Tax Withholding Election Form Page 2
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4P.O. Box 942716 Sacramento, CA 94229-2716
888 CalPERS (or 888-225-7377)
California Public Employees’ Retirement System
Tax Withholding Election—Instructions
Read these instructions before completing this form.
SECTION 1: MEMBER/PAYEE INFORMATION
Print or type in dark ink. Initial all corrections.
Enter your full name, CalPERS ID or Social Security
Number, mailing address, and telephone number. For an
PURPOSE: Use this form to tell CalPERS the amount of federal
estate, enter the estate’s Employer Identification Number
and state income tax to withhold from your benefit payments.
instead of the Social Security Number. Choose the payment/s
you want your withholding preferences applied to. You may
Complete the Tax Withholding Election form
complete a separate form if you want to elect different
(PERS-PRS-W-4P/DE-4P) and submit it to CalPERS as soon as
withholding amounts for different types of payments. Refer to
possible. Because your tax situation may change from year to
your benefits application or warrant for account information.
year, you may want to recalculate your withholdings each year
and submit a new form.
SECTION 2 & 3: Federal Tax Withholding Election & State Tax
Withholding Election
COMPLETING THIS FORM: To calculate the proper amount of
If you are receiving a lifetime monthly benefit, indicate your
tax withholding, use IRS Form W-4P (which has a worksheet
federal and state tax withholding preferences in this section.
and instructions) at irs.gov for your federal withholding, and
If you do not complete this section, CalPERS must withhold
EDD Form DE 4P at edd.ca.gov for your state withholding. If
federal and state income tax from your monthly benefit
you do not want any federal or state tax withheld, skip the
payments as married claiming three withholding allowances.
worksheets and go directly to the Tax Withholding Election
form (PERS-PRS-W-4P/DE-4P).
To withhold federal income tax, you must indicate your
marital status by checking the appropriate box and designate
California state income tax will not be automatically withheld
the number of withholding allowances.
from your benefit payment if you reside outside of California.
If you do not live in California but think you may be liable for
You cannot designate a specific dollar amount to be withheld
California state income tax, you may request CalPERS to
for federal tax. However, you may designate an additional
withhold state income tax.
dollar amount to be withheld. Use the IRS Form W-4P
worksheet to calculate your federal tax withholding. If you do
CHOOSING NOT TO HAVE INCOME TAX WITHHELD:
not want any federal income tax withheld, check the
You (or in the event of death, your beneficiary or estate) can
appropriate box.
choose not to have federal income tax withheld from your
payments that are not eligible for rollover.
If you want state income tax withheld, you must indicate your
marital status by checking the appropriate box and designate
CAUTION: There are penalties for not paying enough federal
the number of withholding allowances. You can also specify
and state tax during the year, either through withholding or
an additional dollar amount, if any. Use the EDD Form
estimated tax payments. See IRS Publication 505, Tax
DE-4P at edd.ca.gov/pdf_pub_ctr/de4p.pdf to calculate state
Withholding and Estimated Tax, at irs.gov. It explains your
tax withholding. You may designate a dollar amount to
estimated tax requirements and describes penalties in detail.
withhold instead of claiming withholding allowances. If you do
You may be able to avoid quarterly estimated tax payments by
not want any state income tax withheld, check the appropriate
having enough tax withheld from your benefit payment.
box. If you want ten percent of the amount of federal
withholding computed pursuant to Section 3405 of the
Internal Revenue Code, complete line 4 in section 3 by writing
10%.
SECTION 4: REQUIRED SIGNATURE
Sign and date your form before submitting it to CalPERS. Your
form will not be accepted without your signature and date.
My|CalPERS 1289 (10/16)
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