Form 4972 2023

Tax on Lump-Sum Distributions 

(From Qualified Plans of Participants Born Before January 2, 1936)

Department of the Treasury 

Internal Revenue Service

Attach to Form 1040, 1040-SR, 1040-NR, or 1041. 

Go to www.irs.gov/Form4972 for the latest information.

OMB No. 1545-0193

Attachment 

Sequence No. 28

Name of recipient of distribution Identifying number

Part I Complete this part to see if you can use Form 4972

1 Was this a distribution of a plan participant’s entire balance (excluding deductible voluntary employee 

contributions and certain forfeited amounts) from all of an employer’s qualified plans of one kind (for 

example, pension, profit-sharing, or stock bonus)? If “No,” don’t use this form . . . . . . . . . .

Yes No

1 

2 Did you roll over any part of the distribution? If “Yes,” don’t use this form . . . . . . . . . . . 2 

3 Was this distribution paid to you as a beneficiary of a plan participant who was born before January 2, 1936? 3 

4 Were you (a) a plan participant who received this distribution, (b) born before January 2, 1936, and (c) a 

participant in the plan for at least 5 years before the year of the distribution? . . . . . . . . . . 4 

If you answered “No” to both questions 3 and 4, don’t use this form.

5 a Did you use Form 4972 after 1986 for a previous distribution from your own plan? If “Yes,” don’t use this 

form for a 2023 distribution from your own plan . . . . . . . . . . . . . . . . . . . . 5a 

b If you are receiving this distribution as a beneficiary of a plan participant who died, did you use Form 4972 

for a previous distribution received as a beneficiary of that participant after 1986? If “Yes,” don’t use this

form for this distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5b

Part II Complete this part to choose the 20% capital gain elections (see instructions)

6 Capital gain part from Form 1099-R, box 3 . . . . . . . . . . . . . . . . . . . . 6 

7 Multiply line 6 by 20% (0.20) . . . . . . . . . . . . . . . . . . . . . . . . 7 

If you also choose to use Part III, go to line 8. Otherwise, include the amount from line 7 in the total 

on Form 1040, 1040-SR, or 1040-NR, line 16, or Form 1041, Schedule G, line 1b. Be sure to check 

box 2 on Form 1040, 1040-SR, or 1040-NR, line 16.

Part III Complete this part to choose the 10-year tax option (see instructions)

8 If you completed Part II, enter the amount from Form 1099-R, box 2a, minus box 3. If you didn’t 

complete Part II, enter the amount from box 2a. Multiple recipients (and recipients who elect to 

include net unrealized appreciation (NUA) in taxable income), see instructions . . . . . . . . 8 

9 Death benefit exclusion for a beneficiary of a plan participant who died before August 21, 1996 . . 9 

10 Total taxable amount. Subtract line 9 from line 8 . . . . . . . . . . . . . . . . . . 10 

11 Current actuarial value of annuity from Form 1099-R, box 8. If none, enter -0- . . . . . . . . 11 

12 Adjusted total taxable amount. Add lines 10 and 11. If this amount is $70,000 or more, skip lines 13 

through 16, enter this amount on line 17, and go to line 18 . . . . . . . . . . . . . . . 12 

13 Multiply line 12 by 50% (0.50), but don’t enter more than $10,000 . . . . 13 

14 Subtract $20,000 from line 12. If line 12 is $20,000 or 

less, enter -0- . . . . . . . . . . . . . 14 

15 Multiply line 14 by 20% (0.20) . . . . . . . . . . . . . . . . 15 

16 Minimum distribution allowance. Subtract line 15 from line 13 . . . . . . . . . . . . . 16 

17 Subtract line 16 from line 12 . . . . . . . . . . . . . . . . . . . . . . . . . 17 

18 Federal estate tax attributable to lump-sum distribution . . . . . . . . . . . . . . . 18 

19 Subtract line 18 from line 17. If line 11 is zero, skip lines 20 through 22 and go to line 23 . . . . 19 

20 Divide line 11 by line 12 and enter the result as a decimal (rounded to at least 

three places) . . . . . . . . . . . . . . . . . . . . . . 20 .

21 Multiply line 16 by the decimal on line 20 . . . . . . . . . . . . 21 

22 Subtract line 21 from line 11 . . . . . . . . . . . . . . . . 22 

23 Multiply line 19 by 10% (0.10) . . . . . . . . . . . . . . . . . . . . . . . . 23 

24 Tax on amount on line 23. Use the Tax Rate Schedule in the instructions . . . . . . . . . . 24 

25 Multiply line 24 by 10.0. If line 11 is zero, skip lines 26 through 28, enter this amount on line 29, and 

go to line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 

26 Multiply line 22 by 10% (0.10) . . . . . . . . . . . . . . . . 26 

27 Tax on amount on line 26. Use the Tax Rate Schedule in the instructions . . 27 

28 Multiply line 27 by 10.0 . . . . . . . . . . . . . . . . . . . . . . . . . . 28 

29 Subtract line 28 from line 25. Multiple recipients, see instructions . . . . . . . . . . . . 29 

30 Tax on lump-sum distribution. Add lines 7 and 29. Also, include this amount in the total on Form

1040, 1040-SR, or 1040-NR, line 16 (check box 2), or Form 1041, Schedule G, line 1b . . . . . 30 

For Paperwork Reduction Act Notice, see instructions. Cat. No. 13187U Form 4972 (2023)
Form 4972 (2023) Page 2

Section references are to the Internal Revenue 

Code.

Future developments. For the latest 

information about developments related to 

Form 4972 and its instructions, such as 

legislation enacted after they were published, 

go to www.irs.gov/Form4972.

General Instructions

Purpose of Form

Use Form 4972 to figure the tax on a qualified 

lump-sum distribution (defined below) you 

received in 2023 using the 20% capital gain 

election, the 10-year tax option, or both. 

These are special formulas used to figure a 

separate tax on the distribution that may 

result in a smaller tax than if you reported the 

taxable amount of the distribution as ordinary 

income.

You pay the tax only once, for the year you 

receive the distribution, not over the next 10 

years. The separate tax is added to the 

regular tax figured on your other income.

Related Publications

For more information related to this topic, see 

the following publications.

• Pub. 575, Pension and Annuity Income. 

• Pub. 721, Tax Guide to U.S. Civil Service 

Retirement Benefits.

• Pub. 939, General Rule for Pensions and 

Annuities.

What Is a Qualified Lump-Sum 

Distribution?

It is the distribution or payment in 1 tax year 

of a plan participant’s entire balance from all 

of an employer’s qualified plans of one kind 

(for example, pension, profit-sharing, or stock 

bonus plans) in which the participant had 

funds. The participant’s entire balance 

doesn’t include deductible voluntary 

employee contributions or certain forfeited 

amounts. The participant must have been 

born before January 2, 1936.

Distributions upon death of the plan 

participant. If you received a qualified

distribution as a beneficiary after the

participant’s death, the participant must have 

been born before January 2, 1936, for you to 

use this form for that distribution.

Distributions to alternate payees. If you are 

the spouse or former spouse of a plan

participant who was born before January 2, 

1936, and you received a qualified lump-sum 

distribution as an alternate payee under a 

qualified domestic relations order, you can 

use Form 4972 to figure the tax on the 

distribution using the 20% capital gain 

election, the 10-year tax option, or both. For 

details, see Pub. 575.

Distributions That Don’t Qualify for the 

20% Capital Gain Election or the 10-

Year Tax Option

The following distributions aren’t qualified 

lump-sum distributions and don’t qualify for 

the 20% capital gain election or the 10-year 

tax option. 

• The part of a distribution not rolled over if 

the distribution is partially rolled over to 

another qualified plan or an IRA. 

• Any distribution if an earlier election to use 

either the 5- or 10-year tax option had been 

made after 1986 for the same plan participant.

• U.S. Retirement Plan Bonds distributed with 

the lump sum.

• A distribution made during the first 5 tax 

years that the participant was in the plan, 

unless it was made because the participant 

died.

• The current actuarial value of any annuity 

contract included in the lump sum (Form 

1099-R, box 8, should show this amount, 

which you use only to figure tax on the 

ordinary income part of the distribution).

• A distribution to a 5% owner that is subject 

to penalties under section 72(m)(5)(A).

• A distribution from an IRA.

• A distribution from a tax-sheltered annuity 

(section 403(b) plan).

• A distribution of the redemption proceeds of 

bonds rolled over tax free to a qualified 

pension plan, etc., from a qualified bond 

purchase plan.

• A distribution from a qualified plan if the 

participant or his or her surviving spouse 

previously received an eligible rollover 

distribution from the same plan (or another 

plan of the employer that must be combined 

with that plan for the lump-sum distribution 

rules) and the previous distribution was rolled 

over tax free to another qualified plan or an 

IRA.

• A distribution from a qualified plan that 

received a rollover after 2001 from an IRA 

(other than a conduit IRA), a governmental 

section 457(b) plan, or a section 403(b) taxsheltered annuity on behalf of the plan 

participant.

• A distribution from a qualified plan that 

received a rollover after 2001 from another 

qualified plan on behalf of that plan 

participant’s surviving spouse.

• A corrective distribution of excess deferrals, 

excess contributions, excess aggregate 

contributions, or excess annual additions.

• A lump-sum credit or payment under the 

alternative annuity option from the Federal 

Civil Service Retirement System (or the 

Federal Employees’ Retirement System).

How To Report the Distribution

If you can use Form 4972, attach it to Form 

1040 or 1040-SR (individuals), Form 1040-NR 

(nonresident aliens), or Form 1041 (estates or 

trusts). The payer should have given you a 

Form 1099-R or other statement that shows 

the amounts needed to complete Form 4972. 

The following choices are available.

20% capital gain election. If there is an

amount in Form 1099-R, box 3, you can use 

Form 4972, Part II, to apply a 20% tax rate to 

the capital gain portion. See Capital Gain 

Election, later.

10-year tax option. You can use Part III to

figure your tax on the lump-sum distribution 

using the 10-year tax option whether or not 

you make the 20% capital gain election.

Taxable amount. If Form 1099-R, box 2a, is 

blank, you must figure the taxable amount to 

complete Form 4972. For details, see Pub. 

575.

Where to report. Report amounts from your 

Form 1099-R either directly on your tax return 

(Form 1040, 1040-SR, 1040-NR, or 1041) or

on Form 4972.

1. If you don’t use Form 4972, and you file:

a. Form 1040, 1040-SR, or 1040-NR. Report 

the entire amount from box 1 (Gross 

distribution) of Form 1099-R on line 5a, and 

the taxable amount on line 5b. If your pension 

or annuity is fully taxable, enter the amount 

from box 2a (Taxable amount) of Form 

1099-R on line 5b; don’t make an entry on line 

5a.

b. Form 1041. Report the amount on line 8. 

2. If you don’t use Part III of Form 4972, but 

use Part II, report only the ordinary income 

portion of the distribution on Form 1040, 

1040-SR, or 1040-NR, lines 5a and 5b; or on 

Form 1041, line 8. The ordinary income 

portion is the amount from box 2a of Form 

1099-R, minus the amount from box 3 of that 

form.

3. If you use Part III of Form 4972, don’t 

include any part of the distribution on Form 

1040, 1040-SR, or 1040-NR, lines 5a and 5b; 

or on Form 1041, line 8.

The entries in other boxes on Form 1099-R 

may also apply in completing Form 4972. 

• Box 6 (Net unrealized appreciation in 

employer’s securities). See Net unrealized

appreciation (NUA), later.

• Box 8 (Other). Current actuarial value of an 

annuity.

How Often You Can Use Form 4972

After 1986, you can use Form 4972 only once 

for each plan participant. If you receive more 

than one lump-sum distribution for the same 

participant in 1 tax year, you must treat all 

those distributions the same way. Combine 

them on a single Form 4972.

If you make an election as a beneficiary of a 

deceased participant, it doesn’t affect any 

election you can make for qualified lump-sum 

distributions from your own plan. You can 

also make an election as the beneficiary of 

more than one qualifying person.

Example. Your mother and father died and 

each was born before January 2, 1936. Each 

had a qualified plan of which you are the 

beneficiary. You also received a qualified 

lump-sum distribution from your own plan and 

you were born before January 2, 1936. You 

can make an election for each of the 

distributions: one for yourself, one as your 

mother’s beneficiary, and one as your father’s 

beneficiary. It doesn’t matter if the 

distributions all occur in the same year or in 

different years. File a separate Form 4972 for 

each participant’s distribution.

TIP

An earlier election on Form 4972 

or Form 5544 for a distribution 

before 1987 doesn’t prevent you 

from making an election for a 

distribution after 1986 for the 

same participant, provided the participant was 

under age 591⁄2 at the time of the pre-1987 

distribution.
Form 4972 (2023) Page 3

When To File Form 4972

You can file Form 4972 with either an original 

or amended return. For an amended return, 

you must generally file within 3 years after the 

date the original return was filed or within 2 

years after the date the tax was paid, 

whichever is later, to use any part of Form 

4972.

Capital Gain Election

If the distribution includes a capital gain 

amount, you can (a) make the 20% capital 

gain election in Part II of Form 4972, or (b) 

treat the capital gain as ordinary income.

Only the taxable amount of distributions 

resulting from pre-1974 participation qualifies 

for capital gain treatment. The capital gain 

amount should be shown in Form 1099-R, 

box 3. If there is a net unrealized appreciation 

(NUA) amount in Form 1099-R, box 6, part of 

it will also qualify for capital gain treatment. 

Use the NUA Worksheet on this page to figure 

the capital gain part of NUA if you make the 

election to include NUA in your taxable 

income.

You can report the ordinary income portion 

of the distribution on Form 1040, 1040-SR, or 

1040-NR, line 5b; or Form 1041, line 8; or you 

can figure the tax using the 10-year tax 

option. The ordinary income portion is 

generally the amount from Form 1099-R, box 

2a, minus the amount from box 3 of that form.

Net unrealized appreciation (NUA). 

Normally, NUA in employer securities 

received as part of a lump-sum distribution 

isn’t taxable until the securities are sold. 

However, you can elect to include NUA in 

taxable income in the year received.

The total amount to report as NUA should 

be shown in Form 1099-R, box 6. Part of the 

amount in box 6 will qualify for capital gain 

treatment if there is an amount in Form 

1099-R, box 3. To figure the total amount 

subject to capital gain treatment including the 

NUA, complete the NUA Worksheet on this 

page.

Specific Instructions

Name of recipient of distribution and 

identifying number. At the top of Form 4972, 

fill in the name and identifying number of the 

recipient of the distribution.

If you received more than one qualified 

distribution in 2023 for the same plan 

participant, add them and figure the tax on 

the total amount. If you received qualified 

distributions in 2023 for more than one 

participant, file a separate Form 4972 for the 

distributions of each participant.

If you and your spouse are filing a joint 

return and each has received a lump-sum 

distribution, complete and file a separate 

Form 4972 for each spouse, combine the tax, 

and include the combined tax in the total on 

Form 1040 or 1040-SR, line 16. Be sure to 

check box 2 on Form 1040 or 1040-SR, 

line 16. 

Multiple recipients of a lump-sum 

distribution. If you are filing for a trust that 

shared the distribution only with other trusts, 

figure the tax on the total lump sum first. The 

trusts then share the tax in the same 

proportion that they shared the distribution.

If you shared in a lump-sum distribution 

from a qualified retirement plan when not all 

recipients were trusts (a percentage will be 

shown in Form 1099-R, boxes 8 and/or 9a), 

figure your tax on Form 4972 as follows.

Step 1. Complete Form 4972, Parts I and II. 

If you make the 20% capital gain election in 

Part II and also elect to include NUA in 

taxable income, complete the NUA Worksheet 

below to determine the amount of NUA that 

qualifies for capital gain treatment. Then, skip 

Step 2 and go to Step 3.

Step 2. Use this step only if you don’t elect 

to include NUA in your taxable income or if 

you don’t have NUA.

• If you aren’t making the capital gain 

election, divide the amount from Form 

1099-R, box 2a, by your percentage of 

distribution in box 9a. Enter this amount on 

Form 4972, line 8.

• If you are making the capital gain election, 

subtract the amount from Form 1099-R, box 

3, from the amount in box 2a. Divide the result 

by your percentage of distribution from Form 

1099-R, box 9a. Enter the result on Form 

4972, line 8.

• Complete Form 4972, lines 9 and 10. Divide 

the amount from Form 1099-R, box 8, by the 

percentage in box 8. Enter the result on Form 

4972, line 11. Then, skip Step 3 and go to 

Step 4.

Step 3. Use this step only if you elect to

include NUA in your taxable income.

• If you aren’t making the capital gain 

election, add the amount from Form 1099-R, 

box 2a, to the amount in box 6. Divide the 

result by your percentage of distribution from 

Form 1099-R, box 9a. Enter the result on 

Form 4972, line 8. On the dotted line next to 

line 8, write “NUA” and the amount of NUA 

included (Form 1099-R, box 6, divided by 

your percentage of distribution in box 9a). 

• If you are making the capital gain election, 

subtract the amount from Form 1099-R, box 

3, from the amount in box 2a. Add to the 

result the amount from line F of your NUA 

Worksheet. Then, divide the total by your 

percentage of distribution from Form 1099-R, 

box 9a. Enter the result on Form 4972, line 8. 

On the dotted line next to line 8, write “NUA” 

and the amount of NUA included (line F of 

your NUA Worksheet divided by your 

percentage of distribution from Form 1099-R, 

box 9a).

• Complete Form 4972, lines 9 and 10. Divide 

the amount from Form 1099-R, box 8, by the 

percentage in box 8. Enter the result on Form 

4972, line 11.

Step 4. Complete Form 4972 through line 

28.

Step 5. Complete the following worksheet 

to figure the entry for Form 4972, line 29.

A. Subtract line 28 from line 25 .

B. Enter your percentage of the 

distribution from box 9a . .

C. Multiply line A by line B. Enter 

here and on Form 4972, line 29. 

Also, write “MRD” on the dotted 

line next to line 29 . . . .

NUA Worksheet (keep for your records)

A. Enter the amount from Form 1099-R, box 3 . . . . . . . . A.

B. Enter the amount from Form 1099-R, box 2a . . . . . . . . B.

C. Divide line A by line B and enter the result as a decimal (rounded to at 

least three places) . . . . . . . . . . . . . . . C. .

D. Enter the amount from Form 1099-R, box 6 . . . . . . . . D.

E. Capital gain portion of NUA. Multiply line C by line D . . . . . E.

F. Ordinary income portion of NUA. Subtract line E from line D . . . F.

G. Total capital gain portion of distribution. Add lines A and E. Enter here 

and on Form 4972, line 6. On the dotted line next to line 6, write 

“NUA” and the amount from line E above . . . . . . . . . G.

Death Benefit Worksheet (keep for your records)

A. Enter the amount from Form 1099-R, box 3, or, if you are including 

NUA in taxable income, the amount from line G of the NUA Worksheet A.

B. Enter the amount from Form 1099-R, box 2a, plus, if you are including 

NUA in taxable income, the amount from Form 1099-R, box 6 . . . B.

C. Divide line A by line B and enter the result as a decimal (rounded to at 

least three places) . . . . . . . . . . . . . . . . C. .

D. Enter your share of the death benefit exclusion* . . . . . . . D.

E. Death benefit exclusion allocated to capital gain. Multiply line D by 

line C . . . . . . . . . . . . . . . . . . . E.

F. Subtract line E from line A. Enter here and on Form 4972, line 6 . . F.

*Applies only for participants who died before August 21, 1996. If there are multiple recipients of the distribution, 

the allowable death benefit exclusion must be allocated among the recipients in the same proportion that they 

share the distribution.
Form 4972 (2023) Page 4

Part II

See Capital Gain Election, earlier, before 

completing Part II.

Line 6. Leave this line blank if your

distribution doesn’t include a capital gain

amount or you aren’t making the 20% capital 

gain election, and go to Part III.

Generally, enter on line 6 the amount from 

Form 1099-R, box 3. However, if you elect to 

include NUA in your taxable income, use the 

NUA Worksheet, earlier, to figure the amount 

to enter on line 6. If you are taking a death 

benefit exclusion (see Line 9 below for the 

definition), use the Death Benefit Worksheet, 

earlier, to figure the amount to enter on line 6. 

The remaining allowable death benefit 

exclusion should be entered on line 9 if you 

choose the 10-year tax option.

If any federal estate tax was paid on the 

lump-sum distribution, you must decrease the 

capital gain amount by the amount of estate 

tax applicable to it. To figure this amount, you 

must complete the Death Benefit Worksheet, 

earlier, through line C, even if you don’t take 

the death benefit exclusion. Multiply the total 

federal estate tax paid on the lump-sum 

distribution (get this amount from the 

administrator of the deceased’s estate) by the 

decimal on line C of the Death Benefit 

Worksheet. The result is the portion of the 

federal estate tax applicable to the capital 

gain amount. Then, use that result to reduce 

the amount in Form 1099-R, box 3, if you 

don’t take the death benefit exclusion, or 

reduce line F of the Death Benefit Worksheet 

if you do. Enter the remaining capital gain on 

line 6. If you elected to include NUA in taxable 

income and you didn’t take the death benefit 

exclusion, subtract the portion of federal 

estate tax applicable to the capital gain 

amount from the amount on line G of the NUA 

Worksheet. Enter the result on line 6. Enter 

the remainder of the federal estate tax on line 

18.

▲!

CAUTION

If you take the death benefit 

exclusion and federal estate tax 

was paid on the capital gain 

amount, the capital gain amount 

must be reduced by both the procedures 

discussed above to figure the correct entry for 

line 6.

Part III

Multiple recipients, see Multiple recipients of a 

lump-sum distribution, earlier. 

Line 8. If Form 1099-R, box 2a, is blank, you 

must first figure the taxable amount. For 

details on how to do this, see Pub. 575.

If you made the 20% capital gain election, 

enter only the ordinary income portion of the 

distribution on this line. The ordinary income 

portion is the amount from Form 1099-R, box 

2a, minus the amount from box 3 of that form. 

Add the amount from line F of the NUA 

Worksheet if you included NUA capital gain in 

the 20% capital gain election. On the dotted 

line next to line 8, write “NUA” and the 

amount from line F of the NUA Worksheet.

If you didn’t make the 20% capital gain 

election and didn’t elect to include NUA in 

taxable income, enter the amount from Form 

1099-R, box 2a. If you didn’t make the 20% 

capital gain election but did elect to include 

NUA in your taxable income, add the amount 

from Form 1099-R, box 2a, to the amount 

from Form 1099-R, box 6. Enter the total on 

line 8. On the dotted line next to line 8, write 

“NUA” and the amount from Form 1099-R, 

box 6.

▲!

CAUTION

Community property laws don’t 

apply in figuring tax on the amount 

you report on line 8.

Line 9. If you received the distribution

because of the plan participant’s death and 

the participant died before August 21, 1996, 

you may be able to exclude up to $5,000 of 

the lump sum from your gross income. This 

exclusion applies to the beneficiaries or 

estates of common-law employees, selfemployed individuals, and shareholderemployees who owned more than 2% of the 

stock of an S corporation.

Enter the allowable death benefit exclusion 

on line 9. If you made the 20% capital gain 

election, enter the amount from line D of the 

Death Benefit Worksheet minus the amount 

from line E of that worksheet. 

Multiple recipients. If there are multiple 

recipients of the distribution not all of whom 

are trusts, and you didn’t complete Part II, 

enter the full allowable death benefit exclusion 

on line 9. Don’t allocate the exclusion among 

the recipients; the computation under Multiple 

recipients of a lump-sum distribution, earlier, 

effectively allocates the exclusion.

If you completed Part II, multiply the full 

allowable death benefit exclusion (don’t 

allocate among the recipients) by the 

percentage on line C of the Death Benefit 

Worksheet. Subtract the result from the full 

allowable death benefit exclusion. Enter the 

result on line 9. 

Line 18. A beneficiary who receives a lumpsum distribution because of a plan

participant’s death must reduce the taxable

part of the distribution by any federal estate 

tax paid on the lump-sum distribution (get this 

amount from the administrator of the 

deceased’s estate). Do this by entering on line 

18 the federal estate tax attributable to the

lump-sum distribution. Also, see Line 6 above 

if you made a capital gain election.

Lines 24 and 27. Use the following Tax Rate 

Schedule to complete lines 24 and 27.

Line 29. Multiple recipients, see Multiple 

recipients of a lump-sum distribution, earlier.

Tax Rate Schedule

If the amount on 

line 23 or 26 is:

Enter on line 

24 or 27:

Over—

But not 

over—

 Of the 

amount 

over—

$ 0 $ 1,190 - - - - - 11% $ 0 

 1,190 2,270 $130.90 + 12% 1,190 

2,270 4,530 260.50 + 14% 2,270 

 4,530 6,690 576.90 + 15% 4,530 

6,690 9,170 900.90 + 16% 6,690 

 9,170 11,440 1,297.70 + 18% 9,170 

11,440 13,710 1,706.30 + 20% 11,440 

 13,710 17,160 2,160.30 + 23% 13,710 

17,160 22,880 2,953.80 + 26% 17,160 

 22,880 28,600 4,441.00 + 30% 22,880 

28,600 34,320 6,157.00 + 34% 28,600 

 34,320 42,300 8,101.80 + 38% 34,320 

42,300 57,190 11,134.20 + 42% 42,300 

 57,190 85,790 17,388.00 + 48% 57,190 

85,790 - - - - - 31,116.00 + 50% 85,790

Paperwork Reduction Act Notice. We ask 

for the information on this form to carry out 

the Internal Revenue laws of the United 

States. You are required to give us the 

information. We need it to ensure that you are 

complying with these laws and to allow us to 

figure and collect the right amount of tax.

You aren’t required to provide the 

information requested on a form that is 

subject to the Paperwork Reduction Act 

unless the form displays a valid OMB control 

number. Books or records relating to a form 

or its instructions must be retained as long as 

their contents may become material in the 

administration of any Internal Revenue law. 

Generally, tax returns and return information 

are confidential, as required by section 6103.

The time needed to complete this form will 

vary depending on individual circumstances. 

The estimated burden for individual taxpayers 

filing this form is approved under OMB control 

number 1545-0074 and is included in the 

estimates shown in the instructions for their 

individual income tax return. The estimated 

burden for all other taxpayers who file this 

form is shown below.

Recordkeeping . . . . . . 19 min.

Learning about the law 

or the form . . . . . . 1 hr., 36 min.

Preparing the form . . . . 2 hr., 7 min.

Copying, assembling, and 

sending the form to the IRS. . . 20 min.

If you have comments concerning the 

accuracy of these time estimates or 

suggestions for making this form simpler, we 

would be happy to hear from you. See the 

instructions for the tax return with which this 

form is filed.