Form 4029 (2008) - Application For Exemption From Social Security And Medicare Taxes And Waiver Of Benefits Page 2

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Form 4029 (Rev. 11-2008)
General Instructions
How to show exemption from self-employment taxes on Form
1040. If the IRS returned your copy of Form 4029 marked
Section references are to the Internal Revenue Code.
“Approved,” write “Form 4029” on the “Self-employment tax” line in
the Other Taxes section of Form 1040, page 2.
Purpose of form. Form 4029 is used by members of recognized
religious groups to apply for exemption from social security and
Instructions to Employers
Medicare taxes. The exemption is for individuals and partnerships
(when all the partners have approved certification).
Employees without Form 4029 approval. If you have employees
Note. The election to waive social security benefits, including
who do not have an approved Form 4029, you must withhold the
Medicare benefits, applies to all wages and self-employment income
employee’s share of social security and Medicare taxes and pay the
earned before and during the effective period of this exemption and
employer’s share.
is irrevocable for that period.
Reporting exempt wages. If you are a qualifying employer with one
Who may apply. You may apply for this exemption if you are a
or more qualifying employees, you are not required to report wages
member of, and follow the teachings of, a recognized religious group
that are exempt under section 3127. Do not include these wages for
(as defined below). If you already have approval for exemption from
social security and Medicare tax purposes on Form 941, Employer’s
self-employment taxes, you are considered to have met the
QUARTERLY Federal Tax Return, Form 943, Employer’s Annual Tax
requirements for exemption from social security and Medicare taxes
Return for Agricultural Employees, or on Form 944, Employer’s
on wages and do not need to file this form.
ANNUAL Federal Tax Return. If you have received an approved Form
4029, check the box on line 4 of Form 941 (line 3 of Form 944) and
You are not eligible for this exemption if you received social
write “Form 4029” in the empty space below the check box. If you file
security benefits or payments, or if anyone else received these
Form 943 and have received an approved Form 4029, write “Form
benefits or payments based on your wages or self-employment
4029” to the left of the wage entry spaces for Total wages subject to
income. However, you can file Form 4029 and be considered for
social security taxes and Total wages subject to Medicare taxes.
approval if you paid back any benefits you received.
Preparation of Form W-2. When you prepare Form W-2 for a
Recognized religious group. A recognized religious group must
qualifying employee, enter “Form 4029” in the box marked “Other.”
meet all the following requirements:
Do not make any entries in the boxes for Social security wages,
It is conscientiously opposed to accepting benefits of any private
Medicare wages and tips, Social security tax withheld, or Medicare
or public insurance that makes payments in the event of death,
tax withheld for these employees.
disability, old age, or retirement; makes payments for the cost of
medical care; or provides services for medical care (including social
Privacy Act and Paperwork Reduction Act Notice. The Privacy Act
security and Medicare benefits).
of 1974 and the Paperwork Reduction Act of 1980 require that when
It has provided a reasonable level of living for its dependent
we ask you for information we must first tell you our legal right to
ask for the information, why we are asking for it, and how it will be
used. We must also tell you what could happen if we do not receive
It has existed continuously since December 31, 1950.
it and whether your response is voluntary, required to obtain a
Certification. In order to complete the certification portion under
benefit, or mandatory under the law.
Part I, you need to enter your religious group (on the first line)
Our authority to ask for information is Internal Revenue Code
followed by the religious district or congregation (on the second line).
sections 6001, 6011, and 6012(a) which require you to file a return or
For example, if you enter “Old Order Amish” as your religious group,
statement with us for any tax for which you are liable. Your response
then you would enter “Conewango Valley North District,”
is mandatory under these sections. Section 6109 requires that you
“Conewango Valley West District,” etc., on the second line as the
provide your social security number on what you file. This is so we
district. However, if you are Anabaptist or Mennonite, enter the name
know who you are, and can process your return and other papers.
of your religious group as “Unaffiliated Mennonite Churches” or
You must fill in all parts of the tax form that apply to you. You are
“Eastern Pennsylvania Mennonite Church,” etc., and the
not required to provide the information requested on a form that is
congregation as “Antrim Mennonite Church (Anabaptist)” or “Bethel
subject to the Paperwork Reduction Act unless the form displays a
Mennonite Church (Mennonite),” on the second line.
valid OMB control number. Books or records relating to a form or its
When to file. File Form 4029 when you want to apply for exemption
instructions must be retained as long as their contents may be
from social security and Medicare taxes. This is a one-time election.
material in the administration of any Internal Revenue law.
Keep your approved copy of Form 4029 for your permanent records.
Generally, tax returns and return information are confidential, as
stated in section 6103. However, section 6103 allows or requires the
Where to file. Send the original and two copies of Form 4029 to:
Internal Revenue Service to disclose or give the information shown
Social Security Administration, Security Records Center, Attn:
on your tax return to others as described in the Code. For example,
Religious Exemption Unit, P.O. Box 7, Boyers, PA 16020. If you are
we may disclose your tax information to the Department of Justice
no longer a member or no longer follow the teachings of the religious
to enforce the tax laws, both civil and criminal, to cities, states, the
group and your exemption is no longer effective, send a letter to
District of Columbia, U.S. commonwealths or possessions. We may
Internal Revenue Service, Ministerial Waivers Unit, DP - N837, P.O.
also disclose this information to other countries under a tax treaty, to
Box 16325, Philadelphia, PA 19114-0425.
federal and state agencies to enforce federal nontax criminal laws, or
Social security number. Enter your social security number on line 2.
to federal law enforcement and intelligence agencies to combat
If you do not have a social security number, file Form SS-5,
Application for a Social Security Card, at your local social security
Please keep this notice with your records. It may help you if we
office. You can order Form SS-5 by calling 1-800-772-1213 or by
ask for other information. If you have any questions about the rules
visiting the website for Social Security at
for filing and giving information, please call or visit any Internal
Effective period of exemption. An approved exemption granted to
Revenue Service office.
employers and employees is effective on the first day of the first
The time needed to complete and file this form will vary depending
quarter after the quarter in which Form 4029 is filed. An approved
on individual circumstances. The estimated average time is:
exemption granted to self-employed individuals is effective when
Recordkeeping, 6 min.; Learning about the law or the form, 19
granted and applies for all years for which you satisfy the
min.; Preparing the form, 18 min.; Copying, assembling, and
requirements. The exemption will continue as long as you, or in the
sending the form to the SSA, 16 min.
case of wage payments, both the employee and employer continue to
If you have comments concerning the accuracy of these time
meet the exemption requirements.
estimates or suggestions for making this form simpler, we would be
Signature. The completed Form 4029 must be signed and dated by
happy to hear from you. You can write to the Internal Revenue
the applicant in Part I and by the authorized representative of the
Service, Tax Products Coordinating Committee,
religious group/district/congregation in Part II.
SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-6526,
Washington, DC 20224. Do not send the form to this address.
Instead, see Where to file on this page.


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