Form Ct-W4p - Withholding Certifi Cate For Pension Or Annuity Payments

Social Security Beneﬁ t Adjustment Worksheet

Enter the amount you expect to enter on Form CT-1040 or Form CT-1040NR/PY, Line 1. ................................. ___________________

If your ﬁ ling status is single or ﬁ ling separately, is the amount on Line 1 $50,000 or more?



Yes Complete this worksheet.



N o

Do not complete this worksheet.*

If your ﬁ ling status is ﬁ ling jointly, qualifying widow(er) with dependent child, or head of household, is the amount on Line 1 $60,000 or more?



Yes Complete this worksheet.



N o

Do not complete this worksheet.*

*Enter the amount of federally taxable Social Security beneﬁ ts you expect to report on federal Form 1040, Line 20b, or federal Form 1040A,

Line 14b, on the 2013 Form CT-W4P Estimated Income Tax Worksheet, Line 2.

Enter the amount you reported on federal Publication 505, Tax Withholding and Estimated Tax, Worksheet 2–1,

2013 Estimated Tax Worksheet–Line 1, Expected Taxable Social Security and Railroad Retirement Beneﬁ ts, Line 1.

If Line A is zero or less, stop here. Otherwise, go to Line B.

Enter the amount you reported on federal Publication 505, Worksheet 2–1, Line 10.

If Line B is zero or less, stop here. Otherwise, go to Line C.

Enter the lesser of Line A or Line B.

Multiply Line C by 25% (.25).

Expected taxable amount of Social Security beneﬁ ts you reported on federal Publication 505*,

Worksheet 2–1, Line 19

Social Security Beneﬁ t Adjustment: Subtract Line D from Line E. Enter the amount here

and as a subtraction on the 2013 Form CT-W4P, Line 2. If Line D is greater than or equal to

Line E, enter “0.”

*You may obtain federal Publication 505 by visiting the IRS website at or by calling the Internal Revenue Service (IRS) at

800-829-3676.

Line 2 (continued)

adjusted gross income, complete the following calculation and

Social Security Beneﬁ t Adjustment: If you ﬁ le a federal income

enter the result on Line 5.

tax return as single or married ﬁ ling separately and you expect

your 2013 federal adjusted gross income will be less than

Connecticut-Sourced Income

= Line 5

$50,000, enter as a subtraction the amount of federally taxable

Connecticut Adjusted Gross Income (Line 3)

Social Security beneﬁ ts you expect to report on your 2013 federal

Do not enter a number less than zero or greater than 1. If the

Form 1040, Line 20b, or federal Form 1040A, Line 14b.

result is less than zero, enter “0”; if greater than 1, enter 1.0000.

If you will ﬁ le a federal income tax return as married ﬁ ling jointly,

Round to four decimal places.

qualifying widow(er) with dependent child, or head of household

Line 7 - Resident and Part-Year Residents: Enter estimated

and you expect your 2013 federal adjusted gross income will be

allowable credit for income taxes paid to qualifying jurisdictions.

less than $60,000, enter as a subtraction the amount of federally

Enter “0” if not applicable. See instructions for Schedule 2

taxable Social Security beneﬁ ts you expect to report on your 2013

- Credit for Income Taxes Paid to Qualifying Jurisdictions of

federal Form 1040, Line 20b, or federal Form 1040A, Line 14b.

Form CT-1040 or Form CT-1040NR/PY.

If you expect your federal adjusted gross income will be above

Line 9: If you expect to owe federal alternative minimum tax for

the threshold for your ﬁ ling status, complete the Social Security

the 2013 taxable year, you may also owe Connecticut alternative

Beneﬁ t Adjustment Worksheet above. Enter the Line F amount

minimum tax. Enter your estimated Connecticut alternative

as a subtraction on Line 2.

minimum tax liability. See instructions for Form CT-6251,

Military Pensions: If you are a retired member of the U.S. armed

Connecticut Alternative Minimum Tax Return - Individuals.

forces or the National Guard, enter as a subtraction 50% of the

Line 11: Enter estimated allowable Connecticut income tax

amount of federally taxable military retirement pay you expect

credit(s). Enter “0” if you are not entitled to a credit. (Credit for a

to report on your 2013 federal income tax return.

prior year alternative minimum tax is not allowed if you entered

Line 3 - Nonresidents and Part-Year Residents: If your

an amount on Line 9.) See the instructions for Schedule CT-IT

Connecticut-sourced income is greater than your Connecticut

Credit, Income Tax Credit Summary.

adjusted gross income, enter your Connecticut-sourced income.

Line 15: Divide the amount on Line 14 by the number of pension

Line 5 - Nonresidents and Part-Year Residents: If your

or annuity payments you will receive in 2013. Round to nearest

Connecticut-sourced income is greater than or equal to your

whole dollar but not less than $10. Enter this amount on Line 1

Connecticut adjusted gross income, enter 1.0000. If your

of the certiﬁ cate on the front of this form.

Connecticut-sourced income is less than your Connecticut

2013 Form CT-W4P (Rev. 12/12)

Page 3 of 6

Form Ct-W4p - Withholding Certifi Cate For Pension Or Annuity Payments - 2013 Page 3

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