Form Iowa W-4p - Withholding Certificate For Pension Or Annuity Payments

Iowa W-4P Instructions

Eligibility Requirements:

A partial exemption is provided to qualified Iowa residents receiving pensions, annuities, self-employed retirement

benefits, deferred compensation, and other retirement benefits. To qualify you must be 55 years of age or older, disabled

or a surviving spouse or other survivor of an individual who would have qualified for the partial exemption in the tax

year. To be considered disabled you must be receiving the retirement income on the basis of a documented disability or

you must meet federal or state criteria for disability. Social Security benefits are not covered by this exemption.

Federal Civil Service annuitants who want Iowa tax withheld from federal pensions should call the Office of Personnel

Management toll-free at 1-888-767-6738 or e-mail them at retire@opm.gov.

Withholding Choices:

An Iowa resident may choose to have Iowa tax withheld on the annual taxable amount, exempting $6,000. Married

taxpayers may exclude up to $12,000 from the annual taxable amount. If no choice is made, you will automatically be

given a $6,000 exemption. If you are receiving retirement income from more than one source, you are still entitled to

claim only a maximum $6,000/$12,000 exemption.

Claiming No Exemption:

If this box is checked, Iowa income tax will be withheld on the entire amount of taxable benefits received.

Withholding Rates:

Payers have the option of withholding at the rate of 5% or using the published withholding formulas or withholding

tables.

Where To Send The Iowa W-4P:

Return the completed form to the person who handles your pension/retirement check, or, if planning to retire, your

current payroll officer. If you are a federal employee, return it to OPM. Your choice will remain in effect until you

complete a new W-4P. Withholding agents will retain the completed W-4P as required under Iowa rule 701-38.3(1).

Iowa Department of Revenue

2010 Iowa W-4P

Withholding Certificate for Pension or Annuity Payments

Name: _________________________________________________ SSN: _________________________

Address: ______________________________________________________________________________

City: _____________________________________ State: ____________________ Zip: ______________

Signature: __________________________________________________________ Date: _____________

Are you an Iowa resident? ............................................................................................

Yes

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.

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): $ ______________

44-020 (06/04/09)

See instructions for eligibility requirements.

Form Iowa W-4p - Withholding Certificate For Pension Or Annuity Payments - 2010

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