Form PERS-PRS-W-4P/DE-4P "Tax Withholding Election" - California

What Is Form PERS-PRS-W-4P/DE-4P?

This is a legal form that was released by the California Public Employees' Retirement System - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2013;
  • The latest edition provided by the California Public Employees' Retirement System;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form PERS-PRS-W-4P/DE-4P by clicking the link below or browse more documents and templates provided by the California Public Employees' Retirement System.

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Download Form PERS-PRS-W-4P/DE-4P "Tax Withholding Election" - California

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P.O. Box 942715 Sacramento, CA 94229-2715
888 CalPERS (or 888-225-7377) | Fax: (800) 959-6545
www.calpers.ca.gov
Judges’ and Legislators’ Retirement System
Tax Withholding Election
Section 1: Member Payee Information
Payee Name (Last, First, Initial)
CalPERS ID/SSN (Required)
Payee Address
Payee Phone Number
(
)
City
State
Zip Code
Please Specify Which Account(s) You Would Like This Election Applied To:
Retirement
Benefit Beneficiary/Survivor Monthly Benefit
Community Property Benefit
Other
Section 2: Federal Tax Withholdings Election
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 of allowances.)
Marital status:
Single
Married
Married, but withhold at higher Single rate.
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.) . . . . ▶ $
Section 3: State Tax Withholdings Election
Complete the following applicable lines:
1) Check here if you do not want any State income tax withheld from your pension or annuity. (Do not complete line 2, 3,or 4)▶
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 of allowances.)
Marital status:
Single
Married
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.) . . . . ▶ $
4) I want this designated amount withheld from each pension or annuity payment. (Do not complete lines 1, 2 or 3) $
Section 4: Payee Signature
Payee Signature:
Date:
P.O. Box 942715 Sacramento, CA 94229-2715
888 CalPERS (or 888-225-7377) | Fax: (800) 959-6545
www.calpers.ca.gov
Judges’ and Legislators’ Retirement System
Tax Withholding Election
Section 1: Member Payee Information
Payee Name (Last, First, Initial)
CalPERS ID/SSN (Required)
Payee Address
Payee Phone Number
(
)
City
State
Zip Code
Please Specify Which Account(s) You Would Like This Election Applied To:
Retirement
Benefit Beneficiary/Survivor Monthly Benefit
Community Property Benefit
Other
Section 2: Federal Tax Withholdings Election
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 of allowances.)
Marital status:
Single
Married
Married, but withhold at higher Single rate.
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.) . . . . ▶ $
Section 3: State Tax Withholdings Election
Complete the following applicable lines:
1) Check here if you do not want any State income tax withheld from your pension or annuity. (Do not complete line 2, 3,or 4)▶
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 of allowances.)
Marital status:
Single
Married
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.) . . . . ▶ $
4) I want this designated amount withheld from each pension or annuity payment. (Do not complete lines 1, 2 or 3) $
Section 4: Payee Signature
Payee Signature:
Date:
Tax Withholding Election—Instructions
SECTION 1: MEMBER/PAYEE INFORMATION
Read these instructions before completing this form.
Enter your full name, CalPERS ID or Social Security
Print or type in dark ink. Initial all corrections.
Number, mailing address, and telephone number. For an
estate, enter the estate’s Employer Identification Number
PURPOSE: Use this form to tell CalPERS the amount of
instead of the Social Security Number. List the payments
federal and state income tax to withhold from your
you want your withholding preferences applied to. You may
benefit payments.
complete a separate form if you want to elect different
withholding amounts for different types of payments. Refer to
Complete the Tax Withholding Election form
your benefits application or warrant for account information.
(PERS-PRS-W-4P/DE-4P) and submit it to CalPERS as
soon as possible. Because your tax situation may change
SECTION 2 & 3: Federal Tax Withholdings Election & State
from year to year, you may want to recalculate your
Tax Withholdings Election
withholdings each year and submit a new form.
If you are receiving a lifetime monthly benefit, indicate your
federal and state tax withholding preferences in this section.
COMPLETING THIS FORM: To calculate the proper
If you do not complete this section, CalPERS must withhold
amount of tax withholding, use IRS Form W-4P (which
federal and state income tax from your monthly benefit
has a worksheet and instructions) at irs.gov for your
payments as married claiming three withholding allowances.
federal withholding, and EDD Form DE 4P at
edd.ca.gov for your state withholding. If you do not want
To withhold federal income tax, you must designate the
any federal or state tax withheld, skip the worksheets
number of withholding allowances and indicate your
and go directly to the Tax Withholding Election form
marital status by checking the appropriate box.
(PERS-PRS-W-4P/DE-4P).
You cannot designate a specific dollar amount only to be
withheld for federal tax. However, you may designate an
California state income tax will not be automatically withheld
additional dollar amount to be withheld. Use the IRS
from your benefit payment if you reside outside of California.
Form W-4P worksheet to calculate your federal tax
If you do not live in California but think you may be liable for
withholding. If you do not want any federal income tax
California state income tax, you may request CalPERS
withheld, check the appropriate box.
to withhold state income tax.
If you want state income tax withheld, indicate the
CHOOSING NOT TO HAVE INCOME TAX WITHHELD:
number of withholding allowances and your marital
You (or in the event of death, your beneficiary or estate)
status by checking the appropriate box, and specify an
Can choose not to have federal income tax withheld from
additional flat dollar amount, if any. Use the EDD Form
your payments that are not eligible for rollover.
DE-4P at edd.ca.gov/pdf_pub_ctr/de4p.pdf to calculate
state tax withholding. You may designate a dollar
CAUTION: There are penalties for not paying enough
amount to withhold instead of claiming withholding
federal and state tax during the year, either through
allowances. If you do not want any state income tax
withholding or estimated tax payments. See IRS
withheld, check the appropriate box. If you want
Publication 505, Tax Withholding and Estimated Tax, at
ten percent of the amount of federal withholding
irs.gov. It explains your estimated tax requirements and
computed pursuant to Section 3405 of the Internal
describes penalties in detail. You may be able to avoid
Revenue Code, complete line 4 in section 3 by writing
quarterly estimated tax payments by having enough tax
10%.
withheld from your benefit payment.
SECTION 4: REQUIRED SIGNATURE
Sign and date your form before submitting it to
CalPERS. Your form will not be accepted without your
signature and date.
California Public Employees’ Retirement System
PERS-PRS-W-4P/DE-4P (09/13)
www.calpers.ca.gov
Tax Withholding Election—Instructions
IMPORTANT INFORMATION
QUESTIONS
PAYMENTS TO FOREIGN PERSONS AND PAYMENTS
For information about federal tax withholding, contact
DELIVERED OUTSIDE THE U.S.
the IRS at 800-829-1040 or visit irs.gov. For information
For U.S. citizens and residents, federal tax withholding
about state tax withholding, contact the California
is required on monthly or lump-sum payments delivered
Franchise Tax Board at 888-792-4900 or visit ftb.ca.gov.
to you outside the U.S. or its possessions. You cannot
Also read IRS Publication 575, Pension and Annuity
waive federal income tax withholding in this situation.
See IRS Publication 505 at irs.gov for details.
Income, IRS Publication 919, How Do I Adjust My Tax
Withholding, and FTB Publication 1005, Pension and
Annuity Guidelines, or contact a qualified tax
For nonresident aliens, nonresident alien beneficiaries,
and foreign estates, in the absence of a tax treaty
professional.
exemption, monthly or lump-sum payments generally are
subject to a 30 percent federal withholding tax on the
Find a tax withholding calculator at irs.gov/individuals
taxable portion of payments from U.S. sources. See IRS
to help determine your withholding allowances. Also see
Publication 515, Withholding of Tax on Nonresident
the allowance worksheets at irs.gov/pub/irs-pdf/fw4p.pdf
Aliens and Foreign Entities, and IRS Publication 519,
and edd.ca.gov/pdf_pub_ctr/de4p.pdf.
U.S. Tax Guide for Aliens, at irs.gov.
If you are a foreign person, you should submit Form
re, Certificate of Foreign Status of Beneficial
Owner for United States Tax Withholding, to CalPERS
before receiving any payments.
ANNUAL STATEMENT OF FEDERAL INCOME TAX
WITHHELD
By January 31 of next year (and each following year),
CalPERS will furnish a statement to you on Form
1099-R showing the total amount of benefit payments
and the total federal income tax withheld during the
preceding year. If you are a foreign person who has
provided CalPERS with Form W-8BEN, CalPERS
instead will furnish a statement to you on Form 1042-S,
Foreign Person’s U.S. Source Income Subject to
Withholding, by March 15 of the following year.
California Public Employees’ Retirement System
PERS-PRS-W-4P/DE-4P (09/13)
www.calpers.ca.gov
Privacy Notice
The privacy of personal information is of the utmost importance to CalPERS.
The following information is provided to you in compliance with the Information
Practices Act of 1977 and the Federal Privacy Act of 1974.
Information Purpose
Social Security numbers are used for the
following purposes:
The information requested is collected pursuant
1.
Enrollee identifcation
to the Government Code (sections 20000 et seq.)
2. Payroll deduction/state contributions
and will be used for administration of Board
3. Billing of contracting agencies for employee/
duties under the Retirement Law, the Social
employer contributions
Security Act, and the Public Employees’ Medical
4. Reports to CalPERS and other state agencies
and Hospital Care Act, as the case may be.
5. Coordination of benefts among carriers
Submission of the requested information is
6. Resolving member appeals, complaints,
mandatory. Failure to comply may result in
or grievances with health plan carriers
CalPERS being unable to perform its functions
regarding your status.
Information Disclosure
Please do not include information that is
Portions of this information may be transferred
not requested.
to other state agencies (such as your employer),
physicians, and insurance carriers, but only
Social Security Numbers
in strict accordance with current statutes
regarding confdentiality.
Social Security numbers are collected on a
mandatory and voluntary basis. If this is CalPERS’
Your Rights
frst request for disclosure of your Social Security
number, then disclosure is mandatory. If your
You have the right to review your membership
Social Security number has already been provided,
fles maintained by the System. For questions
disclosure is voluntary. Due to the use of Social
about this notice, our Privacy Policy, or your rights,
Security numbers by other agencies for
please write to the CalPERS Privacy Ofcer at
identifcation purposes, we may be unable to
400 Q Street, Sacramento, CA 95811 or call us
verify eligibility for benefts without the number.
at 888 CalPERS (or 888-225-7377).
May 2016
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