Form 1042-T - Annual Summary And Transmittal Of Forms 1042-S - 2015
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1042-T
OMB No. 1545-0096
Annual Summary and Transmittal of
Form
2015
Forms 1042-S
Department of the Treasury
Internal Revenue Service
1) Ch. 4 Status Code
Employer identification number
Name of withholding agent
2) Ch. 3 Status Code
Number, street, and room or suite no.
City or town, state or province, country, and ZIP or foreign postal code
1a Type of paper Forms 1042-S attached (check only one box):
Original
Amended
Also check here if pro-rata (see instructions)
▶
b Number of paper Forms 1042-S attached
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2
Total gross income reported on all paper Forms 1042-S (box 2) attached .
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$
3
Total federal tax withheld on all paper Forms 1042-S attached:
a Total federal tax withheld under chapter 4 .
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$
b Total federal tax withheld under chapter 3 .
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$
Caution: If you have already filed a Form 1042 and an attached Form 1042-S causes the gross income or tax withheld
information shown on your previously filed Form 1042 to change, you must file an amended Form 1042. See the
instructions below.
If this is your FINAL return, enter an “X” here (see instructions)
▶
Please return this entire page to the Internal Revenue Service.
Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and
Sign
belief, they are true, correct, and complete.
Here
Your signature
Title
Date
Daytime phone number
Instructions
Identifying information at top of form. The name, address, EIN,
and chapter 4 and 3 status codes of the withholding agent named
Purpose of form. Use this form to transmit paper Forms 1042-S,
on this form must be the same as those you enter on Forms 1042
Foreign Person’s U.S. Source Income Subject to Withholding, to the
and 1042-S. See the instructions for Form 1042 for definitions of
Internal Revenue Service. Use a separate Form 1042-T to transmit
withholding agent. See the instructions for Form 1042-S for the
each type of Form 1042-S (see the instructions for line 1a).
withholding agent codes for the chapter 3 and 4 status codes. See
instructions for Form 1042-S for the definition of withholdable
Electronic filing requirement. If you file 250 or more Forms 1042-
payment to determine when a chapter 4 status code is required.
S, you are required to submit them electronically. If you submit less
Line 1a. You must file a separate Form 1042-T for each type of
than 250 Forms 1042-S, you are encouraged to file them
paper Form 1042-S you are transmitting. Check only the Original or
electronically. If you are a financial institution you are required to
Amended box. If you are filing pro-rata Forms 1042-S (see Form
submit Form 1042-S electronically irrespective of the number of
1042-S instructions), also check the pro-rata box. As a result, there
Forms 1042-S you submit. If you submit Forms 1042-S
are four possible types of Form 1042-S that may be transmitted:
electronically, do not use Form 1042-T. See the instructions for
Form 1042 for the definition of financial institution.
• Original non pro-rata
• Original pro-rata
Filing Forms 1042 and 1042-S. Use of this form to transmit paper
• Amended non pro-rata
• Amended pro-rata
Forms 1042-S does not affect your obligation to file Form 1042,
Each type must be transmitted with a separate Form 1042-T. For
Annual Withholding Tax Return for U.S. Source Income of Foreign
example, you must transmit only original non pro-rata Forms 1042-
Persons.
S with one Form 1042-T.
If you have not yet filed a Form 1042 for 2015, you may send in
Line 2. Enter the total of the gross income amounts shown on the
more than one Form 1042-T to submit paper Forms 1042-S prior to
Forms 1042-S (box 2) being transmitted with this Form 1042-T.
filing your Form 1042. You may submit amended Forms 1042-S
Line 3. Enter the total of the federal tax withheld amounts shown on
even though changes reflect differences in gross income and tax
all Forms 1042-S (total of amounts in boxes 7, 8, and 9, reduced by
withheld information of Forms 1042-S previously submitted with a
any amount in box 11) being transmitted with this Form 1042-T.
Form 1042-T.
Allocate withheld amounts between chapter 4 and chapter 3 on
If you have already filed a Form 1042 for 2015 and an attached
lines 3a and 3b.
Form 1042-S caused the gross income or tax withheld information
previously reported on line 62c or 63e of your Form 1042 to change,
Final return. If you will not be required to file additional Forms
you must file an amended Form 1042.
1042-S, including amended Forms 1042-S for the 2015 year (on
paper or electronically), enter an “X” in the “FINAL return” box.
Where and when to file. File Form 1042-T (and Copy A of the
paper Forms 1042-S being transmitted) with the Ogden Service
Paperwork Reduction Act Notice. The time needed to complete
Center; P.O. Box 409101; Ogden, UT 84409; by March 15, 2016.
and file this form will vary depending on individual circumstances.
Send the forms in a flat mailing (not folded).
The estimated average time is 12 minutes.
1042-T
For more information and the Privacy Act and Paperwork Reduction Act Notice, see Form 1042-S.
Form
(2015)
Cat. No. 28848W
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