TN 2 (09-11)

NL 00720.345 TAX Taxation of Benefits

TAX002 COA — DOMESTIC TO FOREIGN (A81)

(Requested)

Caption: What We Will Pay

We will withhold Federal income tax from  (1)  benefit each month starting  (2)  . If  (3)  is a citizen or U.S. resident, please let us know and we will stop withholding the tax.

The United States has income tax treaties with Canada, Egypt, Germany, India, Ireland, Israel, Italy, Japan, Romania, Switzerland and the United Kingdom that may reduce or eliminate this tax on Social Security benefits for certain residents of these countries. Please contact the Internal Revenue Service to learn more about these treaties. Please contact us to stop or reduce the tax if  (4)  the conditions of an income tax treaty.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: your

Choice 2: Beneficiary Name Possessive

Fill-in (2) - Requested As A Date CCYY

Fill-in (3) - Systems Generated

Choice 1: you become

Choice 2: he becomes

Choice 3: she becomes

Fill-in (4) - Systems Generated

Choice 1: you meet

Choice 2: he meets

Choice 3: she meets

TAX003 ALIEN WITHHOLDING TAX APPEAL (A86)

(System Generated)

Caption: Your Benefits

We use information about  (1)  citizenship and residency to decide whether to withhold Federal income tax from  (2)  benefits. If you think we have the wrong information, please contact us. We collect this tax for the Internal Revenue Service (IRS). If you have questions about this tax, or to learn about  (3)  appeal rights, please contact the IRS.

Fill-in values:

Fill-in (1)

Choice 1: Beneficiary Name Possessive

Choice 2: your

Fill-in (2)

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (3)

Choice 1: Beneficiary Name Possessive

Choice 2: your

Fill-in (4)

Choice 1: your

Choice 2: her

Choice 3: his

TAX004 REFUND OF TAX — GENERAL PARAGRAPH FOR USE WHEN REFUND IS DUE— SSA CANNOT MAKE REFUND (A74)

(Requested)

Caption: Your Benefits

We deducted too much in Federal income tax from your Social Security benefits in  (1)  . Since we deducted too much, you are due a  (2)  refund. Because this refund is not for this year, we cannot pay you this money. IRS should refund this money.

If IRS has not refunded the  (3)  you are due for  (4)  , you must request a refund from IRS in order to get this money. To request this refund, you must file a U.S. tax return and report your income. The return should be filed with the Internal Revenue Service Center, Philadelphia, PA 19255.

IRS has advised us that there is a time limit to request a refund. Generally, you must request a refund within 3 years after the due date of the tax return for the year we deducted the tax.

Fill-in values:

Fill-in (1) - Requested As A Date In Format Shown Below

Month(s)/year(s) tax withheld

Choice 1: MM/CCYY

Choice 2: MM/CCYY through MM/CCYY

Fill-in (2) - Requested As A Money Amount In Format $$$$$.cc

Amount of refund

Fill-in (3) - Requested As A Money Amount In Format $$$$$.cc

Amount IRS can pay

Fill-in (4) - Requested As A Date In Format Shown Below

Month(s)/year(s) tax withheld

Choice 1: MM/CCYY

Choice 2: MM/CCYY through MM/CCYY

TAX006 ALIEN TAX DEDUCTION CONTINUES (G25)

(System Generated)

Caption: Your Benefits

We will continue to deduct Federal income tax from your monthly checks.

TAX011 COA — NONTAX TREATY TO TAX TREATY COUNTRY (A83)

(Requested)

Caption: Your Benefits

Because of the information you gave us, we are no longer deducting Federal income tax from your monthly benefits. This is because of a treaty which says we will not tax Social Security benefits paid to residents of  (1)  .

Please let us know if you change your address again.

Fill-in values:

Fill-in (1) Requested As A One Position Alpha Character

Choice 1: (A) Canada

Choice 2: (B) Egypt

Choice 3: (C) Germany

Choice 4: (D) India

Choice 5: (E) Ireland

Choice 6: (F) Israel

Choice 7: (G) Italy

Choice 8: (H) Japan

Choice 9: (I) Romania

Choice10: (J) the United Kingdom

TAX019 REFUND OF TAX — BENEFICIARY ESTABLISHED U.S. CITIZENSHIP OR RESIDENCY, OR RESIDENCY IN A TAX TREATY COUNTRY — SSA CANNOT MAKE REFUND (A77)

(Requested)

Caption: Your Benefits

We deducted  (1)  in Federal income tax from  (2)  Social Security benefits in  (3)  . Since  (4)  a  (5)   (6)  , we should not have deducted any tax for this period.  (7)  should receive a  (8)  refund. Because the refund is not for this year, we cannot pay  (9)  this money. IRS should refund this money. If IRS has not refunded the  (10)   (11)  due for  (12)  ,  (13)  must request a refund from IRS in order to get this money. To request this refund,  (14)  must file a U.S. tax return and report  (15)  income. The return should be filed with the Internal Revenue Service Center, Philadelphia, PA 19255.

IRS has advised us that there is a time limit to request a refund. Generally,  (16)  must request a refund within 3 years after the due date of the tax return for the year we deducted the tax.

Fill-in values:

Fill-in (1) Requested As A Money Amount In Format $$$$$.cc

Amount of tax withheld

Fill-in (2) Systems Generated

Choice 1: your

Choice 2: Beneficiary's name possessive

Fill-in (3) Request As A Date In Format Shown Below

Choice 1: MM/CCYY

Choice 2: MM/CCYY through MM/CCYY

Fill-in (4) Systems Generated

Choice 1: you were

Choice 2: he was

Choice 3: she was

Fill-in (5) Requested As A One Position Alpha Character

Choice 1: (A) United States citizen

Choice 2: (B) citizen of

Fill-in (6) Requested As A One Position Alpha Character

Choice 1: (A) Canada

Choice 2: (B) Egypt

Choice 3: C) Germany

Choice 4: (D) India

Choice 5: (E) Ireland

Choice 6: (F) Israel

Choice 7: (G) Italy

Choice 8: (H) Japan

Choice 9: (I) Romania

Choice 10: (J) Switzerland

Choice 11: (K) the United Kingdom

Choice 12: (L) null (if Country of Citizenship is U.S.)

Fill-in (7) Systems Generated

Choice 1: You

Choice 2: He

Choice 3: She

Fill-in (8) Requested As A Money Amount in Format $$$$$.¢¢

Amount of refund

Fill-in (9) Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (10)

Amount IRS should pay

Fill-in (11) Systems Generated

Choice 1: you are

Choice 2: he is

Choice 3: she is

Fill-in (12)

same as #3 above

Fill-in (13) Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (14) Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (15) Systems Generated

Choice 1: your

Choice 2: his

Fill-in (16) Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

TAX020 REFUND OF TAX — BENEFICIARY ESTABLISHED U.S. CITIZENSHIP OR RESIDENCY, OR RESIDENCY IN A TAX TREATY COUNTRY — SSA CAN MAKE REFUND (A78)

(Requested)

Caption: Your Benefits

We deducted  (1)  in Federal income tax from  (2)  Social Security benefits in  (3)  . Since  (4)  a  (5)   (6)  , we should not have deducted any tax for this period.  (7)  should receive a  (8)  refund. We will send  (9)  a check for this amount.

Fill-in values:

Fill-in (1) Requested As A Money Amount in Format $$$$$.¢¢

Amount of tax withheld

Fill-in (2) Systems Generated

Choice 1: your

Choice 2: Beneficiary's name possessive

Fill-in (3) Requested As A Date In Format Shown Below

Choice 1: MM/CCYY

Choice 2: MM/CCYY through MM/CCYY

Fill-in (4) Systems Generated

Choice 1: you were

Choice 2: he was

Choice 3: she was

Fill-in (5) Requested As A One Position Alpha Character

Choice 1: (A) United States citizen

Choice 2: (B) citizen of

Fill-in (6) Requested As A One Position Alpha Character

Choice 1: (A) Canada

Choice 2: (B) Egypt

Choice 3: C) Germany

Choice 4: (D) India

Choice 5: (E) Ireland

Choice 6: (F) Israel

Choice 7: (G) Italy

Choice 8: (H) Japan

Choice 9: (I) Romania

Choice 10: (J) Switzerland

Choice 11: (K) the United Kingdom

Choice 12: (L) null (if Country of Citizenship is U.S.)

Fill-in (7) Systems Generated

Choice 1: You

Choice 2: He

Choice 3: She

Fill-in (8) Requested As A Money Amount in Format $$$$$.¢¢

Amount of refund

Fill-in (9) Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

TAX021 COA — TAX TREATY TO NONTAX TREATY COUNTRY (A82)

(Requested)

Caption: Your Benefits

We are deducting a Federal income tax from  (1)  your benefits each month. We did not deduct the tax before  (2)  because you were living in  (3)  . We will stop deducting the tax or deduct it at a lower rate if:

 (4)  a U.S. citizen,

OR

 (5)  in the United States, Canada, Egypt, Germany, Ireland, Israel, Italy, Japan, Romania, Switzerland or the United Kingdom.

 (6) 

Please let us know if any of these things happen.

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: your

Choice 2: Beneficiary name Possessive

Fill- in (2) Systems Generated

Choice 1: you were

Choice 2: he was

Choice 3: she was

Fill-in (3) Requested As A One Position Alpha Character

Choice 1: (A) Canada

Choice 2: (B) Egypt

Choice 3: (C) Germany

Choice 4: (D) India

Choice 5: (E) Ireland

Choice 6: (F) Israel

Choice 7: (G) Italy

Choice 8: (H) Japan

Choice 9: (I) Romania

Choice 10: (J) Switzerland

Choice 11: (K) the United Kingdom

Fill- in (4) Systems Generated

Choice 1: You become

Choice 2: He becomes

Choice 3: She becomes

Fill- in (5) Systems Generated

Choice 1: You live

Choice 2: He lives

Choice 3: she lives

Fill-in (6) Request As A One Position Alpha Character

Choice 1: (A) Also, if you are a citizen and resident of India, all or part of your benefits can be exempt from this Federal income tax if your benefits are based on Federal, State or local government.

Choice 2: (B) Also, if he is a citizen and resident of India, all or part of his benefits can be exempt from this Federal income tax if his benefits are based on Federal, State or local government employment.

Choice 3: (C) Also, if she is a citizen and resident of India, all or part of her benefits can be exempt from this Federal income tax if her benefits are based on Federal, State or local government employment.

Choice 4 : (D) Null

TAX022 CHANGE IN TAX STATUS — NEW INFORMATION OR EVIDENCE SUBMITTED (A84)

(Requested)

Caption: Your Benefits

Because of the information  (1)  gave us, we are  (2)  deducting Federal income tax from  (3)  benefits. We do not deduct this tax or deduct it at a lower rate if  (4)  a U.S. citizen, or if  (5)  in the United States, Canada, Egypt, Japan, Romania, Ireland, Israel, Italy, Germany, Switzerland or the United Kingdom.  (6)  Please let us know if  (7)   (8)  address again.

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: you

Choice 2: Beneficiary's name

Fill-in (2) Requested As A One Position Alpha Character

Choice 1: (A) no longer

Choice 2: (B) now

Fill-in (3) Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (4) Systems Generated

Choice 1: you are

Choice 2: he is

Choice 3: she is

Fill-in (5) Systems Generated

Choice 1: you live

Choice 2: he lives

Choice 3: she lives

Fill-in (6) Systems Generated

Choice 1: Also, if you are a citizen and resident of India, all or part of your benefits can be exempt from this Federal income tax if your benefits are based on Federal, State or local government.

Choice 2: Also, if he is a citizen and resident of India, all or part of his benefits can be exempt from this Federal income tax if his benefits are based on Federal, State or local government.

Choice 3: Also, if she is a citizen and resident of India, all or part of her benefits can be exempt from this Federal income tax if her benefits are based on Federal, State or local government.

Fill-in (7) Systems Generated

Choice 1: you change

Choice 2: he changes

Choice 3: she changes

Fill-in (8) Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

TAX023 ALIEN WITHHOLDING INCREASED TO 25.5 PERCENT (A85)

(Requested)

Caption: Your Benefits

We are deducting a Federal income tax of 25.5 percent from  (1)  Social Security benefit each month. This is because of a change in the United States Internal Revenue law which says that we must tax Social Security benefits at this higher rate.

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: your

Choice 2: Beneficiary's name possessive

TAX024 REFERRAL TO IRS FOR QUESTIONS ABOUT TAX LIABILITY (A87)

(Requested)

Caption: Your Benefits

If  (1)  any further questions about  (2)  tax, please write to the Internal Revenue Service, Taxpayer Service Division, Washington, DC 20225.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you have

Choice 2: Beneficiary's name has

Fill-in (2) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

TAX025 NO CHANGE IN TAX STATUS — NEW INFORMATION OR EVIDENCE SUBMITTED (A89)

(Requested)

Caption: Your Benefits

We will continue to deduct a Federal income tax from  (1)  benefit each month. The new facts  (2)  gave us did not cause us to stop deducting the tax. We will stop deducting the tax or deduct it at a lower rate if:

  •  (3)  a U.S. citizen,

OR

  •  (4)  in the United States, Canada, Egypt, Germany, Ireland, Israel, Italy, Japan, Romania, Switzerland or the United Kingdom.

 (5)  Please let us know if any of these things happen

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: your

Choice 2: Beneficiary's name possessive

Fill-in (2) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (3) - Systems Generated

Choice 1: you become

Choice 2: he becomes

Choice 3: she becomes

Fill-in (4) - Systems Generated

Choice 1: you live

Choice 2: he lives

Choice 3: she lives

Fill-in (5) - Systems Generated

Choice 1: Also, if you are a citizen and resident of India, all or part of your benefits can be exempt from this Federal income tax if your benefits are based on Federal, State or local government.

Choice 2: Also, if he is a citizen and resident of India, all or part of his benefits can be exempt from this Federal income tax if his benefits are based on Federal, State or local government.

Choice 3: Also, if she is a citizen and resident of India, all or part of her benefits can be exempt from this Federal income tax if her benefits are based on Federal, State or local government.

TAX026 OVERPAYMENT INCLUDES AMOUNTS WITHHELD FOR NONRESIDENT ALIEN TAX - OVERPAID PERSON IN NONPAY STATUS - NO CROSS PROGRAM ADJUSTMENT (A91)

(Requested)

Caption: Your Benefits

 (1)  total overpayment is  (2)  . This includes the Federal income tax we deducted from the benefits  (3)  not due.

When  (4)  us back,  (5)   (6)  . We will use the tax we deducted from  (7)  check to get back the rest of the overpayment.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: Your

Choice 2: Beneficiary's name possessive

Fill-in (2) Requested As A Money Amount in Format $$$$$.¢¢

Amount

Fill-in (3) - Systems Generated

Choice 1: you were

Choice 2: he was

Choice 3: she was

Fill-in (4) - Systems Generated

Choice 1: you pay

Choice 2: he pays

Choice 3: she pays

Fill-in (5) - Systems Generated

Choice 1: you only need to repay

Choice 2: he only needs to repay

Choice 3: she only needs to repay

Fill-in (6) Requested As A Money Amount in Format $$$$$.¢¢

Amount

Fill-in (7) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

TAX027 WITHHOLDING TAX (DOE 12/83 OR LATER) (G27)

(System Generated)

Caption: Your Benefits

We are deducting Federal income tax from  (1)  benefit each month  (2)   (3)  . We will stop deducting the tax or deduct it at a lower rate if:

  •  (4)   (5)  a U.S. citizen, or

  •  (6)   (7)  in the United States, Canada, Egypt, Germany, Ireland, Israel, Italy, Japan, Romania, Switzerland or the United Kingdom

Also, if an individual is a citizen and resident of India, all or part of that person's benefits can be exempt from this Federal income tax if those benefits are based on Federal, State or local government employment.

 Please contact us if any of these things happen.

We collect this tax for the Internal Revenue Service. So, if you disagree with the decision to tax  (8)  , you will have to contact them to appeal. However, if you think we made a mistake about where  (9)   (10)  or about  (11)  citizenship, let us know. We will correct the mistake.

Fill-in values:

Fill-in (1)

Choice 1: Beneficiary's Name Possessive

Choice 2: your

Fill-in (2)

Choice 1: null

Choice 2: beginning

Fill-in (3)

Choice 1: MM/CCYY

Choice 2: null

Fill-in (4)

Choice 1: she

Choice 2: he

Choice 3: you

Fill-in (5)

Choice 1: become

Choice 2: becomes

Fill-in (6)

Choice 1: she

Choice 2: he

Choice 3: you

Fill-in (7)

Choice 1: live

Choice 2: lives

Fill-in (8)

Choice 1: Beneficiary's Name

Choice 2: you

Fill-in (9)

Choice 1: Beneficiary's Name

Choice 2: you

Fill-in (10)

Choice 1: live

Choice 2: lives

Fill-in (11)

Choice 1: her

Choice 2: his

Choice 3: you

TAX050 COA — FOREIGN TO DOMESTIC — BENEFICIARY SUBJECT TO ALIEN TAX UNTIL RESIDENCE IN U.S. ESTABLISHED (A80)

(Requested)

Caption: Your Benefits

We are deducting Federal income tax from  (1)  benefits because our records show that  (2)  . We may stop deducting the tax if  (3)  of the U.S. Please get in touch with a Social Security office if  (4)  .

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: your

Choice 2: Beneficiary name possessive

Fill-in (2) Systems Generated

Choice 1: you are not a U.S. citizen or resident

Choice 2: he is not a U.S. citizen or resident

Choice 3: she is not a U.S. citizen or resident

Fill-in (3) Systems Generated

Choice 1: you become a resident

Choice 2: he becomes a resident

Choice 3: she becomes a resident

Fill-in (4) Systems Generated

Choice 1: you become a resident

Choice 2: he becomes a resident

Choice 3: she becomes a resident


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900720345