DO NOT STAPLE

Form 1042-T

Department of the Treasury 

Internal Revenue Service

Annual Summary and Transmittal of 

Forms 1042-S

Go to www.irs.gov/Form1042T for the latest information.

OMB No. 1545-0096

2023

Name of withholding agent Ch. 4 status code

Ch. 3 status code 

Employer identification number

Number, street, and room or suite no.

City or town, state or province, country, and ZIP or foreign postal code 

1 Type of paper Forms 1042-S attached:

a Choose only one: Chapter 4 or chapter 3 (enter 4 or 3)

b Check only one box: Original Amended

c Check if pro rata 

d Enter the number of paper Forms 1042-S attached 

e Check if you are a partnership reporting withholding that occurred in the subsequent year. See instructions. 

2 Total gross income reported on all paper Forms 1042-S (box 2) attached . . . . . . . . . . $

3 Total federal tax withheld on all paper Forms 1042-S attached:

a Total federal tax withheld under chapter 4 . . . . . . . . . . . . $

b Total federal tax withheld under chapter 3 . . . . . . . . . . . . $

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 on page 2.

If this is your FINAL return, enter an “X” here. See instructions.

Please return this entire page to the Internal Revenue Service.

Sign 

Here

Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and 

belief, they are true, correct, and complete.

Your signature Title Date Daytime phone number

For more information and the Privacy Act and Paperwork Reduction Act Notice, see Form 1042-S. Cat. No. 28848W Form 1042-T (2023)
Form 1042-T (2023) Page 2 

Instructions

Future Developments

For the latest information about developments related to Form 

1042-T and its instructions, such as legislation enacted after 

they were published, go to www.irs.gov/Form1042T.

Purpose of Form

Use this form to transmit paper Forms 1042-S, Foreign Person’s 

U.S. Source Income Subject to Withholding, to the Internal 

Revenue Service. Use a separate Form 1042-T to transmit each 

type of Form 1042-S. See the instructions for line 1 below.

▲!

CAUTION

Do not use Form 1042-T if you submit Forms 1042-S 

electronically. See the Instructions for Form 1042-S 

for the electronic filing requirements for Form 1042-S.

Filing Forms 1042 and 1042-S

Use of this form to transmit paper Forms 1042-S does not affect 

your obligation to file Form 1042, Annual Withholding Tax 

Return for U.S. Source Income of Foreign Persons.

If you have not yet filed a Form 1042 for 2023, you may send 

in more than one Form 1042-T to submit paper Forms 1042-S 

prior to filing your Form 1042. You may submit amended Forms 

1042-S even though changes reflect differences in gross 

income and tax withheld information of Forms 1042-S 

previously submitted with a Form 1042-T.

If you have already filed a Form 1042 for 2023 and an 

attached Form 1042-S caused the gross income or tax withheld 

information previously reported on line 62c or 63e of your Form 

1042 to change, you must file an amended Form 1042.

Where and When To File

File Form 1042-T (and Copy A of the paper Forms 1042-S being 

transmitted) with the Ogden Service Center, P.O. Box 409101, 

Ogden, UT 84409, by March 15, 2024. Send the forms in a flat 

mailing (not folded).

Line Instructions

Identifying information at top of form. The name, address, 

employer identification number, and chapter 4 and chapter 3 

status codes of the withholding agent named on this form must

be the same as those you enter on Forms 1042 and 1042-S. 

See the Instructions for Form 1042 for the definition of 

withholding agent. See the Instructions for Form 1042-S for the 

withholding agent codes for the chapter 4 and chapter 3 status 

codes. You must enter both a chapter 4 and a chapter 3 

withholding agent status code regardless of the type of payment 

being made. 

Line 1. You must file a separate Form 1042‐T for each type of 

paper Form 1042‐S you are transmitting.

Line 1a. Withholding agents are not permitted to file a single 

Form 1042‐T to transmit both chapter 4 and chapter 3 amounts. 

Withholding agents must indicate either chapter 4 or chapter 3 

to designate the chapter for which they are filing a given Form 

1042‐T. The chapter you designate on this form must be the 

same as that on all attached Forms 1042‐S. See Chapter 

indicator in the Form 1042‐S instructions for additional 

information.

Line 1b. Check either the Original or Amended box (but not 

both).

Line 1c. Check the box on this line 1c if you are filing pro rata 

Forms 1042‐S. See the Form 1042‐S instructions.

Line 1e. Check the box on line 1e if you are a partnership 

reporting withholding that occurred in the subsequent year with 

respect to a foreign partner’s share of undistributed income for 

the prior year. The attached Form(s) 1042-S should have the 

checkbox checked in box 7c.

As a result of the above rules, there are sixteen possible types 

of Form 1042‐S that may be transmitted, and each type requires 

a separate Form 1042‐T.

• Chapter 4, original, pro rata.

• Chapter 4, original, non‐pro rata.

• Chapter 4, amended, pro rata.

• Chapter 4, amended, non‐pro rata.

• Chapter 4, original, pro rata, partnership.

• Chapter 4, original, non-pro rata, partnership.

• Chapter 4, amended, pro rata, partnership.

• Chapter 4, amended, non-pro rata, partnership.

• Chapter 3, original, pro rata.

• Chapter 3, original, non‐pro rata.

• Chapter 3, amended, pro rata.

• Chapter 3, amended, non‐pro rata.

• Chapter 3, original, pro rata, partnership.

• Chapter 3, original, non-pro rata, partnership.

• Chapter 3, amended, pro rata, partnership.

• Chapter 3, amended, non-pro rata, partnership.

Each type must be transmitted with a separate Form 1042-T. 

For example, you must transmit only chapter 3, original, pro rata 

Forms 1042-S with one Form 1042-T.

Line 2. Enter the total of the gross income amounts shown on

the Forms 1042-S (box 2) being transmitted with this Form 

1042-T.

Line 3. Enter the total of the federal tax withheld amounts

shown on all Forms 1042-S (total of amounts reported in boxes 

10 and 11) being transmitted with this Form 1042-T. On this 

Form 1042-T, complete either line 3a or line 3b, but not both. If 

you indicated “chapter 4” on line 1a, complete line 3a to report 

the total amounts withheld pursuant to chapter 4. If you 

indicated “chapter 3” on line 1a, complete line 3b to report the 

total amounts withheld pursuant to chapter 3. 

Final return. If you will not be required to file additional Forms 

1042-S, including amended Forms 1042-S for the 2023 year (on 

paper or electronically), enter an “X” in the FINAL return box.

Paperwork Reduction Act Notice. The time needed to 

complete and file this form will vary depending on individual 

circumstances. The estimated average time is 12 minutes.