest retirement
reason,
this
for
void
from the effective date of retirement indicated above. lf this application becomes
application, or the last day of
date can then be no earlier than the last day of the month in which rRS receives a new retirement
payments will be payable for the
either of the two preceding months, prorid"a employment has terminated. No annuity
intervening months.
Teacher Retirement System of Texas
Page 1 of 3
sEciloN c
- DESIGNATION OF BENEFICIARY(IES)
plan (Option 1, 2, 3, +, or
Designate your beneficiary for your retirement annuity payment
'and
!)
and for retiree survivor benefits below'
musi be received by TRS before your death. A blank designation of
To be effective, this form must bear your signaturl
you
any previous designation for the applicable benefits and leaves no
revokes
by
beneficiary on a TRS form that is signed
applicable law determines who will receive benefits after your death'
designation of beneficiary.
-a when no beneficiary is designated,
you designate below for your
lf you wish to designate beneficiary for retiiee srrriuor benefits different from the beneficiary
(TRS15).
Please see the enclosed
torm
Beneficiary
of
Designation
for
a
TRS
retirement annuity payment plan, please contact
lnstructions and tnformqtion for Designating a Beneficiary form (TRS677) for important information.
4 payments plans' Only one
Joint primary beneficiaries may be designated under the Standard Annuity Option, Option 3 or Option
5. Also, option 1 and
or
option
2,
1,
option
option
payments
under
continuing
primary beneficiary can be designated to receive
you.
younger
years
than
10
more
than
is
who
beneficiary
a
non-spouse
with
be
available
bption S may not
DESTGNATION OF PRIMARY BENEFICIARY(IES)
following person(s) as my primary
Unless I have provided otherwise by specific designation, I hereby designate the
(surviving
designated joint beneficiaries will
death
my
following
due
be
may
which
beneficiary(ies) to receive applicable benefits
receive equal portions, share and share alike):
SocialSecurity Number
Name
Relationship
Date of
Birth
Address
DESIGNATION OF ALTERNATE BENEFICIARY(IES)
predeceases me, waives the benefits'
Unless I have provided otherurise by specific designation, in the event the primary beneficiary
beneficiary(ies), to receive applicable
my
alternate
person(s)
as
following
I
designatJthe
or is ineligible to receive the benefits,
will receive equal portions,
joint
beneficiaries
alternate
benefits which may be due following my death (surviving-designated
share and share alike):
Social Security Number
Name
SECTION
D.
Relationship
Date of
Birth
Address
SIGNATURE
Your signature is required to complete this application for service retirement.
annuity payment plan
I hereby elect to retire effective the month and year indicated in section A of this form and to receive the for
my beneficiary(ies)
except
selected in Section B of this form. I further nereOy revoke any previous designations of beneficiaries
partial
survivor benefits
(PLSO),
retiree
or
option
Lump-sum
designated for the Deferred Retirement option etan lonoi), tre
it is
payable after retirement, if applicable. The designations I have made on this form in Section
received by TRS, provided it is received before my death.
c
shall be in effect from the date
plan except as provided by law and
I understand that after TRS makes a payment to rire, I cannot change my retirement annuity
cannot revoke mY retirement.
my retirement packet' I
that I received and read lhe tnstructions for service Retirement (TRS31) that was provided in
to
current and any
adhere
position
I
must
understand that upon retirement if I return to work for a TRS covered employer in any
and not
responsibility,
my
It
is
annuity.
monthly
my
potential changes to employment after retirement laws and rules or I may lose
annuity'
monthly
my
of
or
suspension
loss
in
the
my employerL, to undersland the limitations that can result
I acknowledge
Signature
Teacher Retirement System of Texas
Date
Page 2 of 3
I
Service Retirement Estimate of Benefits TRS 25
You will need to run this form from the TRS Website.
Retirement Estimate Calculator lnstructions
You will need to iog !n to rL{yFffiS to access the calculator" The calculator uses data frorn
your account such as your tier, years of service credit, highest average salaries, etc. You
can change that data if you want to explore different scenarios.
The Benefit Calculator is available under Planning Tools.
Step 1 - Select Your Benefit Type
Benefit Type - The Benefit Calculator allows you to run estimates for service
retirement, disability retirement, and active member death benefits.
SteB 2
-
Basic lnformation
Retirement Date - lf you are running a service or disability retirement estimate, you will
select your desired retirernent date" All TRS retirements are effective on the last day of
the month.
Death Date - An active member death estimate can be run if you would like to see the
benefits available it you were to die while working for a TRS-covered employer. ln the
calculator, you will select a death date.
Beneficiary lnformation - Enter the data for your proposed beneficiary. This can be the
same beneficiary that you currently have on file, or it can be someone else.
Note: This is not an official designation of beneficiary. lf you wish to change your
beneficiary, pfease print, complete, and rnailto TRS a form Tffi],-$*#es;gnafrpnruf"
ffienefieiary {pdfi.
Step 3
- Service
Credit & Salaries
Years of Service Credit - This field shows the current service credit that you have. You
can change this amount if you plan to work longer.
Highest Annual Salaries - These salaries represent the highest salaries reported to
TRS. You can change the amounts if you plan to work longer or know you will be earning
a higher salary in the future.
Step 4
- Calculation Results
OMB No. 1545-0074
,",.W'4P
Withhold i ng Gertificate
for Periodic Pension or Annuity Payments
(Rev. January 2022)
Department of the TreasurY
lnternal Revenue Service
(a)
Step 1:
Enter
Personal
lnformation
)
2022
Give Form W-4P to the payer of your pension or annuity payments'
(b) Social securitY number
First name and middle initial
City or town, state, and ZIP code
n
E
Single or Married filling separately '
Married filing jointly or Qualifying widow(er)
the costs of keeping up a home for yourself and
Head of household (Check oniy if-you're unmarried and pay more than half
a qualifying individual.)
pages 2 and 3 for more information on each
complete steps 24 ONLY if they apply to you; otherwise, skip to step 5.See
stepandhowtoelecttohavenofederalincometaxwithheld(ifpermitted)
Step 2:
lncome
iro,,' ,.loU
and/or
Multiple
Pensions/
i;;;iii".
pension/annuity, or (2) are married filing
Complete this step if you (1) have income from a job or more than one
page 2 for examples on how to
joi
pension/annuity'See
or a
jointly and your spouse receives income from a
comPlete SteP 2.
Do only one of the following.
(a) Reserved
(b) complete
(i)
(lncluding a
Spouse's
Job/
Pension/
Annuity)
for future use.
the items below'
annual
lf you (and/or your spouse) have one or more jobs, then enter th_e total taxable
jobs less
pay from all jo-bs, plus anyincome entered on Form W-4, Step 4(a), for the
"-0-"
the deductions entered on Fot. w-4, step 4(b), for the jobs. othenvise, enter
(ii)
lf you (and/or your spouse) have any other pensions/annuities that.pay less annually
' ' thin
this one, then enter the total annual taxable payments from all lower-paying
pensions/annuities. Otherwise, enter "-0-"
(iii)Addtheamountsfromitems(i)and(ii)andenterthetotalhere>
Submit a new Form w-4 for your
Tlp: To be accurate, submit a 2022 Form w-4p for all other pensions/annuities.
youi withholding since 2O1g.li you have self-employment income, see page 2'
job(s) if you
rrrr" not updated
on this form'
lf (b)(i) is blank and this pension/annuity pays the most annually, complete Steps 3-4(b)
form'
Otherwise, do not complete Steps 3-4(b) on this
Step 3:
Claim
[LiT"o"*
and Other
Credits
Step 4
(optional):
Other
Adjustments
Step 5:
Sign Here
filing jointly):
tf your total income will be $200,000 or less ($400,000 or less if married
Muttipty the number of quatifying chitdren under age 17 by $2,000
Multiply the number of other dependents by $500
Addothercredits,suchasforeigntaxcreditandeducationtaxcredits.>
and enter the
Add the amounts for qualifying children, other dependents, and other credits
total here
(a) other income (not from jobs or pension/annuity payments).lf you want tax withheld
this year that won,t have withholding, enter the amount of
on other income yo,
dividends
"^p""t
other income here. This may include interest, taxable social security, and
1U1
Oeductions. lf you expect to claim deductions other than the basic standard deduction
(c)
payment
Extra withholding. Enter any additional tax you want withheld fromeach
page 3 and enter
and want to reduce your withholding, use the Deductions Worksheet on
the result here
)
)
Date
Your signature (This form is not v?]ld unless you sign iO
ForPrivacyActandPaperworkReductionActNotice,seepage3.
Cat. No. 102257
rorm
W-4P
(zozz)
tI
I
fEACHEN
Notice of Final Deposit before Retirement
of Salaries
Gertification
Official
School
and
Wffiffi
SYSI€M OF TEMS
NEINEMffi
1000 Red River Street
Austin, TX 78701-2698
(800) 223-8778
\/W.trs.texas.gov
Participant Name
Social Security Number or TRS Participant lD
Name of Employing lnstitution
Was the participant in a TRS membership eligible position in the last school year of employment?
yes
(lf no, only complete effective date of resignation/termination and sign the form.)
No
Effective Date of Resignation/Termination
(month, day, year)
Semester dates for current school year or last school year of employment:
Beginning
Ending
Beginning
Ending
Total amount of salary during final month $
Final Member Contribution
report period.
of
will be included in the
$
(month)
Annual salary paid for final year (September 1 through termination date) $
Has any non-creditable compensation been converted to salary for the above named employee during any
No
of the last five school years before retirement? Yes
-
-
per month was converted to salary beginning
lf yes, $
(month and year)
(amount of conversion)
paid for final
CERTIFICATION: I certify the above is true and correct and that the reported "Annual salary
year', does not include ahy (1) payment for unused sick leave, vacation leave, or compensatory overtime;
(2) expense payment; (3)'aliowance; (4) fringe benefit; (5) drivers education courses in excess of $5,000
earned outside the reguiar contract; oi (o)tther non-creditable compensation referenced in TRS Rule
25.21(d). I also certify it.'rt no part of the salary reported for this member represents amounts converted
from non-creditable compensation during the last five school years, except as specified above.
Signature of Reporting Official
Printed Name of Reporting Official
Date
Title
Do not copy this form as it has been personalized for the TRS member who has requested it.
SEE REVERSE SIDE FOR INSTRUCTIONS
Teacher Retirement System of Texas
Page 1 of 2
Fr
\ Wffiffi
Partial Lump Sum OPtion Election
TRS30P (09-16)
ffi;,".,,=:
I
Austin, TX 78701-2698
(800) 223-8778
ilntfllffi iltilil liffi llliuilillilililliilffi il|ffi ll
ill
*.trs-texas.gov.
TRS Participant lD or
Social Security Number
Name
a PLSo
Eligibility for pLSO is described in the lnstructions for Service Retirement, form TRS31. lf you wish to elect
at TRS
received
be
must
form
This
form.
disiribution, you must complete both Sections A and B below, and sign this
ELECTED
BE
CANNoT
PLSo
is
laier.
whichever
before your iirst monthly annuity payment has been issued or is due,
BENEFIT.
OR CHANGED AFTER YOU HAVE BEGUN RECEIVING YOUR MONTHLY ANNUITY RETIREMENT
Part A
to
ln addition to the retirement annuity plan selected on my "Application for Service Retirement" form TRS30, I elect
of
paid
the
number
for
receive the following lump-sum payment, which is an amount equal to a Standard Annuity amount
months indicated:
fl,rmonths in one lump-sum payment ffi
ffirO months in one lump-sum payment fl
frrO
months in two annual PaYments
il
,U months in one lump-sum payment
,O months in two annual payments
aO months in three annual payments
payment. lf you
The tump sum or your first annual payment wilt be rssued at the same time as yourfirst monthly annuity
designate
beneficiary
to
the
ptSo
payments, any remaining balance witl be distributed
oi" gsloire you reieive a1 of your
on the Deiignation of Beneficiary for pafilal Lump-Sim Payment(s) (form TRS12L), or to the beneficiary designated to
in that order.
receive your retirement benefits,-or to the beneficiary etigibte to receive death and suruivor benefits,
PATt B: TAX INFORMATION REGARDING PARTIAL LUMP'SUM OPTION (PLSO) DISTRIBUTION
lf you are electing a partial lump-sum option distribution, please refer to the enclosed "special Tax Notice Regarding
your Rollover Op-tions under the Teacher Retirement System" which explains federal income tax laws. lf you have
professional
questions or do not understand the tax notice, we urge you to contact the lnternal Revenue Service or a tax
for advice.
I elect
to have my PLSO distribution paid in the following manner:
paid direcgy to me (20% will be withheld for federal income taxes. I understand that 30% will be withheld for federal
mailed to a
income taxes if I am not a U.S. citizen or a resident alien of the U.S. and I request that my PLSO be
a U.S. tax
under
foreign address, unless I qualify for a reduced tax withholding rate or exempt from tax withholding
provide
any
and
withholding
from
treat!. lf so, I must notify TRS of my eligibility for reduced withrrolding or exemption
req uired documentation)
Rollover payment into an eligibte retirement plan . TRS will provide you with the Partial Lump-Sum
date.
Option oistriuution Rollover El6ction (form TRS5B0) no earlier than two months before your retirement
Part C: NOTICE TO MEMBER AND MEMBER'S ACKNOWLEDGEMENT
I acknowledge receipt of the estimated reduction to my annuity caused by my electing a PLSQ -aM receipt of the
I hereby elect
estimate of the available partial lump-sum amounts (refei to "Service Retirement Estimate" form TRS25).
in Part
I
elected
paid
manner
the
in
PLSO
pLSo
the
have
to
distribution selected in Part R of tnis form and
to receive the
permanently
will
be
annuity
retirement
monthly
my
B of this form. I understand that because of my PLSO election,
on form TRS25 are
reduced as described on my retirement estimate, TRS25. I also understand that the amounts shown
with a PLSO
annuity
reduced
a
to
receive
payment.
I
elect
prior
to
estimated and subject to audit and adjustment
the payment
payment
due
or
is
the
date
the
of
later
the
after
distribution. I understand that I cannot change this election
is made.
Signature
Teacher Retirement System of Texas
Date
tu
\ Tm$
Service Retirement Estimate
*Th;E is &w'gx€wtgle of uLg2s L.,:1,, f ?:t I i L<4W-* tlts
-t-l"e--^
tl-r*
;;J;
^Lg*u .
I tsv*fi
Austrn, lX 78701-269U
(800) 2?3-8778
e^
!
.,
Name:
r's2s{06"151
$-.:il'r-:
F*r-*
ra
TRS Participant
HffiflflilhtiffiP,41ff#ilffifl1d#*1ffiffiffi[$l
lD:
Important lnformation: The following calculations are based on service credit and salary information contained in your
file at the Teacher Retirement System ffRS). Please notify TRS if any figures differ from your personal records and
explain the differences. The lasl annual salary is usually estimated. Your annuity will be recatculated after your
employer repotts your exact final salary- Annual salaries used in this estirnate are subject to audit and
-
adiustment by TRS.
ESTIMATE
tD:
*
Membership
Tier:
1
Retirement Date:
45t31/2019
Age of Member at Retirement: 64
Beneficiary:
Spouse
Beneficiary
Age:
61
CALCULAT]NG YOUR ANNUITY
Highestannualsalaries: 2018-19
$72,050
2417-18
2416-17
$68,936
$67,900
Highest average salary: $69,629
Years of service credit: 25
25X2.300a
Tolalservice:
57.50o/o
$69,629 X 57.50o/o = $40,037 Standard Annuiiy per year (gross)
$40,037 / 12 = $3,336.39 Standard Annuity per month (gross)
lncludes no additional service credit
I-;
Retirement
Payment Plans
r
No PLSO elected
Partial Lump
Sum Option
TRS-Care Eligibility: Yes
PLSO equal to 12
months elected
s40,036.68
(PL$o)
Plus Reduced Lifetime Monthly Annuities As Follows
t
Standard
Annuity
Option 1
Option 2
Option 3
Option 4
Option 5
$3,336,39
$2,997.75
$2,880.31
$2,587.95
*ff,777.71
$3,307.03
$3,229.96
$2,982.40l
$2,971.37
$2,902.12
$2,679.69
$2,320"13l
$2,463.62
$2,635.37
$2,002.96
149.83
$2,299.71
,l
Teacher Retirement System of Texas
aos7772A
Page 1 of 3
t.*e flt- f"lr'"^
Z ttfnsfrwt-f,-ons
(o
Formw-4P (2022)
2L8 h
Page 2
General lnstructions
Step 2. Use this step if you have at least one of the following:
income from a job, income from more than one pension/annuity,
Section references are to the lnternal Revenue Code.
and/or a spouse (if married filing jointly) that receives income
from a job/pension/annuity. The following examples will assist
you in completing Step 2.
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 of form. Complete Form W-4P to have payers
withhold the correct amount of federal income tax from your
periodic pension, annuity (including commercial annuities),
profrt-sharing and stock bonus plan, or IRA payments. Federal
income tax withholding applies to the taxable part of these
payments. Periodic payments are made in installments at
regular intervals (for example, annually, quarterly, or monthly)
over a period of more than 1 year. Don't use Form W-4P for a
nonperiodic payment (note that distributions from an IRA that
are payable on demand are treated as nonperiodic payments) or
an eligible rollover distribution (including a lump-sum pension
payment). lnstead, use Form W-4R, Withholding Certificate for
Nonperiodic Payments and Eligible Rollover Distributions, for
these payments/distributions. For more information on
withholding, see Pub. 505, Tax Withholding and Estimated Tax.
Choosing not to have income tax withheld. You can choose
not to have federal income tax withheld from your payments by
writing "No Withholding" on Form W-4P in the space below
Step 4(c). Then, complete Steps 1a, lb, and 5. Generally, if you
are a U.S. citizen or a resident alien, you are not permitted to
elect not to have federal income tax withheld on payments to be
delivered outside the United States and its possessions.
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. lf too much
tax is withheld, you will generally be due a refund when you file
your tax return. lf your tax situation changes, or you chose not
to have federal income tax withheld and you now want
withholding, you should submit a new Form W-4P.
Caution: lf you have too
Self-employment. Generally, you will owe both income and
self-employment taxes on any self-employment income you (or
you and your spouse) receive. lf you do not have a job and want
to pay these taxes through withholding from your payments,
you should enter the self-employment income in Step 4(a). Then
compute your self-employment tax, divide that tax by the
number of payments remaining in the year, and include that
resulting amount per payment in Step 4(c). You can also add
half of the annual amount of self-employment tax to Step 4(b) as
a deduction. To calculate self-employment tax, you generally
multiply the self-employment income by 14J3% (this rate is a
quick way to figure your self-employment tax and equals the
sum of the 12.4o/o social security tax and lhe 2.9% Medicare tax
multiplied by 0.9235). See Pub. 505 for more information,
especially if your self-employment income multiplied by 0.9235
is over $147,000.
Payments to nonresident aliens and foreign estates. Do not
use Form W-4P. See Pub.515, Withholding of Taxon
Nonresident Aliens and Foreign Entities, and Pub. 519, U.S. Tax
Guide for Aliens, for more information.
Tax relief for victims of terrorist attacks' lf your disability
payments for injuries incurred as a direct result of a terrorist
attack are not taxable, write "No Withholding" in the space
below Step 4(c). See Pub. 3920, Tax Relief for Victims of
Terrorist Attacks, for more details.
Specific lnstructions
Step 1(c). Check your anticipated filing status. This will
determine the standard deduction and tax rates used to
compute your withholding.
ta
Example 7. Bob, a single filer, is completing Form W-4P for
pension
that pays $50,000 a year. Bob also has ajob that pays
a
$25,000 a year. Bob has no other pensions or annuities. Bob will
enter $25,000 in Step 2(b)(i) and in Step 2(bxiii).
lf Bob also has $1,000 of interest income, which he entered on
Form W-4, Step 4(a), then he will instead enter $26,000 in Step
2(b)(i) and in Step 2(bxiii). He will make no entries in Step 4(a) on
this Form W-4P.
Example 2. Carol, a single filer, is completing Form W-4P for
a pension that pays $50,000 a year. Carol does not have ajob,
but she also receives another pension for $25,000 a year (which
pays less annually than the $50,000 pension). Carol will enter
$25,000 in Step 2(b)(ii) and in Step 2(bxiii).
lf Carol also has $1,000 of interest income, then she will enter
$1,000 in Step 4(a) of this Form W-4P.
Example 3. Don, a single filer, is completing Form W-4P for
a pension that pays $50,000 a year. Don does not have a job, but
he receives another pension for $75,000 a year (which pays
more annually than the $50,000 pension). Don will not enter any
amounts in Step 2.
lf Don also has $'l ,000 of interest income, he won't enter that
amount on this Form W-4P because he entered the $1 ,000 on
the Form W-4P for the higher paying $75,000 pension'
Example 4. Ann, a single filer, is completing Form W-4P for
a pension that pays $50,000 ayear. Ann also has a job that pays
$25,000 a year and another pension that pays $20,000 ayeatAnn will enter $25,000 in Step 2(b)(i), $20,000 in step 2(b)(ii), and
$45,000 in Step 2(bxiii).
lf Ann also has $1,000 of interest income, which she entered on
Form W-4, Step 4(a), she will instead enter $26,000 in Step 2(b)
(i), leave Step 2(b)(ii) unchanged, and enter $46,000 in Step 2(b)
(iii). She will make no entries in Step 4(a) of this Form W-4P.
lf you are married filing jointly, the entries described above do
not change if your spouse is the one who has the job or the
other pension/annuity instead of you.
Muttipte sources of pensions/annuities or iobs- lf you
(or if manied fiting iointly, you and/or your spouse) have a
job(s), do NOT comptete Sfeps 3 through 4(b) on Form W-4P'
lnstead, complete Sfeps 3 through 4(b) on the Form W-4 for
the job. lf you (or if manied filing iointly, you and your spouse)
do not have a iob, complefe Sfeps 3 through 4(b) on Form
W-4P for onty the pension/annuity that pays the most annually'
Leave those steps blank for the other pensions/annuities.
Step 3. This step provides instructions for determining the
amount of the child tax credit and the credit for other dependents
that you may be able to claim when you file your tax return. To
qualify for the child tax credit, the child must be under age 17 as
of December 31, must be your dependent who generally lives with
you for more than half the year, and must have the required social
iecurity number. You may be able to claim a credit for other
dependents for whom a child tax credit can't be claimed, such as
an older child or a qualifying relative. For additional eligibility
requirements for these credits, see Pub. 501, Dependents,
Standard Deduction, and Filing lnformation. You can also include
other tax credits for which you are eligible in this step, such as
the foreign tax credit and the education tax credits. lncluding these
credits will increase your payments and reduce the amount of any
refund you may receive when you file your tax return.
Page 3
FormW-4P (2022)
Specific lnstructio ns (continued)
Step 4 (optional).
Step 4(a). Enter in this step the total of your other estimated
income ior t-ne year, if any. You shouldn't include amounts from
any job(s) or pension/annuity payments. lf you complete Step
+(jl, VoL iikely won't have to make estimated tax payments for
tfrai income. lf you prefer to pay estimated tax rather than
having tax on other income withheld from your pension, see
Form'1040-ES, Estimated Tax for lndividuals'
Step 4(b). Enter in this step the amount from the Deductions
Worksheet, line 6, if you expect to claim deductions other than
the basic standard deduction on your 2022laxreturn and want
to reduce your withholding to account for these deductions'
This includes itemized deductions, the additional standard
Step 4(b)
1
$25,900 if you're married filing jointly or qualifying widow(er)
$t g,+OO if you're head of household
$12,950 if you're single or married filing separately
lf line 1 is greater th anline 2, subtract line 2 from line
line
4
Deductions Worksheet (Keep for your records')
(Form 1040))' Such deductions
Enter an estimate of your 2022 ilemized deductions (from Schedule A
and local taxes (up to
may include qualifyini home mortgage interest, charitable contributions, state
your
income
of
7
5%
of
in
excess
$f fi,OOOl, and medical expenses
e
Enter:
f
t
3
-
deduction forthose 65 and over, and other deductions such as
for student loan interest and lRAs.
Step 4(c). Enter in this step any additional tax you want
withheld from each payment' Entering an amount here will
reduce your payments and will either increase your refund or
reduce any amount of tax that you owe.
Note: lf you don't give Form W-4P to your payer, you don't
provide an SSN, or the IRS notifies the payer that you gave an
incorrect SSN, then the payer will withhold tax from your
payments as if your filing status is single with no adjustments in
bteps Z througir 4. For payments that began before 2022, your
curient withho-lding election (or your default rate) remains in
effect unless you submit a new Form W-4P'
1
I
)
t
and enter the result here. lf line 2 is greater than
I, enter"-0.'
1$
2$
3$
lf line 3 equals zero, and you (or your spouse) are 65 or older, enter:
r
$1,750 if you're single or head of household.
you is under age 65.
$r,+oo lf you're a qualifying widow(er) or you,re married and one of
older'
or
$2,800 if you're married and both of you are age 65
Otheruise, enter "-0-'. See Pub. 505 for more information
.
.
and certain other adjustments
Enter an estimate of your student loan interest, deductible IRA contributions,
part lt of Schedub 1 (Form 1040)). See Pub. 505 for more information.
ffrom
Add lines 3 through 5. Enter the result here and in Step 4(b) on Form W-4P.
Privacy Act and Paperwork Reduction Act Notice' We ask for
the information on this form to carry out the lnternal Revenue laws
of the United States. You are required to provide this information
only if you want to (a) request federal income tax withholding from
pension or annuity payments based on your filing status and
adjustments; (b) iequest additional federal income tax withholding
from your pension or annuity payments; (c) choose not to have
federil income tax withheld, when permitted; or (d) change a
previous Form W-4P. To do any of the aforementioned, you are
required by sections 3405(e) and 6109 and their regulations to
provide the information requested on this form' Failure to provide
this information may result in inaccurate withholding on your
payment(s). Failureto provide a properly completed form will result
in yow being treated as a single person with no other entries on
the form; providing fraudulent information may subject you to
penalties.
Routine uses of this information include giving it to the
Department of Justice for civil and criminal litigation, and to
cities, states, the District of Columbia, and U'S' commonwealths
and possessions for use in administering their tax laws' We may
4$
5$
6$
also disclose this information to other countries under a tax treaty,
tofederalandstateagenciestoenforcefederalnontaxcriminal
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 retaiing to a form or its instructions must be retained as
long as their contents may become materialin the
adriinistration of any lnternal 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.
for making this form simpler, we
lf you
-be have suggestions
happy to hear from you. See the instructions for your
would
income tax return.
!l