Publication 915 - Social Security And Equivalent Railroad Retirement Benefits - Internal Revenue Service - 2001 Page 25
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28PAYER’S NAME, STREET ADDRESS, CITY, STATE, AND ZIP CODE
2001
STATEMENT FOR NONRESIDENT
PAYMENTS BY
THE RAILROAD
UNITED STATES RAILROAD RETIREMENT BOARD
ALIEN RECIPIENTS OF:
RETIREMENT
844 N RUSH ST CHICAGO IL 60611-2092
3.
Gross Social Security Equivalent
BOARD
Benefit Portion of Tier 1 Paid in
PAYER’S FEDERAL IDENTIFYING NO. 36-3314600
2001
1. Claim Number and Payee Code
4.
Social Security Equivalent Benefit
Portion of Tier 1 Repaid to RRB
in 2001
COPY C -
2. Recipient’s Identification Number
5.
Net Social Security Equivalent
Benefit Portion of Tier 1 Paid in
2001
FOR
RECIPIENT’S
Recipient’s Name, Street Address, City, State, and Zip Code
6.
Workers’ Compensation Offset in
RECORDS
2001
7.
Social Security Equivalent Benefit
THIS
Portion of Tier 1 Paid in 2000
INFORMATION
IS BEING
8.
Social Security Equivalent Benefit
FURNISHED
Portion of Tier 1 Paid for 1999
TO THE
INTERNAL
9.
Social Security Equivalent Benefit
REVENUE
Portion of Tier 1 Paid for Years
SERVICE.
Prior to 1999
10. Country
11. Rate of Tax
12.
Federal Tax Withheld
13.
Medicare Premium Total
FORM RRB-1042S
DO NOT ATTACH TO YOUR INCOME TAX RETURN
on Form RRB– 1099. However, if Form RRB– 1099 is not
resident of Switzerland, 85% of your benefits are taxed at a
required for your 2001 taxes, then this total will be shown
15% rate.
on Form RRB– 1099– R. Medicare premiums deducted
Under a treaty with India, benefits paid to individuals
who are both residents and nationals of India are exempt
from your social security benefits, paid by a third party, or
from U.S. tax if the benefits are for services performed for
paid by direct billing will not be shown in this box.
the United States, its subdivisions, or local government
authorities. See Publication 519 for more information on
Form RRB–1042S
nonresident aliens.
(Nonresident Aliens)
This form is for nonresident aliens. It contains the following
Box 12—Federal Tax Withheld
four additional items that do not appear on Form
The figure in this box is the total amount of U.S. federal
RRB – 1099.
income tax withheld from the SSEB portion of your tier 1
payments while you were a legal resident of the country in
Note. If your country of legal residence changed or your
tax withholding rate changed during the year, you may
box 10 in 2001. If you received more than one
Form–1042S for 2001, add the amounts in box 12 of all
receive more than one Form RRB–1042S. To determine
Forms–1042S to determine your total amount of U.S.
your total amounts for the year, you should add the
amounts shown on all Forms RRB–1042S you received
federal income tax withheld from SSEB payments for
2001. Tax is withheld for any month in which you were a
for that year.
nonresident alien (unless you claimed exemption under a
tax treaty).
Box 10—Country
The country where you maintain your legal residence is
Box 13—Medicare Premium Total
shown in this box. If you maintained legal residence in
more than one country during the year, you will receive a
This is for information purposes. This is the total amount of
Part B Medicare premiums deducted from your railroad
separate Form RRB– 1042S for each country of legal resi-
dence during the year.
retirement annuity payments shown on your Form
RRB–1042S for 2001. Medicare premium refunds are not
included in this total. The Medicare total is normally shown
Box 11—Rate of Tax
on Form RRB– 1042S. However, if Form RRB–1042S is
not required for your 2001 taxes, then this total will be
The figure in this box is the rate at which tax was withheld
shown on Form RRB– 1099–R. Medicare premiums de-
from 85% of the SSEB portion of tier 1 payments you
ducted from your social security benefits, paid by a third
received. If tax was withheld at more than one rate during
party, or paid by direct billing will not be shown in this box.
the year, you will receive a separate Form RRB–1042S for
each rate change during the year. The tax rate for most
You should contact your nearest RRB field office
TIP
nonresident aliens is 30%. The figure “0%” or “15%” may
(if you reside in the United States) or U.S. consu-
appear in this box if you claimed a tax treaty exemption.
late/embassy (if you reside outside of the United
Benefits received by residents of Canada, Egypt, Ger-
States) for assistance with your RRB tax statement inquir-
many, Ireland, Israel, Italy, Japan, Romania, and the
ies. If you have any questions about how to figure your
United Kingdom are exempt from U.S. tax. If you are a
taxable payments or what amounts to show on your in-
Page 25
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