Form W-4NA "Nebraska Income Tax Withholding Certificate for Nonresident Individuals" - Nebraska

What Is Form W-4NA?

This is a legal form that was released by the Nebraska Department of Revenue - a government authority operating within Nebraska. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2017;
  • The latest edition provided by the Nebraska Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form W-4NA by clicking the link below or browse more documents and templates provided by the Nebraska Department of Revenue.

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Download Form W-4NA "Nebraska Income Tax Withholding Certificate for Nonresident Individuals" - Nebraska

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Nebraska Income Tax Withholding
FORM
W-4NA
Certificate for Nonresident Individuals
Use Federal Forms 1099-MISC or 1042-S.
Payor’s Name and Location Address
Payee’s Name and Location Address
Name of Nebraska Payor
Payee’s First Name and Initial
Last Name
Address (Number and Street, or Rural Route and Box Number)
Address (Number and Street, or Rural Route and Box Number)
City, Town, or Post Office
State
Zip Code
City, Town, or Post Office
State
Zip Code
Nebraska ID Number
Social Security Number
21 —
• Lines 1 and 2, and 6 through 10 must be completed by the PAYOR.
1 Dates the services were performed in Nebraska .................................................................................... 1
2 Total payments for the personal services performed in Nebraska ......................................................... 2
• Lines 3 through 5 and line 11 may be completed by the PAYEE (attach additional schedule if necessary).
3 List the types and amounts of ordinary and necessary business expenses reasonably related
to Nebraska income (see instructions):
Type of Expense
Amount
3
Enter total line 3 amount here ........................................................................
4 List the names, addresses, Social Security numbers, and amounts paid to others for performances
or appearances and other fees reasonably related to Nebraska income (see instructions):
Address
Social Security No.
Amount Paid
Name
4
Enter total line 4 amount here ........................................................................
5 Total business expenses and payments for which you are claiming an
expense deduction (total of lines 3 and 4) ......................................................
5
6 50% limitation on expense deduction (line 2 amount multiplied by .50) .......
6
7 Enter the amount from line 5 or line 6, whichever is less ...................................................................... 7
8 Payments subject to Nebraska income tax withholding (line 2 minus line 7) ........................................ 8
9 If the amount on line 8 is less than $28,000, multiply the amount by .04 and enter
the result on line 9 — the amount to be withheld ................................................................................ 9
10 If the amount on line 8 is $28,000 or greater, multiply the amount by .06 and enter
the result on line 10 — the amount of income tax withholding .......................................................... 10
• Allocation to partners, shareholders, or members subject to Nebraska income tax (attach additional schedule if necessary).
11 Enter in the space provided the partner’s, shareholder’s, or member’s name, Social Security number or federal ID number,
percent of allocation, and the amount of Nebraska income tax withholding allocated to each partner, shareholder, or member.
Social Security Number or
Percent of
Allocation Amount
Names of Partners, Shareholders, or Members
Federal ID Number
Allocation
TOTALS
100%
Under penalties of perjury, I declare that I have been authorized to make this statement and that the information disclosed in determining the amount of
individual income tax to be withheld and allocated from the payment received for personal services performed in Nebraska is, to the best of my knowledge and
belief, correct and complete.
sign
here
Signature of Payee or Authorized Agent
Signature of Preparer Other than Payee
Date
Date
Phone Number
City
State
Zip Code
8-442-1988 Rev. 1-2017
31
Supersedes 8-442-1988 Rev. 11-2012
RESET
PRINT
Nebraska Income Tax Withholding
FORM
W-4NA
Certificate for Nonresident Individuals
Use Federal Forms 1099-MISC or 1042-S.
Payor’s Name and Location Address
Payee’s Name and Location Address
Name of Nebraska Payor
Payee’s First Name and Initial
Last Name
Address (Number and Street, or Rural Route and Box Number)
Address (Number and Street, or Rural Route and Box Number)
City, Town, or Post Office
State
Zip Code
City, Town, or Post Office
State
Zip Code
Nebraska ID Number
Social Security Number
21 —
• Lines 1 and 2, and 6 through 10 must be completed by the PAYOR.
1 Dates the services were performed in Nebraska .................................................................................... 1
2 Total payments for the personal services performed in Nebraska ......................................................... 2
• Lines 3 through 5 and line 11 may be completed by the PAYEE (attach additional schedule if necessary).
3 List the types and amounts of ordinary and necessary business expenses reasonably related
to Nebraska income (see instructions):
Type of Expense
Amount
3
Enter total line 3 amount here ........................................................................
4 List the names, addresses, Social Security numbers, and amounts paid to others for performances
or appearances and other fees reasonably related to Nebraska income (see instructions):
Address
Social Security No.
Amount Paid
Name
4
Enter total line 4 amount here ........................................................................
5 Total business expenses and payments for which you are claiming an
expense deduction (total of lines 3 and 4) ......................................................
5
6 50% limitation on expense deduction (line 2 amount multiplied by .50) .......
6
7 Enter the amount from line 5 or line 6, whichever is less ...................................................................... 7
8 Payments subject to Nebraska income tax withholding (line 2 minus line 7) ........................................ 8
9 If the amount on line 8 is less than $28,000, multiply the amount by .04 and enter
the result on line 9 — the amount to be withheld ................................................................................ 9
10 If the amount on line 8 is $28,000 or greater, multiply the amount by .06 and enter
the result on line 10 — the amount of income tax withholding .......................................................... 10
• Allocation to partners, shareholders, or members subject to Nebraska income tax (attach additional schedule if necessary).
11 Enter in the space provided the partner’s, shareholder’s, or member’s name, Social Security number or federal ID number,
percent of allocation, and the amount of Nebraska income tax withholding allocated to each partner, shareholder, or member.
Social Security Number or
Percent of
Allocation Amount
Names of Partners, Shareholders, or Members
Federal ID Number
Allocation
TOTALS
100%
Under penalties of perjury, I declare that I have been authorized to make this statement and that the information disclosed in determining the amount of
individual income tax to be withheld and allocated from the payment received for personal services performed in Nebraska is, to the best of my knowledge and
belief, correct and complete.
sign
here
Signature of Payee or Authorized Agent
Signature of Preparer Other than Payee
Date
Date
Phone Number
City
State
Zip Code
8-442-1988 Rev. 1-2017
31
Supersedes 8-442-1988 Rev. 11-2012
Instructions
Purpose. Form W-4NA is used by payors of nonresident individuals to compute Nebraska income tax withheld
from payments for personal services in Nebraska. Personal services include, but are not limited to: payments to
nonresident entertainers; individual athletes; performers; consultants; public speakers; corporate board directors; or other
professional services.
Who Must Withhold Income Tax. Any person paying a nonresident for services substantially performed in Nebraska
may be required to withhold Nebraska income tax. A person must withhold Nebraska income tax if the payee is not an
employee; the payment is not subject to federal income tax withholding; and the payor is either (1) maintaining an office or
transacting business within Nebraska and making a payment or payments of more than $600, or (2) making a payment or
payments in excess of $5,000.
Form W-4NA. Cooperation between the payor and payee is necessary to complete the
Nebraska Income Tax Withholding
Certificate for Nonresident Individuals, Form
W-4NA. Compute the amount of income tax to be withheld from payments
using Form W-4NA. The income tax withholding is reported to the person performing the personal services and the
Department in the same manner as wages or other payments subject to income tax withholding. Use Federal Form 1099-
MISC and Forms
941N
and W-3N.
Nonresident Individuals. Nonresident individuals can use Form W-4NA to report their business expenses and payments
in performing personal services in Nebraska. If there are other payees receiving payments for services performed in Nebraska
as nonresident individuals, each must complete a separate Form W-4NA.
A payor or withholding agent who pays a nonresident alien individual for providing personal services and who has withheld
federal income tax on Federal Form 1042-S, Foreign Person’s U.S. Source Income Subject to Withholding, must also
withhold state income tax using Nebraska Form W-4NA.
A nonresident alien whose country has a tax treaty with the U.S. may not be subject to nonresident income tax withholding.
The payor must obtain a written statement from the payee certifying the existence of a treaty exempting U.S. income earned
by the alien from federal or state income tax.
Payments to a corporation are subject to the income tax withholding requirements if 80% or more of the voting stock of
the corporation is held by the shareholders who are performing personal services. Payments to a partnership or LLC are
subject to the income tax withholding requirements if 80% or more of the capital interest or profits interest of the partnership
or LLC is held by the partners or members who are performing personal services. All payments and withholding are deemed
to be made to the individuals performing the personal services. The Form 1099-MISC should be issued only to an individual,
not an entity. See line 11 instructions.
The completed Form W-4NA is a part of the payor’s records and must be kept with other income tax withholding
records. Federal Forms 1099-MISC or 1042-S will be issued by the payor based on the information on the completed Form
W-4NA. The Forms 1099-MISC, or 1042-S state copies, will be included with the Form W -3N, Nebraska Reconciliation of
Income Tax Withheld, filed with the Department.
Penalties. A penalty may be imposed, in addition to other penalties provided by law, on a nonresident individual for giving
false information to a payor regarding payments subject to income tax withholding, if the information could result in the
amount of income tax withheld totaling less than 75% of the income tax liability on these payments. A penalty may also be
imposed on any payor who either knowingly uses false information or who maintains records which show the information
is false.
The penalties will equal: (a) the amount of tax evaded, not collected, or not accounted for and paid over; and (b) an additional
amount up to $1,000.
Taxpayer Assistance. Questions may be directed to the Nebraska Department of Revenue, PO Box 98915, Lincoln,
Nebraska 68509-8915. Call 800-742-7474 in Nebraska and Iowa, or 402-471-5729.
Payor Instructions
Name And Location Address. The payor must complete the payee’s name, address, and Social Security number or
federal employer ID number of the nonresident individual, corporation, partnership, or LLC.
Line 2. Enter the total amount of the payment for personal services. Include any amounts paid to the service provider as
reimbursement for expenses.
Line 9. If line 8 is less than $28,000, compute the amount of income tax to be withheld. Otherwise, enter zero (-0-) and
compute the amount of income tax to be withheld using line 10 instructions.
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Payee Instructions
Line 3. Ordinary and necessary business expenses reasonably related to Nebraska income. Expenses
listed on this schedule are amounts paid for travel, lodging, meals, and other ordinary and necessary expenses incurred
while earning income in Nebraska.
Line 4. Payments made to others for performances, or appearances and other fees reasonably
related to Nebraska income. Payments listed are amounts such as a percentage paid to agents or payments made
to others assisting in the performance. This does not include payments to partners, shareholders, or members.
Note: If persons providing personal services also hire others to assist them, they may have an income tax withholding
responsibility on the payments made to such persons. If the persons are hired as employees, then Nebraska’s regular
income tax withholding rules apply. If the persons are not employees and are nonresidents of Nebraska, then the
person paying them must follow the guidelines in Form W-4NA. Contact the Department to receive an Income Tax
Withholding Certificate to withhold Nebraska income tax.
Line 11. If the payment was payable to a nonresident partnership, corporation, or LLC, the Nebraska income tax
withheld, computed on line 9 or line 10, must be distributed to the appropriate nonresident partners, shareholders,
or members.
The payee must use line 11 to distribute the income tax withheld to the appropriate nonresident partners, shareholders,
or members. Federal Forms 1099-MISC or 1042-S will be issued by the payor to each partner, shareholder, or member
and must be attached to payee's individual income tax return to receive proper credit.
Signatures. The nonresident individual, partner, corporate officer, or member must sign this certificate, and include his
or her phone number. If the payee authorizes another person to sign, there must be a power of attorney on file with the
Department or attached to this certificate. Any person paid to prepare Form W‑4NA must also sign the certificate.
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