Fillable Form 9452 - Filing Assistance Program

Form 9452 (2016)

Page

• Were born before July 1, 1945, and you

General Instructions

Social security benefits

received less than the minimum required

1. Social security payments are NOT

Purpose of Form

distribution from your qualified retirement

taxable unless one-half of all your net

plan.

Use Form 9452 to see if you must file a

social security benefits plus your

2. You must file if you have a gain or

Federal income tax return for 2016.

adjusted gross income and any tax

loss on the sale of stocks or a gain from

However, see Special Situations below

exempt interest total more than $25,000

the sale of bonds or your home.

before you begin.

if you are single (or married filing

3. You must file if you owe social

separately and you lived apart from your

Special Situations

security and Medicare tax on tips you did

spouse for all of 2016), or $32,000 if

not report to your employer.

If any of the following special situations

married filing a joint return. Enter only the

apply to you, you must file a Federal

taxable portion of your social security

4. You must file if you owe uncollected

income tax return for 2016 even if your

benefits on line 6, Other taxable income.

social security and Medicare or Tier 1

gross income is less than the amount

Railroad Retirement (RRTA) tax on tips

Part II

shown in the chart in Part Il.

you reported to your employer or on

group-term life insurance.

Use the table in Part II to determine your

Advance payment of the premium tax

filing requirement.

credit. If you purchased health care

5. You must file if you owe alternative

coverage from a Health Insurance

minimum tax.

If you were born on January 1, 1952,

Marketplace, advanced payments of the

you are considered to be age 65 at the

6. You must file if you owe recapture

premium tax credit may have been made

end of 2016.

taxes.

to the health insurer to help pay for the

insurance coverage of you, your spouse,

Taxable self-employment income

Paperwork Reduction Act Notice.

or your dependent. If advance payments

You must file if you had net self-

Your use of this worksheet is optional. It

of the premium tax credit were made, you

employment income of at least $400.

is provided to aid you in determining

must file a 2016 tax return and Form

whether you must file a Federal tax

8962, Premium Tax Credit, even if you

Church employee income

return.

are otherwise not required to file. If you

You must file if you had wages of

You are not required to provide the

enrolled someone who is not claimed as

$108.28 or more from a church or

information requested on a form that is

a dependent on your tax return or for

qualified church-controlled organization

subject to the Paperwork Reduction Act

more information, see the instructions for

that is exempt from employer social

unless the form displays a valid OMB

Form 8962.

security and Medicare taxes.

control number. Books or records

Withholding. If you had taxes withheld

If someone else can claim you as a

relating to a form or its instructions must

from a job or your annuity or pension

dependent, you may have to file a tax

be retained as long as their contents

income, and you want to get a refund of

return even if your own income is

may become material in the

the withheld taxes, you will need to file.

much lower than the total gross

administration of any Internal Revenue

income amounts in Part Il. If your

Earned Income Credit

law. Generally, tax returns and return

gross income was $4,050 or more,

information are confidential, as required

1. If you wish to apply for the earned

you usually cannot be claimed as a

income credit you will need to file.

by Internal Revenue Code section 6103.

dependent unless at the end of 2016

The time needed to complete this

2. You must file if you received any

you were under age 19 (or a student

worksheet will vary depending on

advance earned income credit payments

under age 24).

individual circumstances. The estimated

from your employer. These payments

average time is 30 minutes.

should be shown in box 9 of your W-2

Specific Instructions

If you have comments concerning the

form.

accuracy of this time estimate or

Part I

Special taxes

suggestions for making this form

Complete Part I to figure your gross

simpler, we would be happy to hear from

1. You must file if you owe any special

income for 2016.

you. You can write to the Internal

tax on a qualified retirement plan

Revenue Service, Tax Products

Gross income means all income you

including an Individual Retirement

Coordinating Committee, SE:W:CAR:

received in the form of money, goods,

Arrangement (IRA), Archer Medical

MP:T:T:SP, 1111 Constitution Ave. NW,

property, and services that is not exempt

Savings Account (MSA), or Coverdell

IR-6406, Washington, DC 20224.

from tax including any income from

Education Savings Account (ESA). You

sources outside the United States (even

may owe this tax if you:

if you may exclude part or all of it).

• Received an early distribution from (a)

an IRA or other qualified retirement plan,

(b) an annuity, or (c) a modified

endowment contract entered into after

June 20, 1988.

• Made excess contributions to your IRA,

Archer MSA, or Coverdell ESA.

• You received distributions from

Coverdell ESAs in excess of your

qualified higher education expenses.

Form 9452 - Filing Assistance Program - 2016 Page 2

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