Iowa Form W-4p - Withholding Certificate For Pension Or Annuity Payments - 2011
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1Iowa W-4P Instructions
Eligibility Requirements
You are single and your income is $24,000 or less, or (2) Your
A partial exemption is provided to qualified Iowa residents
filing status is other than single and your combined income is
receiving pensions, annuities, self-employed retirement benefits,
$32,000 or less. Note: The amount of any pension exclusion or
deferred compensation, IRA distribution, or other retirement
Social Security Phase-out exclusion must be added back to
benefits. To qualify you must be 55 years of age or older,
income for purposes of determining the low income exemption.
disabled or a surviving spouse or other survivor of an individual
Only one spouse must be 65 or older to qualify for the
who would have qualified for the exclusion in the tax year. To
exemption.
be considered disabled you must be receiving the retirement
Taxpayers under 65: You are exempt if (1) Your net income is
income on the basis of a documented disability or you must
less than $5,000 and you are claimed as a dependent on another
meet federal or state criteria for disability. Social Security
person’s Iowa return; or (2) You are single and your net income
benefits are not covered by this exemption. Federal Civil
is $9,000 or less and you are not claimed as a dependent on
Service annuitants who want Iowa tax withheld from federal
another person’s Iowa return; or (3) Your filing status is other
pensions should call the Office of Personnel Management toll-
than single and your combined net income is $13,500 or less.
free at 1-888-767-6738 or e-mail retire@opm.gov.
Claiming No Exemption
Withholding Choices
If this box is checked, Iowa income tax will be withheld on the
An Iowa resident may choose to have Iowa tax withheld on the
entire amount of taxable benefits received.
annual taxable amount, exempting $6,000. Married taxpayers
Withholding Rates
may exclude up to $12,000 from the annual taxable amount.
Only the pension income of the spouse who meets the
Payers have the option of withholding at the rate of 5% or using
eligibility requirements can be excluded. If no choice is
the published withholding formulas or withholding tables.
made, you will automatically be given a $6,000 exemption. If
Where To Send The Iowa W-4P
you are receiving retirement income from more than one source,
Return the completed form to the person who handles your
you are still entitled to claim only a maximum $6,000/$12,000
pension/retirement check, or, if planning to retire, your current
exemption.
payroll officer. If you are a federal employee, return it to OPM.
Low Income Exemption From Tax
Your choice will remain in effect until you complete a new
Taxpayers 65 years of age or older: You are exempt if (1)
W-4P. Withholding agents will retain the completed W-4P as
required under Iowa rule 701-38.3(1).
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Iowa Department of Revenue
2011 Iowa W-4P
Withholding Certificate for Pension or Annuity Payments
Name: _________________________________________________ SSN: _________________________
Address: ______________________________________________________________________________
City: _____________________________________ State: ____________________ Zip: ______________
Signature: __________________________________________________________ Date: _____________
Are you an Iowa resident? ............................................................................................
Yes
No
Iowa income tax can be withheld only for Iowa residents.
I choose not to have income tax withheld from my pension/annuity .......................................................
NOTE: If you are an Iowa resident and the taxable portion of your annual distribution is greater
than $6,000 ($12,000 married Iowa filers), Iowa tax must be withheld if federal tax is being withheld
unless you qualify for the low income exemption described in the instructions above.
I choose to have Iowa income tax withheld from my pension/annuity at a rate of 5% (or based on the
published withholding formulas if the payer so chooses). Select one of the following:
• claiming no exemption (see instructions)..........................................................................................
• exempting $6,000 in benefits each year ...........................................................................................
• exempting $12,000 in benefits each year (married – status 2, 3, or 4 – Iowa filers only) ................
.00
Additional amount, if any, to be withheld from each benefit payment (whole dollars): $ ______________
See instructions for eligibility requirements.
44-020 (07/16/10)
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