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                                            Tax on Lump-Sum Distributions                                                   OMB No. 1545-0193
Form  4972                            (From Qualified Plans of Participants Born Before January 2, 1936)
Department of the Treasury                    Attach to Form 1040, 1040-SR, 1040-NR, or 1041.                               Attachment2023
Internal Revenue Service                    Go to www.irs.gov/Form4972 for the latest information.                          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        Yes No
      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  .   .    .  . .  . . .           . .  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 ( )aa plan participant who received this distribution, ( ) bornb 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)



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Form 4972 (2023)                                                                                                                           Page 2
Section references are to the Internal Revenue   • U.S. Retirement Plan Bonds distributed with    1. If you don’t use Form 4972, and you file:
Code.                                            the lump sum.                                    a. Form 1040, 1040-SR, or 1040-NR. Report 
Future developments. For the latest              • A distribution made during the first 5 tax     the entire amount from box 1 (Gross 
information about developments related to        years that the participant was in the plan,      distribution) of Form 1099-R on line 5a, and 
Form 4972 and its instructions, such as          unless it was made because the participant       the taxable amount on line 5b. If your pension 
legislation enacted after they were published,   died.                                            or annuity is fully taxable, enter the amount 
go to www.irs.gov/Form4972.                      • The current actuarial value of any annuity     from box 2a (Taxable amount) of Form 
                                                 contract included in the lump sum (Form          1099-R on line 5b; don’t make an entry on line 
General Instructions                             1099-R, box 8, should show this amount,          5a.
                                                 which you use only to figure tax on the          b. Form 1041. Report the amount on line 8. 
Purpose of Form                                  ordinary income part of the distribution).       2. If you don’t use Part III of Form 4972, but 
Use Form 4972 to figure the tax on a qualified   • A distribution to a 5% owner that is subject   use Part II, report only the ordinary income 
lump-sum distribution (defined below) you        to penalties under section 72(m)(5)(A).          portion of the distribution on Form 1040, 
received in 2023 using the 20% capital gain                                                       1040-SR, or 1040-NR, lines 5a and 5b; or on 
election, the 10-year tax option, or both.       • A distribution from an IRA.
These are special formulas used to figure a      • A distribution from a tax-sheltered annuity    Form 1041, line 8. The ordinary income 
separate tax on the distribution that may        (section 403(b) plan).                           portion is the amount from box 2a of Form 
result in a smaller tax than if you reported the • A distribution of the redemption proceeds of   1099-R, minus the amount from box 3 of that 
taxable amount of the distribution as ordinary   bonds rolled over tax free to a qualified        form.
income.                                          pension plan, etc., from a qualified bond        3. If you use Part III of Form 4972, don’t 
  You pay the tax only once, for the year you    purchase plan.                                   include any part of the distribution on Form 
receive the distribution, not over the next 10   • A distribution from a qualified plan if the    1040, 1040-SR, or 1040-NR, lines 5a and 5b;  
years. The separate tax is added to the          participant or his or her surviving spouse       or on Form 1041, line 8.
regular tax figured on your other income.        previously received an eligible rollover         The entries in other boxes on Form 1099-R 
                                                 distribution from the same plan (or another      may also apply in completing Form 4972.  
Related Publications                             plan of the employer that must be combined       • Box 6 (Net unrealized appreciation in 
For more information related to this topic, see  with that plan for the lump-sum distribution     employer’s securities). See Net unrealized 
the following publications.                      rules) and the previous distribution was rolled  appreciation (NUA), later.
• Pub. 575, Pension and Annuity Income.          over tax free to another qualified plan or an    • Box 8 (Other). Current actuarial value of an 
• Pub. 721, Tax Guide to U.S. Civil Service      IRA.                                             annuity.
Retirement Benefits.                             • A distribution from a qualified plan that      How Often You Can Use Form 4972
• Pub. 939, General Rule for Pensions and        received a rollover after 2001 from an IRA       After 1986, you can use Form 4972 only once 
Annuities.                                       (other than a conduit IRA), a governmental       for each plan participant. If you receive more 
                                                 section 457(b) plan, or a section 403(b) tax-
What Is a Qualified Lump-Sum                     sheltered annuity on behalf of the plan          than one lump-sum distribution for the same 
Distribution?                                    participant.                                     participant in 1 tax year, you must treat all 
                                                                                                  those distributions the same way. Combine 
It is the distribution or payment in 1 tax year  • A distribution from a qualified plan that      them on a single Form 4972.
of a plan participant’s entire balance from all  received a rollover after 2001 from another      If you make an election as a beneficiary of a 
of an employer’s qualified plans of one kind     qualified plan on behalf of that plan            deceased participant, it doesn’t affect any 
(for example, pension, profit-sharing, or stock  participant’s surviving spouse.                  election you can make for qualified lump-sum 
bonus plans) in which the participant had        • A corrective distribution of excess deferrals, distributions from your own plan. You can 
funds. The participant’s entire balance          excess contributions, excess aggregate           also make an election as the beneficiary of 
doesn’t include deductible voluntary             contributions, or excess annual additions.       more than one qualifying person.
employee contributions or certain forfeited      • A lump-sum credit or payment under the         Example. Your mother and father died and 
amounts. The participant must have been          alternative annuity option from the Federal      each was born before January 2, 1936. Each 
born before January 2, 1936.                     Civil Service Retirement System (or the          had a qualified plan of which you are the 
Distributions upon death of the plan             Federal Employees’ Retirement System).           beneficiary. You also received a qualified 
participant. If you received a qualified         How To Report the Distribution                   lump-sum distribution from your own plan and 
distribution as a beneficiary after the                                                           you were born before January 2, 1936. You 
participant’s death, the participant must have   If you can use Form 4972, attach it to Form 
been born before January 2, 1936, for you to     1040 or 1040-SR (individuals), Form 1040-NR      can make an election for each of the 
use this form for that distribution.             (nonresident aliens), or Form 1041 (estates or   distributions: one for yourself, one as your 
Distributions to alternate payees. If you are    trusts). The payer should have given you a       mother’s beneficiary, and one as your father’s 
the spouse or former spouse of a plan            Form 1099-R or other statement that shows        beneficiary. It doesn’t matter if the 
participant who was born before January 2,       the amounts needed to complete Form 4972.        distributions all occur in the same year or in 
1936, and you received a qualified lump-sum      The following choices are available.             different years. File a separate Form 4972 for 
distribution as an alternate payee under a       20% capital gain election. If there is an        each participant’s distribution.
qualified domestic relations order, you can      amount in Form 1099-R, box 3, you can use                  An earlier election on Form 4972 
use Form 4972 to figure the tax on the           Form 4972, Part II, to apply a 20% tax rate to             or Form 5544 for a distribution 
distribution using the 20% capital gain          the capital gain portion. See Capital Gain       TIP       before 1987 doesn’t prevent you 
election, the 10-year tax option, or both. For   Election , later.                                          from making an election for a 
details, see Pub. 575.                           10-year tax option. You can use Part III to                distribution after 1986 for the 
                                                 figure your tax on the lump-sum distribution     same participant, provided the participant was 
Distributions That Don’t Qualify for the         using the 10-year tax option whether or not      under age 59½ at the time of the pre-1987 
20% Capital Gain Election or the 10-             you make the 20% capital gain election.          distribution.
Year Tax Option                                  Taxable amount. If Form 1099-R, box 2a, is 
The following distributions aren’t qualified     blank, you must figure the taxable amount to 
lump-sum distributions and don’t qualify for     complete Form 4972. For details, see Pub. 
the 20% capital gain election or the 10-year     575.
tax option.                                      Where to report. Report amounts from your 
• The part of a distribution not rolled over if  Form 1099-R either directly on your tax return 
the distribution is partially rolled over to     (Form 1040, 1040-SR, 1040-NR, or 1041) or 
another qualified plan or an IRA.                on Form 4972.
• 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.



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Form 4972 (2023)                                                                                                                                         Page 3
When To File Form 4972                           Multiple recipients of a lump-sum                           Step 3. Use this step only if you elect to 
You can file Form 4972 with either an original   distribution. If you are filing for a trust that          include NUA in your taxable income.
or amended return. For an amended return,        shared the distribution only with other trusts,           • If you aren’t making the capital gain 
you must generally file within 3 years after the figure the tax on the total lump sum first. The           election, add the amount from Form 1099-R, 
date the original return was filed or within 2   trusts then share the tax in the same                     box 2a, to the amount in box 6. Divide the 
years after the date the tax was paid,           proportion that they shared the distribution.             result by your percentage of distribution from 
whichever is later, to use any part of Form         If you shared in a lump-sum distribution               Form 1099-R, box 9a. Enter the result on 
4972.                                            from a qualified retirement plan when not all             Form 4972, line 8. On the dotted line next to 
                                                 recipients were trusts (a percentage will be              line 8, write “NUA” and the amount of NUA 
Capital Gain Election                            shown in Form 1099-R, boxes 8 and/or 9a),                 included (Form 1099-R, box 6, divided by 
If the distribution includes a capital gain      figure your tax on Form 4972 as follows.                  your percentage of distribution in box 9a). 
amount, you can (a) make the 20% capital            Step 1. Complete Form 4972, Parts I and II.            • If you are making the capital gain election, 
gain election in Part II of Form 4972, or (b)    If you make the 20% capital gain election in              subtract the amount from Form 1099-R, box 
treat the capital gain as ordinary income.       Part II and also elect to include NUA in                  3, from the amount in box 2a. Add to the 
   Only the taxable amount of distributions      taxable income, complete the NUA Worksheet                result the amount from line F of your NUA 
resulting from pre-1974 participation qualifies  below to determine the amount of NUA that                 Worksheet. Then, divide the total by your 
for capital gain treatment. The capital gain     qualifies for capital gain treatment. Then, skip          percentage of distribution from Form 1099-R, 
amount should be shown in Form 1099-R,           Step 2 and go to Step 3.                                  box 9a. Enter the result on Form 4972, line 8. 
box 3. If there is a net unrealized appreciation    Step 2. Use this step only if you don’t elect          On the dotted line next to line 8, write “NUA” 
(NUA) amount in Form 1099-R, box 6, part of      to include NUA in your taxable income or if               and the amount of NUA included (line F of 
it will also qualify for capital gain treatment. you don’t have NUA.                                       your NUA Worksheet divided by your 
Use the NUA Worksheet on this page to figure                                                               percentage of distribution from Form 1099-R, 
the capital gain part of NUA if you make the     • If you aren’t making the capital gain 
election to include NUA in your taxable          election, divide the amount from Form                     box 9a).
income.                                          1099-R, box 2a, by your percentage of                     • Complete Form 4972, lines 9 and 10. Divide 
                                                 distribution in box 9a. Enter this amount on              the amount from Form 1099-R, box 8, by the 
   You can report the ordinary income portion    Form 4972, line 8.                                        percentage in box 8. Enter the result on Form 
of the distribution on Form 1040, 1040-SR, or                                                              4972, line 11.
1040-NR, line 5b; or Form 1041, line 8; or you   • If you are making the capital gain election, 
can figure the tax using the 10-year tax         subtract the amount from Form 1099-R, box                   Step 4. Complete Form 4972 through line 
option. The ordinary income portion is           3, from the amount in box 2a. Divide the result           28.
generally the amount from Form 1099-R, box       by your percentage of distribution from Form                Step 5. Complete the following worksheet 
2a, minus the amount from box 3 of that form.    1099-R, box 9a. Enter the result on Form                  to figure the entry for Form 4972, line 29.
                                                 4972, line 8.
Net unrealized appreciation (NUA).                                                                         A. Subtract line 28 from line 25  .
Normally, NUA in employer securities             • Complete Form 4972, lines 9 and 10. Divide 
received as part of a lump-sum distribution      the amount from Form 1099-R, box 8, by the                B. Enter your percentage of the 
isn’t taxable until the securities are sold.     percentage in box 8. Enter the result on Form                distribution from box 9a   .     .
However, you can elect to include NUA in         4972, line 11. Then, skip Step 3 and go to                C. Multiply line A by line B. Enter 
taxable income in the year received.             Step 4.                                                      here and on Form 4972, line 29. 
   The total amount to report as NUA should                                                                   Also, write “MRD” on the dotted 
be shown in Form 1099-R, box 6. Part of the                                                                   line next to line 29  .  . .     .
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                                  NUA Worksheet (keep for your records)
subject to capital gain treatment including the 
NUA, complete the NUA Worksheet on this          A.    Enter the amount from Form 1099-R, box 3  .            .     . .   .   . .      . A.
page.                                            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 
Specific Instructions                                  least three places)      .   .    . .    . .    .   .  .     . .   .   . .      . C.          .
Name of recipient of distribution and 
identifying number. At the top of Form 4972,     D.    Enter the amount from Form 1099-R, box 6  .            .     . .   .   . .      . D.
fill in the name and identifying number of the   E.    Capital gain portion of NUA. Multiply line C by line D         .   .   . .      . E.
recipient of the distribution.                   F.    Ordinary income portion of NUA. Subtract line E from line D            . .      . F.
   If you received more than one qualified 
distribution in 2023 for the same plan           G.    Total capital gain portion of distribution. Add lines A and E. Enter here 
participant, add them and figure the tax on            and  on  Form  4972,  line  6.  On  the  dotted  line  next  to  line  6,  write 
the total amount. If you received qualified            “NUA” and the amount from line E above  .           .  .     . .   .   . .      .
                                                                                                                                         G.
distributions in 2023 for more than one 
participant, file a separate Form 4972 for the                      Death Benefit Worksheet (keep for your records)
distributions of each participant.
   If you and your spouse are filing a joint     A.    Enter the amount from Form 1099-R, box 3, or, if you are including 
return and each has received a lump-sum                NUA in taxable income, the amount from line G of the NUA Worksheet                A.
distribution, complete and file a separate 
Form 4972 for each spouse, combine the tax,      B.    Enter the amount from Form 1099-R, box 2a, plus, if you are including 
and include the combined tax in the total on           NUA in taxable income, the amount from Form 1099-R, box 6 .              .      . B.
Form 1040 or 1040-SR, line 16. Be sure to        C.    Divide line A by line B and enter the result as a decimal (rounded to at 
check box  2on Form 1040 or 1040-SR, 
line 16.                                               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.



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Form 4972 (2023)                                                                                                                                Page 4

Part II                                              If you didn’t make the 20% capital gain                    Tax Rate Schedule
See Capital Gain Election  , earlier, before      election and didn’t elect to include NUA in       If the amount on         Enter on line 
completing Part II.                               taxable income, enter the amount from Form        line 23 or 26 is:        24 or 27:
Line 6. Leave this line blank if your             1099-R, box 2a. If you didn’t make the 20%                                                  Of the 
distribution doesn’t include a capital gain       capital gain election but did elect to include                But not                       amount 
amount or you aren’t making the 20% capital       NUA in your taxable income, add the amount        Over—       over—                         over—
gain election, and go to Part III.                from Form 1099-R, box 2a, to the amount                  $ 0  $ 1,190        - - - - - 11%       $ 0 
                                                  from Form 1099-R, box 6. Enter the total on 
Generally, enter on line 6 the amount from        line 8. On the dotted line next to line 8, write   1,190        2,270      $130.90 + 12%        1,190 
Form 1099-R, box 3. However, if you elect to      “NUA” and the amount from Form 1099-R,               2,270       4,530      260.50 + 14%       2,270 
include NUA in your taxable income, use the       box 6.                                             4,530        6,690      576.90 + 15%         4,530 
NUA Worksheet, earlier, to figure the amount 
to enter on line 6. If you are taking a death                   Community property laws don’t          6,690       9,170     900.90 + 16%        6,690 
benefit exclusion (see Line 9 below for the                     apply in figuring tax on the amount 
definition), use the Death Benefit Worksheet,     !            you report on line 8.                9,170       11,440      1,297.70 + 18%       9,170 
earlier, to figure the amount to enter on line 6. CAUTION                                           11,440       13,710      1,706.30 + 20%      11,440 
The remaining allowable death benefit             Line 9. If you received the distribution           13,710      17,160      2,160.30 + 23%      13,710 
exclusion should be entered on line 9 if you      because of the plan participant’s death and       17,160       22,880      2,953.80 + 26%      17,160 
choose the 10-year tax option.                    the participant died before August 21, 1996, 
If any federal estate tax was paid on the         you may be able to exclude up to $5,000 of         22,880      28,600      4,441.00 + 30%      22,880 
lump-sum distribution, you must decrease the      the lump sum from your gross income. This         28,600       34,320      6,157.00 + 34%      28,600 
capital gain amount by the amount of estate       exclusion applies to the beneficiaries or          34,320      42,300      8,101.80 + 38%      34,320 
tax applicable to it. To figure this amount, you  estates of common-law employees, self-
must complete the Death Benefit Worksheet,        employed individuals, and shareholder-            42,300       57,190   11,134.20 + 42%        42,300 
earlier, through line C, even if you don’t take   employees who owned more than 2% of the            57,190      85,790     17,388.00 + 48%      57,190 
the death benefit exclusion. Multiply the total   stock of an S corporation.                        85,790       - - - - -   31,116.00 + 50%     85,790
federal estate tax paid on the lump-sum              Enter the allowable death benefit exclusion 
distribution (get this amount from the            on line 9. If you made the 20% capital gain       Paperwork Reduction Act Notice.We ask 
administrator of the deceased’s estate) by the    election, enter the amount from line D of the     for the information on this form to carry out 
decimal on line C of the Death Benefit            Death Benefit Worksheet minus the amount          the Internal Revenue laws of the United 
Worksheet. The result is the portion of the       from line E of that worksheet.                    States. You are required to give us the 
federal estate tax applicable to the capital         Multiple recipients. If there are multiple     information. We need it to ensure that you are 
gain amount. Then, use that result to reduce      recipients of the distribution not all of whom    complying with these laws and to allow us to 
the amount in Form 1099-R, box 3, if you          are trusts, and you didn’t complete Part II,      figure and collect the right amount of tax.
don’t take the death benefit exclusion, or        enter the full allowable death benefit exclusion  You aren’t required to provide the 
reduce line F of the Death Benefit Worksheet      on line 9. Don’t allocate the exclusion among     information requested on a form that is 
if you do. Enter the remaining capital gain on    the recipients; the computation under Multiple    subject to the Paperwork Reduction Act 
line 6. If you elected to include NUA in taxable  recipients of a lump-sum distribution  , earlier, unless the form displays a valid OMB control 
income and you didn’t take the death benefit      effectively allocates the exclusion.              number. Books or records relating to a form 
exclusion, subtract the portion of federal           If you completed Part II, multiply the full    or its instructions must be retained as long as 
estate tax applicable to the capital gain         allowable death benefit exclusion (don’t          their contents may become material in the 
amount from the amount on line G of the NUA       allocate among the recipients) by the             administration of any Internal Revenue law. 
Worksheet. Enter the result on line 6. Enter      percentage on line C of the Death Benefit         Generally, tax returns and return information 
the remainder of the federal estate tax on line   Worksheet. Subtract the result from the full      are confidential, as required by section 6103.
18.                                               allowable death benefit exclusion. Enter the      The time needed to complete this form will 
             If you take the death benefit        result on line 9.                                 vary depending on individual circumstances. 
             exclusion and federal estate tax     Line 18. A beneficiary who receives a lump-       The estimated burden for individual taxpayers 
!           was paid on the capital gain         sum distribution because of a plan                filing this form is approved under OMB control 
CAUTION      amount, the capital gain amount      participant’s death must reduce the taxable       number 1545-0074 and is included in the 
must be reduced by both the procedures            part of the distribution by any federal estate    estimates shown in the instructions for their 
discussed above to figure the correct entry for   tax paid on the lump-sum distribution (get this   individual income tax return. The estimated 
line 6.                                           amount from the administrator of the              burden for all other taxpayers who file this 
Part III                                          deceased’s estate). Do this by entering on line   form is shown below.
Multiple recipients, see Multiple recipients of a 18 the federal estate tax attributable to the     Recordkeeping          . . .    .   .   . 19 min.
lump-sum distribution  , earlier.                 lump-sum distribution. Also, see Line 6 above 
                                                  if you made a capital gain election.              Learning about the law                                
Line 8. If Form 1099-R, box 2a, is blank, you     Lines 24 and 27. Use the following Tax Rate       or the form   .   .    . . .    .    1 hr., 36 min.
must first figure the taxable amount. For         Schedule to complete lines 24 and 27.             Preparing the form       . .    .   . 2 hr., 7 min.
details on how to do this, see Pub. 575.                                                            Copying, assembling, and                 
If you made the 20% capital gain election,        Line 29. Multiple recipients, see Multiple 
enter only the ordinary income portion of the     recipients of a lump-sum distribution, earlier.   sending the form to the IRS .       .   . 20 min.
                                                                                                    If you have comments concerning the 
distribution on this line. The ordinary income                                                      accuracy of these time estimates or 
portion is the amount from Form 1099-R, box                                                         suggestions for making this form simpler, we 
2a, minus the amount from box 3 of that form.                                                       would be happy to hear from you. See the 
Add the amount from line F of the NUA                                                               instructions for the tax return with which this 
Worksheet if you included NUA capital gain in                                                       form is filed.
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.






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