Form 1289 "Tax Withholding Election" - California

What Is Form 1289?

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 July 1, 2018;
  • 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 fillable version of Form 1289 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 1289 "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
TTY: (877) 249-7442
www.calpers.ca.gov
California Public Employees' Retirement System
Tax Withholding Election
Section 1: Payee Information
Last Name
SSN
First Name, Middle Initial
Or CalPERS ID
Street Address
Phone Number
(
)
City
State
ZIP Code
Please Specify Which Account(s) You Would Like This Election Applied To:
Retirement - Your Own Account
Death Benefit - Option Portion
Survivor Continuance Benefit
Community Property Benefit
Other _________________________________
Section 2: Federal Tax Withholding 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) Marital status and total number of allowances you are claiming for withholding from each pension or annuity payment.
(You also may designate an additional dollar amount on line 3.)
Marital status:
S i n g l e
M a r r i e d
M a r r i e d , b u t w it h h o l d a t h i g h e r S in g l e r a t e .......... _______________________
(Must enter no. of allowances.)
3) Additional amount, if any, you want withheld from each pension or annuity payment.....................$ _______________________
(Note: You cannot enter an amount here without entering a marital status and the number, including zero, of allowances on line 2.)
Section 3: State Tax Withholding 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, 3, or 4.)
2) Marital status and total number of allowances you are claiming for withholding from each pension or annuity payment.
(You also may designate an additional dollar amount on line 3.)
Marital status:
S i n g l e
M a r r i e d
H e a d O f H o u s e h o ld ............................................. _______________________
(Must enter no. of allowances.)
3) Additional amount, if any, you want withheld from each pension or annuity payment.....................$ _______________________
(Note: You cannot enter an amount here without entering a marital status and 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: Signature and Date
Signature
Date
my|CalPERS 1289 (07/2018)
P.O. Box 942715 Sacramento, CA 94229-2715
888 CalPERS (or 888-225-7377) | Fax: (800) 959-6545
TTY: (877) 249-7442
www.calpers.ca.gov
California Public Employees' Retirement System
Tax Withholding Election
Section 1: Payee Information
Last Name
SSN
First Name, Middle Initial
Or CalPERS ID
Street Address
Phone Number
(
)
City
State
ZIP Code
Please Specify Which Account(s) You Would Like This Election Applied To:
Retirement - Your Own Account
Death Benefit - Option Portion
Survivor Continuance Benefit
Community Property Benefit
Other _________________________________
Section 2: Federal Tax Withholding 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) Marital status and total number of allowances you are claiming for withholding from each pension or annuity payment.
(You also may designate an additional dollar amount on line 3.)
Marital status:
S i n g l e
M a r r i e d
M a r r i e d , b u t w it h h o l d a t h i g h e r S in g l e r a t e .......... _______________________
(Must enter no. of allowances.)
3) Additional amount, if any, you want withheld from each pension or annuity payment.....................$ _______________________
(Note: You cannot enter an amount here without entering a marital status and the number, including zero, of allowances on line 2.)
Section 3: State Tax Withholding 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, 3, or 4.)
2) Marital status and total number of allowances you are claiming for withholding from each pension or annuity payment.
(You also may designate an additional dollar amount on line 3.)
Marital status:
S i n g l e
M a r r i e d
H e a d O f H o u s e h o ld ............................................. _______________________
(Must enter no. of allowances.)
3) Additional amount, if any, you want withheld from each pension or annuity payment.....................$ _______________________
(Note: You cannot enter an amount here without entering a marital status and 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: Signature and Date
Signature
Date
my|CalPERS 1289 (07/2018)
P.O. Box 942715 Sacramento, CA 94229-2715
888 CalPERS (or 888-225-7377) | Fax: (800) 959-6545
TTY: (877) 249-7442
www.calpers.ca.gov
California Public Employees' Retirement System
Tax Withholding Election – Instructions
SECTION 1: MEMBER/PAYEE INFORMATION
Read these instructions before completing this
Enter your full name, CalPERS ID or Social Security
form. Print or type in dark ink. Initial all corrections.
Number, mailing address, and telephone number. For
an estate, enter the estate's Employer Identification
PURPOSE: Use this form to tell CalPERS the amount
Number instead of the Social Security Number. List the
of federal and state income tax to withhold from your
payments you want your withholding preferences
benefit payments.
applied to. You may complete a separate form if you
want to elect different withholding amounts for different
Complete the Tax Withholding Election form
types of payments. Refer to your benefits application or
(my|CalPERS 1289) and submit it to CalPERS as soon
warrant for account information.
as possible. Because your tax situation may change
from year to year, you may want to recalculate your
SECTION 2 & 3: Federal Tax Withholdings Election
withholdings each year and submit a new form.
& State Tax Withholdings Election
If you are receiving a lifetime monthly benefit, indicate
COMPLETING THIS FORM: To calculate the proper
your federal and state tax withholding preferences in
amount of tax withholding, use IRS Form W-4P (which
this section. If you do not complete this section,
has a worksheet and instructions) at irs.gov for your
CalPERS must withhold federal and state income tax
federal withholding, and EDD Form DE 4P at edd.ca.
from your monthly benefit payments as married
gov for your state withholding. If you do not want any
claiming three withholding allowances.
federal or state tax withheld, skip the worksheets and
go directly to the Tax Withholding Election form
To withhold federal income tax, you must designate the
(my|CalPERS 1289).
number of withholding allowances and indicate your
marital status by checking the appropriate box. You
California state income tax will not be automatically
cannot designate a specific dollar amount only to be
withheld from your benefit payment if you reside
withheld for federal tax. However, you may designate
outside of California. If you do not live in California but
an additional dollar amount to be withheld. Use the IRS
think you may be liable for California state income tax,
Form W-4P worksheet to calculate your federal tax
you may request CalPERS to withhold state income
withholding. If you do not want any federal income tax
tax.
withheld. check the appropriate box.
CHOOSING NOT TO HAVE INCOME TAX
If you want state income tax withheld, indicate the
WITHHELD: You (or in the event of death, your
number of withholding allowances and your marital
beneficiary or estate) can choose not to have federal
status by checking the appropriate box, and specify an
income tax withheld from your payments that are not
additional flat dollar amount, if any. Use the EDD Form
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 ten
Publication 505, Tax Withholding and Estimated Tax, at
percent of the amount of federal withholding computed
irs.gov. It explains your estimated tax requirements and
pursuant to Section 3405 of the Internal Revenue
describes penalties in detail. You may be able to avoid
Code, complete line 4 in section 3 by writing 10%.
quarterly estimated tax payments by having enough tax
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.
my|CalPERS 1289 (07/2018)
P.O. Box 942715 Sacramento, CA 94229-2715
888 CalPERS (or 888-225-7377) | Fax: (800) 959-6545
TTY: (877) 249-7442
www.calpers.ca.gov
California Public Employees' Retirement System
Tax Withholding Election – Instructions
IMPORTANT INFORMATION
QUESTIONS
For information about federal tax withholding, contact
PAYMENTS TO FOREIGN PERSONS AND
the IRS at 800-829-1040 or visit irs.gov. For information
PAYMENTS DELIVERED OUTSIDE THE U.S.
about state tax withholding, visit the California
For U.S. citizens and residents, federal tax withholding
Franchise Tax Board website at ftb.ca.gov.
is required on monthly or lump-sum payments delivered
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.
Income, IRS Publication 919, How Do I Adjust My Tax
See IRS Publication 505 at irs.gov for details.
Withholding, and FTB Publication 1005, Pension and
Annuity Guidelines, or contact a qualified tax
For nonresident aliens, nonresident alien beneficiaries,
professional.
and foreign estates, in the absence of a tax treaty
exemption, monthly or lump-sum payments generally
Find a tax withholding calculator at irs.gov/individuals to
are subject to a 30 percent federal withholding tax on
help determine your withholding allowances. Also see
the taxable portion of payments from U.S. sources. See
the allowance worksheets at irs.gov/pub/irs-pdf/fw4p.
IRS Publication 515, Withholding of Tax on Nonresident
pdf and edd.ca.gov/pdf_pub_ctr/de4p.pdf.
Aliens and Foreign Entities, and IRS Publication 519,
U.S. Tax Guide for Aliens, at irs.gov.
If you are a foreign person, you should submit Form
W-8BEN, 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 a 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.
my|CalPERS 1289 (07/2018)
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 identification
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 benefits 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 confidentiality.
Social Security numbers are collected on a
mandatory and voluntary basis. If this is CalPERS’
Your Rights
first 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,
files 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 Officer at
identification purposes, we may be unable to
400 Q Street, Sacramento, CA 95811 or call us
verify eligibility for benefits without the number.
at 888 CalPERS (or 888-225-7377).
May 2016
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