DEFENSE FINANCE AND ACCOUNTING SERVICE

Retired and Annuitant Pay 

8899 E. 56th Street 

Indianapolis, IN 46249-1300 

www.dfas.mil/retiredmilitary 

Note: Please return a copy of this page with your documents. 

 

DOC: DEPREV 

 

 

 

 

Dear , 

Why we are writing

 We are writing regarding the change to the Survivor Benefit Plan (SBP) Optional Annuity for Dependent 

Children and the reversion of SBP annuity payments to eligible surviving spouses in 2023. Congress recently 

enacted significant changes to the SBP program that may enhance this benefit for you as the surviving spouse, but 

first we need to verify your eligibility for the program. 

 Our records show that when your spouse died, an election was made to pay the SBP annuity to the surviving 

child/children. Changes in the law, effective January 1, 2023, direct the SBP annuity to be paid to the member’s 

surviving spouse, if eligible, instead of the child(ren). 

 This packet includes the documents we need you to fill out and return. These documents will help us 

determine your eligibility for SBP annuity payments and set up your account to begin your payments (if you are 

eligible) when the changes take effect on January 1, 2023. See the information on the next page. 

What you need to know 

The Department of Defense Survivor Benefit Plan (SBP) provides financial support to military spouses and/or 

children when a military member dies on active duty or inactive duty in the line of duty. The Survivor Benefit Plan 

(SBP) provides eligible beneficiaries with a monthly payment known as an annuity. The recipient of an SBP 

annuity is referred to as the annuitant. The annuitant may be a surviving spouse or surviving child (but not both).

When a service member dies on active or inactive duty in the line of duty, the surviving spouse can request to 

have the SBP annuity paid directly to an eligible dependent child or children. This is called the “Optional Annuity 

for Dependent Children.” The option is available because until recently, there was a requirement for a spouse’s SBP 

payments to be offset (reduced) by the full amount of the spouse’s Dependency and Indemnity Compensation 

(DIC) payment from the Department of Veterans Affairs (VA). Payments to the surviving child were often 

considered a more favorable option because SBP paid to a child is not required to be offset (reduced) by the DIC 

payment. 

 The National Defense Authorization Act (NDAA) for Fiscal Year 2020 modified the law that requires an 

offset (reduction) of SBP payments for surviving spouses who are also entitled to DIC payments from the VA. 

It directed a phase-out period that will eventually eliminate the entire offset (reduction). Beginning on January 1, 

2023, surviving spouses can receive full SBP payments from DoD/DFAS in addition to their full DIC payments 

from the VA. 
 The NDAA for Fiscal Year 2020 also directed that as of January 1, 2023, the Optional Annuity for Dependent 

Children will be eliminated and the SBP annuity payment must revert to the surviving spouse (if the surviving 

spouse submits documentation confirming eligibility). 

 If you remarried after the death of the member (before age 55), you may not be eligible for the SBP annuity. 

We must receive a reply from you, even if you believe you may not be eligible due to remarriage. If we have the 

documentation to make a determination that you are not eligible, we can continue to pay the annuity to an eligible 

child, even after January of 2023. However, if we do not receive documentation allowing us to confirm you are not 

eligible, the child annuity payments must be suspended as of January 2023 until we receive the documentation. 

Therefore, we ask that you complete and submit the attached documents even if you believe you may not be 

eligible for the SBP annuity. 

 Once we receive your documents, we will provide you with the results of our review in a postal letter. 

 Please note that January 2023 benefits will be paid on February 1, 2023. SBP benefits are paid on the first day 

of the following month. Also, in most instances, SBP annuity payments are subject to federal taxes. State and local 

taxes vary. We are not able to withhold state or local taxes from SBP payments. 

What you need to do 

 Please fill out, sign and return the following four enclosed documents as soon as possible, along with a copy

of the first page of this letter: (1) DD Form 2656-7 Verification for Survivor Annuity; (2) Annuitant Certificate of 

Eligibility; (3) Direct Deposit form 1059; and (4) IRS W-4P Withholding Certificate for Pension or Annuity 

Payments. Please submit the documents as soon as possible. 

 We have enclosed instructions to guide you in filling out the forms and sending your documents. We also have 

a helpful Form Wizard for the DD 2656-7, a helpful how-to checklist, and options for submitting your documents 

online. Please see our special webpage: www.dfas.mil/sbp2023childoptrev 

If you have questions 

 There is additional information and explanation on our special focus webpage. We will post updates on this 

webpage, so please plan to check it for news and information: www.dfas.mil/sbp2023childoptrev 

 If the webpage does not answer your question, you may write us at the address above, fax toll-free: 1-800-982-

8459, or call our customer care center at 317-212-0551 or toll-free 1-800-321-1080. If you call the customer care 

center, please identify yourself as a surviving spouse with an optional dependent annuity. 

Sincerely, 

 Retired and Annuitant Pay 

Enclosures: Instructions, DD2656-7, Annuity COE, Form 1059, W4P 
Page 1 - 10/27/2022 – SBPRev Spouse Package

INSTRUCTIONS - Please use the instructions below that fit your individual situation.

Situation One

If you are the surviving spouse of a service member who died on active duty or on inactive duty in 

the line of duty and you previously requested the Optional Annuity for Dependent Children, you may 

be eligible to begin receiving SBP annuity payments directly (without offset) after the January 1, 2023

effective date. We need the following documents to determine your eligibility.

Please fill out, sign, date and return the following four enclosed documents as soon as possible: 

(1) 2656-7 Verification for Survivor Annuity form (please note: you can disregard sections 4, 5 and 6 on the 

2656-7 form, so they have been removed on the enclosed special version); and

(2) Certificate of Eligibility (COE) for Surviving Spouse; and

(3) Direct Deposit form 1059; and 

(4) IRS W-4P Withholding Certificate for Pension or Annuity Payments. 

Please note: If you are the surviving spouse and you are not a US citizen or you are using an international bank, we 

will need additional documentation from you. Please see the webpage for special instructions: 

https://www.dfas.mil/sbp2023childoptrev

Please submit the documents as quickly as possible.

We have a helpful Form Wizard for the 2656-7 form, a helpful how-to checklist, and options for submitting 

your documents online. See the Helpful Tips and Tools on the next page.

Situation Two

If you are the surviving spouse of a service member who died on active duty or on inactive duty in 

the line of duty and you previously requested the Optional Annuity for Dependent Children, and you 

believe you may NOT be eligible for the SBP annuity payments because you remarried after the death 

of the member and before age 55, we DO need the following documents to determine your eligibility. 

Please fill out, sign, date and return the following two of the enclosed documents as soon as possible, 

along with supporting documents referred to on the COE. You do not need to fill out and return the W4P or 

the Direct Deposit form 1059 at this time. 

(1) 2656-7 Verification for Survivor Annuity form (please note: you can disregard sections 4, 5 and 6 on the 

2656-7 form, so they have been removed from the enclosed special version); and

(2) Certificate of Eligibility (COE) for Surviving Spouse (remember to include supporting documents)

Please submit the documents as quickly as possible. If your marital status changes, please notify us 

promptly, so we can re-determine your eligibility at that time. We have a helpful Form Wizard for the 2656-7

form, a helpful how-to checklist, and options for submitting your documents online. Also, see the Helpful 

Tips and Tools on the next page. 

Situation Three

If you are not the surviving spouse, and the surviving spouse has passed away:

To document a surviving spouse as deceased, we need a photocopy of the certified death certificate showing 

the cause of death. Please write the deceased member’s Social Security Number on the top of a photocopy of 

the spouse’s certified death certificate and include a photocopy of the first page of the cover letter in this 

package with the photocopy of the spouse’s death certificate, as well as a note with your full name and phone 

number and relationship to the deceased. They can be either mailed, faxed or uploaded online as PDFs via the 

askDFAS online upload tool on our website. See the next page for information. Please submit the documents as 

quickly as possible.
Page 2 - 10/27/2022 – SBPRev Spouse Package

HELPFUL TOOLS AND TIPS

Helpful Tools

• Use our 2656-7 Form Wizard to help you fill out the 2656-7 form easily and correctly, which also lets you 

electronically sign the form! It’s downloadable from: https://www.dfas.mil/sbp2023childoptrev

• Or download a special How-To Checklist from: https://www.dfas.mil/sbp2023childoptrev

• Upload a PDF of your completed/signed documents via the online upload tool (this link is case-sensitive): 

https://go.usa.gov/xMF3V

• When you upload your completed/signed documents via our online upload tool (https://go.usa.gov/xMF3V) 

and provide your email address, we will send you email status notifications: (1) when we receive your 

documents, (2) when we begin work on your documents, and (3) when we complete work on your documents

• Once we complete work on your documents, we will send you a postal letter with the eligibility determination 

and additional information. 

Tips

• You can disregard sections 4, 5 and 6 on the 2656-7 form (they have been removed from the enclosed 

special version; that is why there are blank spaces). They are not applicable in this situation.

• Remember to sign and date your documents! We are unable to process documents without a signature. 

• Keep a copy of your completed/signed documents.

• There is additional information and explanation on our special focus webpage. We post updates on this 

webpage, so please plan to check it for news and information: https://www.dfas.mil/sbp2023childoptrev

Submitting Your Documents

Send your completed documents (keep a copy of your completed/signed documents):

Online upload:

Upload a PDF of your completed/signed documents via the askDFAS online upload tool on DFAS.mil (this link is 

case-sensitive): https://go.usa.gov/xMF3V

Or mail to:

Defense Finance and Accounting Service

U.S. Military Annuitant Pay

8899 E 56th Street

Indianapolis, IN 46249-1300

Or fax toll-free to: 1-800-982-8459

Additional Reminders

• Please remember to update us if your mailing address, direct deposit, or marital status changes between the time 

you send in your documents and January 1, 2023. 

• January 2023 benefits will be paid on February 1, 2023. SBP benefits are paid on the first business day of the 

following month. 

• SBP payments are subject to federal taxes. State and local taxes vary. We are not able to withhold state or local 

taxes from SBP payments. Please consult a tax advisor about your state and/or local income tax requirements for 

SBP payments. 
FORM 2656-7 DEPREV Page 1

VERIFICATION FOR SURVIVOR ANNUITY - SPECIAL

PRIVACY ACT STATEMENT 

AUTHORITY: 10 U.S.C. Chapter 73, subchapters II and III Survival Benefit Plan; DoD Instruction 1332.42, Survivor Annuity Program Administration; and E.O. 9397 (SSN), as 

amended. PRINCIPAL PURPOSE(S): Used by the surviving spouse to verify eligibility for an annuity under the Retired Serviceman's Family Protection Plan (RSFPP), Survivor Benefit 

Plan (SBP), and/or Reserve Component Survivor Benefit Plan (RCSBP). 

ROUTINE USE(S): The System of Record Notice (SORN) T7347b is published at: https://www.federalregister.gov/documents/2009/01/07/E9-41/privacy-act-of-1974-systems-ofrecords 

DISCLOSURE: Voluntary; however, failure to provide identifying information may delay the verification process and any subsequent payment.

INSTRUCTIONS 

Please verify that the information provided below is correct. Please provide any missing information and line through and correct any errors. After verifying the information provided, 

please sign the form below and return it to: Defense Finance and Accounting Service, U.S. Military Annuitant Pay, 8899 E. 56th Street, Indianapolis, IN 46249-1300 or fax it to 

DFAS toll-free at 1-800-982-8459. If you have questions or needassistance completing this form, please contact DFAS toll-free at 1-800-321-1080.

1. DECEASED MEMBER DATA VERIFICATION

a. DECEASED MEMBER'S NAME (Last, First, Middle Initial) b. SOCIAL SECURITY NUMBER

c. DATE OF BIRTH (YYYYMMDD) d. DATE OF DEATH (YYYYMMDD) e. BRANCH OF SERVICE f. RANK/RATE

2. CLAIMANT VERIFICATION

a. CLAIMANT'S NAME (Last, First, Middle Initial) b. SOCIAL SECURITY NUMBER

c. DATE OF BIRTH (YYYYMMDD) d. TELEPHONE (Include Area Code) e. CITIZEN OF (Country)

f. IF YOU ARE A NONRESIDENT ALIEN, X HERE, ENTER YOUR COUNTRY OF RESIDENCE, AND SEE NOTE.

NOTE: ALIEN TAX WITHHELD: Nonresident aliens are automatically taxed at the rate of 30 percent, unless there is a tax treaty between the United States and 

the foreign country permitting a lesser rate. If the country in which the annuitant lives has a tax treaty with the United States, then complete IRS Form W-8BEN, 

Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding showing the country of residence. This Form may be obtained from any 

United States Internal Revenue Service office, United States consulate office, on the Internet at www.irs.gov/pub/irs-pdf/fw8ben.pdf, or by calling the Defense 

Finance and Accounting Service, toll free 1-800-321-1080 or from overseas (216) 522-5955. The Defense Finance and Accounting Service will mail foreign 

annuitants IRS Form 1042-S, Foreign Person's U.S. Source Income Subject to Withholding, at the end of each year for tax reporting purposes.

g. TYPE OF BENEFIT

CLAIMED

SBP

RCSBP

RSFPP

i. CORRESPONDENCE ADDRESS (Street, Apartment Number, City, State and

ZIP Code)

3. THE FOLLOWING SECTION APPLIES TO SPOUSE APPLICANTS ONLY

a. I CERTIFY THAT I WAS LEGALLY MARRIED TO THE MEMBER ON THE DATE OF DEATH: YES NO

(1) If YES, please verify date of marriage to member:

(If blank or incorrect, please provide correct marriage date) (2) If NO, please provide the date of divorce: (YYYYMMDD)

b. ARE THERE CHILDREN UNDER AGE 23 OR INCAPACITATED OF THE DECEASED MEMBER?

(If YES, please provide the following for each child:) YES NO

(1) NAME (Last, First Middle Initial) (2) SSN (3) DATE OF BIRTH (YYYYMMDD)

I understand that my annuity may be affected if I am receiving any other military survivor annuity of any kind from this 

deceased member or any other deceased member. I also understand that I am obligated to notify DFAS of any other annuities that 

might affect my entitlement.

c. ARE YOU RECEIVING ANY OTHER ANNUITY FROM DFAS BASED ON THE MILITARY RECORD OF ANY OTHER DECEASED

MILITARY RETIREE? (If YES, please provide the following:) YES NO

(1) Name of Deceased Retiree (Last, First, Middle Initial) (2) SSN (3) Coverage Type

SBP

RSFPP

(4) Monthly Benefit

Amount

$

United States of America
Page 2 2656-7 DEPREV

DECEASED MEMBER'S NAME (Last, First, Middle Initial) MEMBER'S SOCIAL SECURITY NUMBER

7. CLAIM CERTIFICATION AND SIGNATURE (To be completed by ALL applicants)

The claimant or authorized representative must sign. The signature must be that of: the claimant or for the annuitant by: the 

legal representative; guardian; or custodian. Failure to sign will delay payment of the annuity.

a. SIGNATURE OF CLAIMANT OR LEGAL REPRESENTATIVE (If applicable) b. DATE SIGNED (YYYYMMDD)
DEFENSE FINANCE AND ACCOUNTING SERVICE

Retired and Annuitant Pay

8899 E. 56th Street

Indianapolis, IN 46249-1300

www.dfas.mil/retiredmilitary

CERTIFICATE OF ELIGIBILITY (COE) FOR SURVIVING SPOUSE

 

1. Member’s First and Last Name: ___________________

2. Member’s Social Security Number: ___________________

3. Surviving Spouse First Name and Last Name: 

4. Surviving Spouse Date of Birth (MM/DD/YYYY): ___________________

5. Surviving Spouse Social Security Number: _________________________

6. Your marital status is required to establish your eligibility to receive an SBP annuity beginning January 

2023. Please place an ‘X’ in the applicable boxes below and provide supporting documentation if

requested:

 A. I did not marry after the death of the military member noted above.

 B. I am currently married* and my age at the time of marriage was ________.

*Please include a photocopy of the marriage certificate when submitting this COE.

 C. I married* after the death of the military member noted above. My age at the time of 

marriage was ________. The marriage has since ended due to annulment, death or divorce and I

am currently unmarried.

*Please include a photocopy of the marriage certificate and divorce order, annulment order,

and/or death certificate when submitting this COE.

7. Complete 7A OR 7B below: 

7A) If you are the SURVIVING SPOUSE completing this COE please certify and sign here:

1. Certification. I certify that I am the surviving spouse of the above named member and the 

information above is correct. I am providing a copy of all marriage certificates, divorce orders,

annulment orders, and/or death certificates not previously provided to DFAS. I will promptly notify 

DFAS, at the above address, if any changes occur in my marital status.

Signature of surviving spouse: Date (MM/DD/YYYY):

DOC: DEPREV

-Page 1 of 2-
10/15/2021

Member’s Last Name: ________________________________ Member’s SSN: ___________________

7B) If you are the Legal Representative of an INCAPACITATED surviving spouse, please certify 

and sign here:

1. Legal representative name: _________________________________________ 

EIN, if applicable:______________________________

2. Certification. I certify that: I am the legal representative of the above incapacitated surviving spouse

and the information above is correct. I am providing a copy of all marriage certificates, divorce 

orders, annulment orders, and/or death certificates not previously provided to DFAS. I will promptly 

notify DFAS, at the above address, if any changes occur in the surviving spouse’s marital status or if 

I have knowledge that the surviving spouse is deceased. 

If this COE is signed by a legal representative, a photocopy of the legal document or court order 

granting you the authority to act on the surviving spouse’s behalf must be attached.

Signature of legal representative of surviving spouse: Date (MM/DD/YYYY):

NOTE: By providing your signature you are certifying that all information provided is true and correct to the best of 

your knowledge and belief. You further agree to return all overpayments of benefits to which you are not entitled 

under the law. Any intentionally false statement, willful concealment of material fact, or use of a writing or 

document knowing the same to contain a false, fictitious, or fraudulent statement or entry, is a violation of the law 

punishable by a fine of not more than $10,000 or imprisonment of not more than 5 years, or both. (18 U.S.C. 

1001).”

Instructions for Completing the COE for Surviving Spouses

Note: Please fill in the Members’s last name and Social Security Number at the top of Page 2

1. Fill in deceased Member’s first and last name

2. Fill in deceased Member’s Social Security number

3. Fill in your/Surviving Spouse’s first and last name

4. Fill in your/Surviving Spouse’s date of birth (use two-digit month/two-digit day/four-digit year)

5. Fill in your/Surviving Spouse’s Social Security number

6. Place an ‘X’ in the applicable box(es): A, B, and/or C; and

If you chose “B. I am currently married*” fill in your age on the date of marriage and include a photocopy 

of the marriage certificate with this COE. 

If you chose, “C. I married* after the death of the military member noted above. The marriage has since 

ended due to annulment, death or divorce,” fill in your age on the date of marriage and include a photocopy of the 

marriage certificate and divorce order, annulment order, or death certificate with this COE.

7. If you are the Surviving Spouse, sign and date in 7A. 

OR, if you are the Legal Representative of an incapacitated surviving spouse, sign and date in 7B and include 

a photocopy of the legal document or court order granting you the authority to act on the surviving spouse’s 

behalf.

-Page 2 of 2-
 TYPE OF PAYMENT

 YOUR NAME (Last, First MI)

DIRECT DEPOSIT AUTHORIZATION

FOR PROCESSING FEDERAL NET PAYMENTS

(Refer to instructions for preparing authorization before completing the form.)

SECTION 1 - RECIPIENT INFORMATION

 YOUR SOCIAL SECURITY NUMBER 

SECTION II - ACCOUNT INFORMATION

 TYPE OF ACCOUNT

 YOUR HOME TELEPHONE NUMBER YOUR WORK TELEPHONE NUMBER

 YOUR HOME / CORRESPONDENCE ADDRESS

COMMUNITY PROPERTY

CHILD SUPPORT

ALIMONY

CHECKING

SAVINGS

NOTE: IF YOU SELECTED A CHECKING ACCOUNT, A VOIDED PERSONAL CHECK OR SHAREDRAFT

MUST BE ATTACHED, IN ADDITION TO COMPLETING ITEMS 8 THROUGH 12 OF THIS SECTION. SEE

INSTRUCTIONS ON THE BACK OF THIS FORM.

 ROUTING TRANSIT NUMBER 

 ACCOUNT NUMBER

 ACCOUNT TITLE (Account Holder's Name)

 FINANCIAL INSTITUTION NAME AND ADDRESS

SECTION III AUTHORIZATION

 RECIPIENT'S SIGNATURE

 DFAS-CL FORM 1059, FEBRUARY 02 (FF) (Replaces DFAS-CL 7330/2)

DATE (YYYYMMDD)

 RETIREE'S SOCIAL SECURITY NUMBER

SBP ______
 NAME OF DEPOSITOR

 STREET ADDRESS

 CITY, STATE, ZIP CODE

 _________________ 20_____

 PAY TO THE

 ORDER OF ____________________________________________________________________________

 _______________________________________________________________________________________________ DOLLARS

 NAME OF YOUR BANK

 Payable Through Another Bank

 For ______________________________________________ _____________________________________________

 

 

 

 

 99999999 9 000 000 000 0101

8

 

 ACCOUNT NUMBER - Include dashes where the symbol appears on your check or deposit slip. Be sure not to

include the check number (#101 in the example) or deposit slip number as part of your Account Number in Item 9.

 If you cannot determine your Account Number, contact your financial institution.

ROUTING TRANSIT NUMBER - Examine your deposit slip or check for items labeled 9 in the above sample. Is

the Routing Transit Number (RTN) eight numbers in a row followed by a space and then one number? Is the first

number of the RTN "0," "1," "2," or "3"? If the answer to both questions is "yes" enter the numbers from your

deposit slip or check on the reverse of this form in Item 9. Otherwise, call your financial institution and ask them

to provide you with their RTN. 

PRIVACY ACT STATEMENT

Collection of the information you are requested to provide on this form is authorized under 31 CFR 209 and/or 210. The information is

confidential and is needed to prove entitlement to payments. The information will be used to process payment data from the federal agency to

the financial institution and/or its agent.

INSTRUCTIONS FOR PREPARING AUTHORIZATION

PURPOSE - You may use this form to provide instructions for processing your net pay. Failure to provide the requested

information may affect the processing of this form and may delay or prevent the receipt of payments through the Direct

Deposit / Electronic Funds Transfer Program. 

SECTION I - EMPLOYEE / MEMBER / ANNUITANT INFORMATION (ITEMS 1-5)

You must complete all blocks after carefully reading the instructions and Privacy Act Statement. You must keep the agency

informed of any address change to remain qualified for payments.

SECTION II - DIRECT DEPOSIT ACCOUNT INFORMATION

ITEM 6 - TYPE OF ACCOUNT - Place "X" in the appropriate box, to indicate if you want your payment to be sent to a 

 checking or savings account.

ITEM 7 - TYPE OF PAYMENT - Place an "X" in the appropriate box to indicate what type of payment you want sent by Direct 

 Deposit.

ITEM 8 - ROUTING TRANSIT NUMBER - Your financial institution's 9-digit routing transit number. See the illustration below.

ITEM 9 - ACCOUNT NUMBER - Your account number at your financial institution. See the illustration below.

ITEM 10 - ACCOUNT TITLE - The depositor's name on the account at the financial institution. See the illustration below.

ITEM 11 - FINANCIAL INSTITUTION NAME / ADDRESS - The institution to which payments are to be directed

 See the illustration below.

$

10

9 CHECK NUMBER

SECTION III - AUTHORIZATION 

ITEMS 12 AND 13 - You must sign and date this form before the authorization can be processed.

FOR CANCELLATIONS - This authorization will remain in effect until you cancel by providing a written notice to the DoD

Agency or by your death or legal incapacity. Upon cancellation, you should notify the receiving financial institution. The

authorization may be cancelled by the financial institution by providing you a written notice 30 days in advance of the

cancellation date. You must immediately advise the DoD Agency if the authorization is cancelled by the financial institution.

The financial institution cannot cancel the authorization by advice to the Government Agency.

FOR CHANGES - You must complete and submit a new "Direct Deposit Authorization" form to the applicable DoD agency. We

recommend that you maintain accounts at both financial institutions until the new institution receives your Direct Deposit

payments.

DFAS-CL Form 1059, FEBRUARY 02 (FF) (Replaces DFAS-CL 7330/2)

11

101

ACCOUNT TITLE - Must include recipient's name.

FINANCIAL INSTITUTION NAME / ADDRESS - If your check or sharedraft includes "Payable Through" under the

bank name, contact the financial institution to help obtain the correct Routing Transit Number for Direct Deposit.

8 -

9 -

10 -

11 -
Form W-4P

2022

Withholding Certificate 

for Periodic Pension or Annuity Payments

Department of the Treasury 

Internal Revenue Service a Give Form W-4P to the payer of your pension or annuity payments.

OMB No. 1545-0074

(Rev. January 2022)

Step 1: 

Enter 

Personal

Information

(a) First name and middle initial Last name

Address 

City or town, state, and ZIP code

(b) Social security number

(c) Single or Married filing separately

Married filing jointly or Qualifying widow(er)

Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)

Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See pages 2 and 3 for more information on each step 

and how to elect to have no federal income tax withheld (if permitted).

Step 2: 

Income 

From a Job 

and/or 

Multiple 

Pensions/

Annuities 

(Including a 

Spouse’s 

Job/

Pension/

Annuity)

Complete this step if you (1) have income from a job or more than one pension/annuity, or (2) are married filing 

jointly and your spouse receives income from a job or a pension/annuity. See page 2 for examples on how to

complete Step 2.

Do only one of the following.

(a) Reserved for future use.

(b) Complete the items below.

(i) If you (and/or your spouse) have one or more jobs, then enter the total taxable annual pay 

from all jobs, plus any income entered on Form W-4, Step 4(a), for the jobs less the 

deductions entered on Form W-4, Step 4(b), for the jobs. Otherwise, enter “-0-” . . a $

(ii) If you (and/or your spouse) have any other pensions/annuities that pay less annually than 

this one, then enter the total annual taxable payments from all lower-paying pensions/

annuities. Otherwise, enter “-0-” .................. a $

(iii) Add the amounts from items (i) and (ii) and enter the total here ........ a $

TIP: To be accurate, submit a 2022 Form W-4P for all other pensions/annuities. Submit a new Form W-4 for your 

job(s) if you have not updated your withholding since 2019. If you have self-employment income, see page 2.

If (b)(i) is blank and this pension/annuity pays the most annually, complete Steps 3–4(b) on this form. 

Otherwise, do not complete Steps 3–4(b) on this form.

Step 3: 

Claim 

Dependent 

and Other 

Credits

If your total income will be $200,000 or less ($400,000 or less if married filing jointly): 

Multiply the number of qualifying children under age 17 by $2,000 a $

Multiply the number of other dependents by $500 ..... a $

Add other credits, such as foreign tax credit and education tax credits a $

Add the amounts for qualifying children, other dependents, and other credits and enter the

total here ........................... 3 $

Step 4 

(optional): 

Other 

Adjustments

(a) Other income (not from jobs or pension/annuity payments). If you want tax withheld 

on other income you expect this year that won’t have withholding, enter the amount of 

other income here. This may include interest, taxable social security, and dividends . 4(a) $

(b) Deductions. If you expect to claim deductions other than the basic standard deduction

and want to reduce your withholding, use the Deductions Worksheet on page 3 and 

enter the result here ...................... 4(b) $

(c) Extra withholding. Enter any additional tax you want withheld from each payment . 4(c) $

Step 5: 

Sign 

Here F

Your signature (This form is not valid unless you sign it.)

F

Date 

For Privacy Act and Paperwork Reduction Act Notice, see page 3. Cat. No. 10225T Form W-4P (2022)
Form W-4P (2022) Page 2

General Instructions

Section references are to the Internal Revenue Code. 

Future developments. For the latest information about any 

future developments related to Form W-4P, such as legislation 

enacted after it was published, go to www.irs.gov/FormW4P.

Purpose of form. Complete Form W-4P to have payers 

withhold the correct amount of federal income tax from your 

periodic pension, annuity (including commercial annuities), 

profit-sharing and stock bonus plan, or IRA payments. Federal 

income tax withholding applies to the taxable part of these 

payments. Periodic payments are made in installments at 

regular intervals (for example, annually, quarterly, or monthly) 

over a period of more than 1 year. Don’t use Form W-4P for a 

nonperiodic payment (note that distributions from an IRA that 

are payable on demand are treated as nonperiodic payments) or 

an eligible rollover distribution (including a lump-sum pension 

payment). Instead, use Form W-4R, Withholding Certificate for 

Nonperiodic Payments and Eligible Rollover Distributions, for 

these payments/distributions. For more information on 

withholding, see Pub. 505, Tax Withholding and Estimated Tax.

Choosing not to have income tax withheld. You can choose 

not to have federal income tax withheld from your payments by

writing “No Withholding” on Form W-4P in the space below 

Step 4(c). Then, complete Steps 1a, 1b, and 5. Generally, if you 

are a U.S. citizen or a resident alien, you are not permitted to 

elect not to have federal income tax withheld on payments to be 

delivered outside the United States and its possessions. 

Caution: If you have too little tax withheld, you will generally 

owe tax when you file your tax return and may owe a penalty 

unless you make timely payments of estimated tax. If too much 

tax is withheld, you will generally be due a refund when you file 

your tax return. If your tax situation changes, or you chose not 

to have federal income tax withheld and you now want 

withholding, you should submit a new Form W-4P.

Self-employment. Generally, you will owe both income and 

self-employment taxes on any self-employment income you (or 

you and your spouse) receive. If you do not have a job and want 

to pay these taxes through withholding from your payments, 

you should enter the self-employment income in Step 4(a). Then 

compute your self-employment tax, divide that tax by the 

number of payments remaining in the year, and include that 

resulting amount per payment in Step 4(c). You can also add 

half of the annual amount of self-employment tax to Step 4(b) as 

a deduction. To calculate self-employment tax, you generally 

multiply the self-employment income by 14.13% (this rate is a 

quick way to figure your self-employment tax and equals the 

sum of the 12.4% social security tax and the 2.9% Medicare tax 

multiplied by 0.9235). See Pub. 505 for more information, 

especially if your self-employment income multiplied by 0.9235 

is over $147,000.

Payments to nonresident aliens and foreign estates. Do not 

use Form W-4P. See Pub. 515, Withholding of Tax on 

Nonresident Aliens and Foreign Entities, and Pub. 519, U.S. Tax 

Guide for Aliens, for more information.

Tax relief for victims of terrorist attacks. If your disability 

payments for injuries incurred as a direct result of a terrorist 

attack are not taxable, write “No Withholding” in the space 

below Step 4(c). See Pub. 3920, Tax Relief for Victims of 

Terrorist Attacks, for more details. 

Specific Instructions

Step 1(c). Check your anticipated filing status. This will 

determine the standard deduction and tax rates used to 

compute your withholding.

Step 2. Use this step if you have at least one of the following: 

income from a job, income from more than one pension/annuity, 

and/or a spouse (if married filing jointly) that receives income 

from a job/pension/annuity. The following examples will assist 

you in completing Step 2.

Example 1. Bob, a single filer, is completing Form W-4P for a 

pension that pays $50,000 a year. Bob also has a job that pays 

$25,000 a year. Bob has no other pensions or annuities. Bob will 

enter $25,000 in Step 2(b)(i) and in Step 2(b)(iii). 

If Bob also has $1,000 of interest income, which he entered on 

Form W-4, Step 4(a), then he will instead enter $26,000 in Step 

2(b)(i) and in Step 2(b)(iii). He will make no entries in Step 4(a) on 

this Form W-4P.

Example 2. Carol, a single filer, is completing Form W-4P for 

a pension that pays $50,000 a year. Carol does not have a job, 

but she also receives another pension for $25,000 a year (which 

pays less annually than the $50,000 pension). Carol will enter 

$25,000 in Step 2(b)(ii) and in Step 2(b)(iii).

If Carol also has $1,000 of interest income, then she will enter 

$1,000 in Step 4(a) of this Form W-4P.

Example 3. Don, a single filer, is completing Form W-4P for a 

pension that pays $50,000 a year. Don does not have a job, but 

he receives another pension for $75,000 a year (which pays 

more annually than the $50,000 pension). Don will not enter any 

amounts in Step 2.

If Don also has $1,000 of interest income, he won’t enter that 

amount on this Form W-4P because he entered the $1,000 on 

the Form W-4P for the higher paying $75,000 pension.

Example 4. Ann, a single filer, is completing Form W-4P for a 

pension that pays $50,000 a year. Ann also has a job that pays 

$25,000 a year and another pension that pays $20,000 a year. 

Ann will enter $25,000 in Step 2(b)(i), $20,000 in Step 2(b)(ii), and 

$45,000 in Step 2(b)(iii).

If Ann also has $1,000 of interest income, which she entered on 

Form W-4, Step 4(a), she will instead enter $26,000 in Step 2(b)

(i), leave Step 2(b)(ii) unchanged, and enter $46,000 in Step 2(b)

(iii). She will make no entries in Step 4(a) of this Form W-4P.

If you are married filing jointly, the entries described above do 

not change if your spouse is the one who has the job or the 

other pension/annuity instead of you. 

F! CAUTION

Multiple sources of pensions/annuities or jobs. If you 

(or if married filing jointly, you and/or your spouse) have a 

job(s), do NOT complete Steps 3 through 4(b) 

on Form W-4P. Instead, complete Steps 3 through 4(b) on the 

Form W-4 for the job. If you (or if married filing jointly, you and 

your spouse) do not have a job, complete Steps 3 through 4(b) 

on Form W-4P for only the pension/annuity that pays the most 

annually. Leave those steps blank for the other pensions/

annuities.

Step 3. This step provides instructions for determining the 

amount of the child tax credit and the credit for other 

dependents that you may be able to claim when you file your 

tax return. To qualify for the child tax credit, the child must be 

under age 17 as of December 31, must be your dependent who 

generally lives with you for more than half the year, and must 

have the required social security number. You may be able to 

claim a credit for other dependents for whom a child tax credit 

can’t be claimed, such as an older child or a qualifying relative. 

For additional eligibility requirements for these credits, see Pub. 

501, Dependents, Standard Deduction, and Filing Information. 

You can also include other tax credits for which you are eligible 

in this step, such as the foreign tax credit and the education tax 

credits. Including these credits will increase your payments and 

reduce the amount of any refund you may receive when you file 

your tax return. 
Form W-4P (2022) Page 3

Specific Instructions (continued)

Step 4 (optional).

Step 4(a). Enter in this step the total of your other estimated 

income for the year, if any. You shouldn’t include amounts from 

any job(s) or pension/annuity payments. If you complete Step 

4(a), you likely won’t have to make estimated tax payments for 

that income. If you prefer to pay estimated tax rather than 

having tax on other income withheld from your pension, see 

Form 1040-ES, Estimated Tax for Individuals.

Step 4(b). Enter in this step the amount from the Deductions 

Worksheet, line 6, if you expect to claim deductions other than 

the basic standard deduction on your 2022 tax return and want 

to reduce your withholding to account for these deductions. 

This includes itemized deductions, the additional standard

deduction for those 65 and over, and other deductions such as 

for student loan interest and IRAs.

Step 4(c). Enter in this step any additional tax you want 

withheld from each payment. Entering an amount here will 

reduce your payments and will either increase your refund or 

reduce any amount of tax that you owe.

Note: If you don’t give Form W-4P to your payer, you don’t 

provide an SSN, or the IRS notifies the payer that you gave an 

incorrect SSN, then the payer will withhold tax from your 

payments as if your filing status is single with no adjustments in 

Steps 2 through 4. For payments that began before 2022, your 

current withholding election (or your default rate) remains in 

effect unless you submit a new Form W-4P. 

Step 4(b)—Deductions Worksheet (Keep for your records.)

1 Enter an estimate of your 2022 itemized deductions (from Schedule A (Form 1040)). Such deductions

may include qualifying home mortgage interest, charitable contributions, state and local taxes (up to 

$10,000), and medical expenses in excess of 7.5% of your income ............ 1 $

2 Enter: { • $25,900 if you’re married filing jointly or qualifying widow(er)

• $19,400 if you’re head of household

• $12,950 if you’re single or married filing separately } ........ 2 $

3 If line 1 is greater than line 2, subtract line 2 from line 1 and enter the result here. If line 2 is greater 

than line 1, enter “-0-” .......................... 3 $

4 If line 3 equals zero, and you (or your spouse) are 65 or older, enter:

• $1,750 if you’re single or head of household.

• $1,400 if you’re a qualifying widow(er) or you’re married and one of you is under age 65.

• $2,800 if you’re married and both of you are age 65 or older.

Otherwise, enter “-0-”. See Pub. 505 for more information ............... 4 $

5 Enter an estimate of your student loan interest, deductible IRA contributions, and certain other 

adjustments (from Part II of Schedule 1 (Form 1040)). See Pub. 505 for more information .... 5 $

6 Add lines 3 through 5. Enter the result here and in Step 4(b) on Form W-4P ......... 6 $

Privacy Act and 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 provide this information 

only if you want to (a) request federal income tax withholding from 

pension or annuity payments based on your filing status and 

adjustments; (b) request additional federal income tax withholding 

from your pension or annuity payments; (c) choose not to have 

federal income tax withheld, when permitted; or (d) change a 

previous Form W-4P. To do any of the aforementioned, you are 

required by sections 3405(e) and 6109 and their regulations to 

provide the information requested on this form. Failure to provide 

this information may result in inaccurate withholding on your 

payment(s). Failure to provide a properly completed form will result 

in your being treated as a single person with no other entries on 

the form; providing fraudulent information may subject you to 

penalties.

Routine uses of this information include giving it to the 

Department of Justice for civil and criminal litigation, and to 

cities, states, the District of Columbia, and U.S. commonwealths 

and possessions for use in administering their tax laws. We may

also disclose this information to other countries under a tax 

treaty, to federal and state agencies to enforce federal nontax 

criminal laws, or to federal law enforcement and intelligence 

agencies to combat terrorism.

You are not 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 average time and expenses required to complete and file 

this form will vary depending on individual circumstances. For 

estimated averages, see the instructions for your income tax 

return.

If you have suggestions for making this form simpler, we 

would be happy to hear from you. See the instructions for your 

income tax return.