Form 4029 - Application For Exemption From Social Security And Medicare Taxes And Waiver Of Benefits Page 2
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Form 4029 (Rev. 9-2014)
Page
General Instructions
Signature. The completed Form 4029 must be signed and dated by the
applicant in Part I and by the authorized representative of the religious group/
district/congregation in Part II.
Section references are to the Internal Revenue Code.
How to show exemption from self-employment taxes on Form 1040. If
Purpose of form. Form 4029 is used by members of recognized religious
the IRS returned your copy of Form 4029 marked “Approved,” write “Form
groups to apply for exemption from social security and Medicare taxes. The
4029” on the “Self-employment tax” line in the Other Taxes section of Form
exemption is for individuals and partnerships (when all the partners have
1040, page 2.
approved certification).
Note. The election to waive social security benefits, including Medicare
Instructions to Employers
benefits, applies to all wages and self-employment income earned before
and during the effective period of this exemption and is irrevocable for that
Employees without Form 4029 approval. If you have employees who do
period.
not have an approved Form 4029, you must withhold the employee’s share
Who may apply. You may apply for this exemption if you are a member of,
of social security and Medicare taxes and pay the employer’s share.
and follow the teachings of, a recognized religious group (as defined below).
Reporting exempt wages. If you are a qualifying employer with one or more
If you already have approval for exemption from self-employment taxes, you
qualifying employees, you are not required to report wages that are exempt
are considered to have met the requirements for exemption from social
under section 3127. Do not include these wages for social security and
security and Medicare taxes on wages and do not need to file this form.
Medicare tax purposes on Form 941, Employer’s QUARTERLY Federal Tax
You are not eligible for this exemption if you received social security
Return, Form 943, Employer’s Annual Tax Return for Agricultural Employees,
benefits or payments, or if anyone else received these benefits or payments
or on Form 944, Employer’s ANNUAL Federal Tax Return. If you have
based on your wages or self-employment income. However, you can file
received an approved Form 4029, check the box on line 4 of Form 941 (line
Form 4029 and be considered for approval if you paid back any benefits you
3 of Form 944) and write “Form 4029” in the empty space below the check
received.
box. If you file Form 943 and have received an approved Form 4029, write
“Form 4029” to the left of the wage entry spaces for Total wages subject to
Recognized religious group. A recognized religious group must meet all the
social security taxes and Total wages subject to Medicare taxes.
following requirements:
Preparation of Form W-2. When you prepare Form W-2 for a qualifying
• It is conscientiously opposed to accepting benefits of any private or public
employee, enter “Form 4029” in the box marked “Other.” Do not make any
insurance that makes payments in the event of death, disability, old age, or
entries in the boxes for Social security wages, Medicare wages and tips,
retirement; makes payments for the cost of medical care; or provides
Social security tax withheld, or Medicare tax withheld for these employees.
services for medical care (including social security and Medicare benefits).
• It has provided a reasonable level of living for its dependent members.
Privacy Act and Paperwork Reduction Act Notice. We ask for the
• It has existed continuously since December 31, 1950.
information on this form to carry out the Internal Revenue laws of the United
Certification. In order to complete the certification portion under Part I,
States. We need this information to ensure that you are complying with these
you need to enter your religious group (on the first line) followed by the
laws and to allow us to figure and to collect the right amount of tax. Applying
religious district or congregation (on the second line). For example, if you
for an exemption from social security and Medicare taxes is voluntary.
enter “Old Order Amish” as your religious group, then you would enter
Providing the requested information, however, is mandatory if you apply for
“Conewango Valley North District,” “Conewango Valley West District,” etc.,
the exemption. Our legal right to ask for the information requested on this
on the second line as the district. However, if you are Anabaptist or
form is Internal Revenue Code sections 6001, 6011, 6012(a) and 6109. Code
Mennonite, enter the name of your religious group as “Unaffiliated Mennonite
section 6109 requires that you provide your social security number on what
Churches” or “Eastern Pennsylvania Mennonite Church,” etc., and the
you file. If you fail to provide all or part of the information requested on Form
congregation as “Antrim Mennonite Church (Anabaptist)” or “Bethel
4029, your application may be denied. If you provide false or fraudulent
Mennonite Church (Mennonite),” on the second line.
information, you may be subject to penalties.
When to file. File Form 4029 when you want to apply for exemption from
Generally, tax returns and return information are confidential, as stated in
social security and Medicare taxes. This is a one-time election. Keep your
section 6103. However, section 6103 allows or requires the Internal Revenue
approved copy of Form 4029 for your permanent records.
Service to disclose or give the information shown on your tax return to others
as described in the Code. For example, we may disclose your tax information
Where to file. Send the original and two copies of Form 4029 to:
to the Department of Justice to enforce the tax laws, both civil and criminal,
Social Security Administration
to cities, states, the District of Columbia, U.S. commonwealths or
Security Records Branch,
possessions for use in administering their tax laws. We may also disclose
Attn: Religious Exemption Unit
this information to other countries under a tax treaty, to federal and state
P.O. Box 7
agencies to enforce federal nontax criminal laws, or to federal law
Boyers, PA 16020
enforcement and intelligence agencies to combat terrorism.
If you are no longer a member or no longer follow the teachings of the
Please keep this notice with your records. It may help you if we ask for
religious group, your exemption is no longer effective. Notify the Internal
other information. If you have any questions about the rules for filing and
Revenue Service by sending a letter to:
giving information, please call or visit any Internal Revenue Service office.
Department of the Treasury
The time needed to complete and file this form will vary depending on
Internal Revenue Service Center
individual circumstances. The estimated average time is: Recordkeeping, 6
Philadelphia, PA 19255-0733
min.; Learning about the law or the form, 19 min.; Preparing the form, 18
min.; Copying, assembling, and sending the form to the SSA, 16 min.
Social security number. Enter your social security number on line 2. If you
do not have a social security number, file Form SS-5, Application for a Social
If you have comments concerning the accuracy of these time estimates or
Security Card, at your local social security office. You can order Form SS-5
suggestions for making this form simpler, we would be happy to hear from
by calling 1-800-772-1213 or by visiting the website for Social Security at
you. You can send us comments from Click on
More Information and then click on Give us feedback. Or you can send your
comments to Internal Revenue Service, Tax Forms and Publications Division,
Effective period of exemption. An approved exemption granted to
1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send
employers and employees is effective on the first day of the first quarter after
the form to this address. Instead, see Where to file, earlier.
the quarter in which Form 4029 is filed. An approved exemption granted to
self-employed individuals is effective when granted and applies for all years
for which you satisfy the requirements. The exemption will continue as long
as you, or in the case of wage payments, both the employee and employer
continue to meet the exemption requirements.
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