TN 4 (09-86)

Z-1 Questions Regarding Tax Refunds

As authorized by Public Law 98-21, a U.S. Federal income tax will be withheld from your monthly Social Security benefits for (1) and later. Your benefits are subject to this tax unless you are a U.S. citizen or resident of the United States, Canada, Egypt, Italy, Japan, Malta, Romania or the United Kingdom. Taxes correctly withheld will not be refunded when you file a U.S. income tax return.

1. First month of withholding

Z-2 Tax Treaty Resident Wants to Know Withholding Status

We will not withhold a U.S. Federal income tax from your monthly Social Security benefits. (1) has a tax treaty with the United States that prohibits taxing the Social Security benefits of its residents. Notify us of any change of address as it may change your tax liability.

1. Country of residence—Must be Canada, Egypt, Italy, Japan, Malta, Romania or the United Kingdom.

Z-3 Questions Regarding Tax Treaty Between the United States and Country Other Than Canada, Egypt, Italy, Japan, Malta, Romania and the United Kingdom

Only the tax treaties between the United States and Canada, Egypt, Italy, Japan, Malta, Romania and the United Kingdom (England, Scotland, Wales and Northern Ireland) prohibit the taxing of Social Security benefits of their residents. If you have any further questions about tax treaties, please write to the Internal Revenue Service, Taxpayer Service Division, Washington, D.C. 20225.

Z-5 How Marriage to a U.S. Citizen Affects Taxation

Your Social Security benefits are subject to the U.S. Federal income tax unless you are a U.S. citizen or resident. The fact that you are married to a U.S. citizen or resident does not exempt you from the tax.

Z-6 General Taxation Provision

If you are a U.S. citizen or a U.S. resident, depending on your other income, you may need to include up to one-half of your Social Security payments when computing your gross income for income tax purposes when your income exceeds certain base amounts. The base amounts are $25,000 for a single taxpayer, $32,000 for married taxpayers filing jointly and zero for married taxpayers filing separately. For further information on this taxing provision, please write to the Internal Revenue Service, Taxpayer Service Division, Washington, D.C. 20225.

Z-7 Request for Withholding Status—Not Subject to Taxation

Since you are a (1) through (9), you are not subject to the nonresident alien Federal income tax withholding.

1. U.S. citizen

2. U.S. resident

3. resident of Japan

4. resident of Malta

5. resident of Romania

6. resident of Egypt

7. resident of the United Kingdom

8. resident of Canada

9. resident of Italy

Z-8 Request for Withholding Status—Subject to Taxation

As authorized by Public Law 98-21, a U.S. Federal income tax will be withheld from your monthly Social Security benefits for (1) and later. Your benefits are subject to this tax unless you are a U.S. citizen or a resident of the United States, Canada, Egypt, Italy, Japan, Malta,Romania or the United Kingdom.

If you want to submit evidence to prove U.S. citizenship or residence in the United States, Canada, Egypt, Italy, Japan, Malta, Romania or the United Kingdom, contact the nearest U.S. Embassy or consulate or Social Security office. In the Philippines, you may contact the Veterans Administration Regional Office in Manila.

1. First month of withholding