2023 IA W-4P 
                                    Withholding Certificate for Pension or Annuity Payments 
                                                                                             tax.iowa.gov 
                                    Instructions 
Eligibility requirements                                      Withholding rates 
For tax years beginning on or after January 1, 2023,  Payers have the option of withholding at a rate of 5%, 
income received from  a pension, an annuity, a self-          using the withholding formula, or using the withholding 
employed retirement plan, deferred compensation, IRA  tables. 
distribution, or other retirement plan benefits, may be 
excludable from taxable income.  To be eligible for the       Low income exemption 
exclusion,  you  must  be 55 years  of  age or older  or  Taxpayers under 55 are exempt if: 
disabled. If you are a surviving spouse or survivor of an     • Your total income is less than $5,000 and you are
individual who would have qualified for the exclusion you       claimed as a dependent on another person’s Iowa
may also be eligible. To be considered disabled you must        return.
be  receiving  retirement  income  on  the  basis  of  a      • You are single and your total income is $9,000 or
documented disability or you must meet federal or state         less and you are not claimed as a dependent on
criteria for disability. Federal Civil Service annuitants who   another person’s Iowa return.
want Iowa  tax withheld from federal  pensions  should        • Your filing status is other than single and your total
contact  the Office  of Personnel Management at                 income is $13,500 or less.
888-767-6738 or retire@opm.gov.

Name:  _____________________________________________________________________________________  
Social Security Number (SSN): __________________________________________________________________  
Address: ____________________________________________________________________________________  
City: ______________________________________________  State: ____________  ZIP:  __________________  

Are you an Iowa resident? Yes ☐ No ☐
Iowa income tax is withheld from pension and annuity payments for Iowa residents only. 
I choose not to have Iowa income tax withheld from my pension/annuity ...............................................  ☐ 
Additional amount, if any, to be withheld from each benefit payment (whole dollars): $ ____________________ .00 

I, the undersigned, declare under penalties of perjury or false certificate, that I have examined this document, and, 
to the best of my knowledge and belief, it is true, correct, and complete. 

Signature:  _______________________________________________________  Date: _____________________  
Where to send the IA W-4P 
Return the completed form to the person who handles your pension/retirement check, or, if planning to retire, your 
current payroll officer. If you are a federal employee, return it to the Office of Personnel Management. 

                                                                                             44-020 (05/31/2022)