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Withholding Certificate for Pension or Annuity Payments
First, Middle, Last Name Social Security Number

Home Address (Number and Street or Rural Route) Claim or Identification Number (if any)
of Your Pension or Annuity Contract

City, State and ZIP Code

Complete the following applicable lines:
1. I elect not to have income tax withheld from my pension or annuity. (Do not complete lines 2, 3, or 4.) 
2. I want my withholding from each pension or annuity payment to be figured using the number of allowances and marital status
shown below:
a. Number of allowances you are claiming from the Regular Withholding Allowances
(Worksheet A). 2a ______________
b. Number of allowances from the Estimated Deductions (Worksheet B). 2b ______________
SINGLE or MARRIED (with two or more incomes) MARRIED (one income) 4 HEAD OF HOUSEHOLD
3. I want the following additional amount withheld from each pension or annuity payment. Note: You cannot
enter an amount here without entering the number (including zero) of allowances on line 2b above $ _______________
4. I want this designated amount withheld from each pension or annuity payment. (Do not complete lines 1, 2, or 3.) $ _______________

Your Signature Date
Cut Here
Give the top part of this form to the payer of your pension or annuity; keep the lower part for your records.
Purpose of Form: Unless you elect otherwise, state law requires Periodic and nonperiodic payments from all of the items above
that California Personal Income Tax (PIT) be withheld from are treated as wages for the purpose of withholding.
payments of pensions and annuities. The marital status and the
withholding allowance claimed on your federal Form W-4P can A periodic payment is one that is includible in your income
be used to figure your state tax withholding. for tax purposes and that you receive in installments at regular
intervals over a period of more than one full year from the
The DE 4P allows you to: starting date of the pension or annuity. The intervals can be
annual, quarterly, monthly, etc. For example, if you receive a
(1) Claim a different number of allowances for California PIT monthly pension or annuity payment and will continue to receive
withholding than for federal income tax withholding. payments for more than a year, the payments are periodic.
(2) Elect not to have California PIT withheld from your periodic, However, distributions from an IRA that are payable upon
or nonperiodic, pension or annuity payments. demand are treated as nonperiodic payments.
(3) Elect to have California PIT withheld on periodic or There are some kinds of periodic and nonperiodic payments for
nonperiodic payments based on: which you cannot use the DE 4P since they are already defined
as wages subject to PIT withholding. Your payer should be able
(a) The number of allowances and marital status specified. to tell you whether the DE 4P will apply.
(b) A designated dollar amount. Your certificate is usually effective 30 days after you file the form.
The certificate stays in effect until you change or revoke it.
(4) Change or revoke the DE 4P previously filed.
Methods of Withholding: The payer can use one of the following
Withholding from Pensions and Annuities: Generally, three methods:
withholding applies to payments made from pension, profit-
sharing, stock bonus, annuity, and certain deferred compensation (1) An amount determined by using the California withholding
plans, from Individual Retirement Arrangements (IRA), and from schedules. Payee completes lines 2 and 3 above.
commercial annuities. Withholding also applies to property other
than cash distributed. (2) A dollar amount that you designate. Payee completes line 4
above.
In compliance with federal law, California PIT is not to be
withheld from pension recipients who reside outside of (3) Ten percent of the amount of federal withholding computed
California. pursuant to section 3405 of the Internal Revenue Code
(law.cornell.edu/uscode/text/26). Payee completes line 4
above.
DE 4P Rev. 41 (12-21) (INTERNET) Page 1 of 5 CU

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Completing the Form: Fill in your name, address, Social Security Line 2, Withholding Based on Specified Withholding
number, and the identification number (if any) of the pension or Allowances: If you want withholding to be based on a specified
annuity. number of allowances, write the number on this line and check
the filing status box you want. The worksheets accompanying
Line 1, Exemption from Withholding: Check this box if you do this form may be used to figure your withholding allowance.
not want any PIT withheld from your payment. You do not have
to give a reason for claiming the exemption from withholding. Line 3, Multiple Pensions/More than One Income: Indicate
additional amount to be withheld from each payment. You may
Caution: Remember that there are penalties for not paying use Worksheet C, accompanying this form, to determine the
enough tax during the year, either through withholding or additional amount.
estimated tax payments. You may be able to avoid paying
quarterly estimated tax to the Franchise Tax Board (FTB) by Line 4, Withholding a Designated Dollar Amount: Indicate
having enough tax withheld from your pension or annuity using dollar amount you want withheld on this line (in lieu of claiming
the DE 4P. withholding allowances).

Revoking the Exemption from Withholding: If you want to
revoke your previously filed exemption from withholding
for periodic and nonperiodic payments, file another DE 4P
completing lines 1, 2, 3, or 4.

DE 4P Rev. 41 (12-21) (INTERNET) Page 2 of 5

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Instructions — 1 — Allowances*
When determining your withholding allowances, you must consider your personal situation:
- Do you claim allowances for dependents or blindness?
- Will you itemize your deductions?
- Do you have more than one income coming into the household?
If you have a working spouse or more than one job or income, it would be best to figure the total number of allowances you are entitled to
claim on all jobs using the worksheets from only one DE 4P. Allowances can then be claimed with one payer only, or split among payers.
Worksheet A Regular Withholding Allowances
A) Allowance for yourself — enter 1 (A) ____________________
B) Allowance for your spouse (if not separately claimed by your spouse) — enter 1 (B) ____________________
C) Allowance for blindness — yourself — enter 1 (C) ____________________
D) Allowance for blindness — your spouse (if not separately claimed by your spouse) — enter 1 (D) ___________________
E) Allowance(s) for dependent(s) — do not include yourself or your spouse (E) ___________________
F) Total — add lines (A) through (E) above and enter on line 2a of the DE 4P (F) ___________________

Instructions — 2 — Additional Withholding Allowances
If you expect to itemize deductions on your California income tax return, you can claim additional withholding allowances. Use Worksheet
B to determine whether your expected estimated deductions may entitle you to claim one or more additional withholding allowances. Use
last year’s FTB Form 540 as a model to calculate this year’s withholding amounts.
You may reduce the amount of tax withheld from your wages by claiming one additional withholding allowance for each $1,000, or fraction
of $1,000, by which you expect your estimated deductions for the year to exceed your allowable standard deduction.

Worksheet B Estimated Deductions
1. Enter an estimate of your itemized deductions for California taxes for this tax year as listed in the
schedules in the FTB Form 540. 1. $ _____________________
2. Enter $9,606 if unmarried head of household or qualifying widow(er) with dependent(s);
$9,606 if married filing jointly with two or more allowances;
$4,803 if single, dual income, married, or married with multiple employers;
$4,803 if married filing separately or married with “0” or “1” allowance. 2. $ _____________________
3. Subtract line 2 from line 1, enter difference. 3. $ _____________________
4. Enter an estimate of your adjustments to income (alimony payments, IRA deposits). 4. $ _____________________
5. Add line 4 to line 3 and enter the sum. 5. $ _____________________
6. Enter an estimate of your nonwage income (dividends, interest income, alimony receipts). 6. $ _____________________
7. If line 5 is greater than line 6 (if less, see below [go to line 9]);
Subtract line 6 from line 5 and, enter the difference. 7. $ _____________________

8. Divide the amount on line 7 by $1,000, round any fraction to the nearest whole number.
Enter this number on line 2b of the DE 4P. Complete Worksheet C, if needed. 8. ______________________

9. If line 6 is greater than line 5;
Enter amount from line 6 (nonwage income). 9. $ _____________________
10. Enter amount from line 5 (deductions). 10. $ _____________________
11. Subtract line 10 from line 9, enter difference. 11. $ _____________________

Complete Worksheet C
*Wages paid to registered domestic partners will be treated the same for state income tax purposes as wages paid to spouses for California PIT withholding
and PIT wages. This law does not impact federal income tax law. A registered domestic partner means an individual partner in a domestic partner
relationship within the meaning of section 297 of the Family Code (leginfo.legislature.ca.gov/faces/codes.xhtml). For more information, please call our
Taxpayer Assistance Center at 1-888-745-3886.

DE 4P Rev. 41 (12-21) (INTERNET) Page 3 of 5

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Worksheet C Tax Withholding and Estimated Tax
1. Enter estimate of total wages for tax year 2022. 1. ______________________
2. Enter estimate of nonwage income on line 6 of Worksheet B. 2. ______________________
3. Add line 1 and line 2 and enter the sum. 3. ______________________
4. Enter itemized deductions or standard deduction on line 1 or 2 of Worksheet B, whichever is largest. 4. ______________________
5. Enter adjustments to income on line 4 of Worksheet B. 5. ______________________
6. Add line 4 and line 5 and enter the sum. 6. ______________________
7. Subtract line 6 from line 3 and enter the difference. 7. ______________________
8. Figure your tax liability for the amount on line 7 by using the 2022 tax rate schedules below. 8. ______________________
9. Enter personal exemptions on line F of Worksheet A x $141.90. 9. ______________________
10. Subtract line 9 from line 8 and enter the difference. 10. ______________________
11. Enter any tax credits. (See FTB Form 540) 11. ______________________
12. Subtract line 11 from line 10 and enter the difference. (This is your total estimated tax liability). 12. ______________________
13. Calculate the tax withheld and estimated to be withheld during 2022. Contact the payer to
request the amount that will be withheld on your wages based on the marital status and number
of withholding allowances you will claim for 2022. Multiply the estimated amount to be withheld
by the number of pay periods left in the year. Add the total to the amount already withheld for 2022 13. ______________________
14. Subtract line 13 from line 12. Enter difference. If this is less than zero, you do not need to have
additional taxes withheld 14. ______________________
15. Divide line 14 by the number of pay periods remaining in the year and enter this figure on line 3 of the DE 4P 15. ______________________
NOTE: Your payer is not required to withhold the additional amount requested on line 3 of your DE 4P. If your payer does not agree
to withhold the additional amount, you may increase your withholdings as much as possible by using the “single” status with “zero”
allowances. If the amount withheld still results in an underpayment of state income taxes, you may need to file quarterly estimates on
Form 540-ES with the FTB to avoid a penalty.
These Tables are for Calculating Worksheet C and for 2022 Only

Single Persons, Dual Income
Married with Multiple Employers Married Persons
IF THE TAXABLE INCOME IS COMPUTED TAX IS IF THE TAXABLE INCOME IS COMPUTED TAX IS
OVER BUT NOT OF AMOUNT OVER... PLUS OVER BUT NOT OF AMOUNT OVER... PLUS
OVER OVER
$0 $9,325 1.100% $0 $0.00 $0 $18,650 1.100% $0 $0.00
$9,325 $22,107 2.200% $9,325 $102.58 $18,650 $44,214 2.200% $18,650 $205.15
$22,107 $34,892 4.400% $22,107 $383.78 $44,214 $69,784 4.400% $44,214 $767.56
$34,892 $48,435 6.600% $34,892 $946.32 $69,784 $96,870 6.600% $69,784 $1,892.64
$48,435 $61,214 8.800% $48,435 $1,840.16 $96,870 $122,428 8.800% $96,870 $3,680.32
$61,214 $312,686 10.230% $61,214 $2,964.71 $122,428 $625,372 10.230% $122,428 $5,929.42
$312,686 $375,221 11.330% $312,686 $28,690.30 $625,372 $750,442 11.330% $625,372 $57,380.59
$375,221 $625,369 12.430% $375,221 $35,775.52 $750,442 $1,000,000 12.430% $750,442 $71,551.02
$625,369 $1,000,000 13.530% $625,369 $66,868.92 $1,000,000 $1,250,738 13.530% $1,000,000 $102,571.08
$1,000,000 and over 14.630% $1,000,000 $117,556.49 $1,250,738 and over 14.630% $1,250,738 $136,495.93

Unmarried Head of Household
IF THE TAXABLE INCOME IS COMPUTED TAX IS
OVER BUT NOT OF AMOUNT OVER... PLUS If you need more detailed information, see the instructions
OVER that came with your last California resident income tax
$0 $18,663 1.100% $0 $0.00 return or call the FTB:
$18,663 $44,217 2.200% $18,663 $205.29
$44,217 $56,999 4.400% $44,217 $767.48 If you are calling from within the United States
$56,999 $70,542 6.600% $56,999 $1,329.89
$70,542 $83,324 8.800% $70,542 $2,223.73 1-800-852-5711 (Voice)
$83,324 $425,251 10.230% $83,324 $3,348.55 1-800-822-6268 (TTY)
$425,251 $510,303 11.330% $425,251 $38,327.68
$510,303 $850,503 12.430% $510,303 $47,964.07 If you are calling from outside the United States
$850,503 $1,000,000 13.530% $850,503 $90,250.93 1-916-845-6500 (Not Toll Free)
$1,000,000 and over 14.630% $1,000,000 $110,477.87

The DE 4P information is collected for purposes of administering the PIT law and under the authority of Title 22, California Code of Regulations (govt.
westlaw.com/calregs/Search/Index), section 4340-1, and the California Revenue and Taxation Code (leginfo.legislature.ca.gov/faces/codes.xhtml),
including section 18624. The Information Practices Act of 1977 requires that individuals be notified of how information they provide may be used. Further
information is contained in the instructions that came with your last California resident income tax return.
DE 4P Rev. 41 (12-21) (INTERNET) Page 4 of 5

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Example for Worksheet C for the Year 2022
Payee estimates income from his or her pension to be $1,500 a month and is claiming the standard 
deduction and single with one withholding allowance.
1. Estimate annualized income ($1,500 a month x 12 months). Enter on line 1.             1. $  18,000.00
2. Estimated nonwage income.                                                             2. $   8,000.00
3. Add lines 1 and 2 and enter total on line 3.                                          3. $  26,000.00
4. Enter amount for single from line 2 of Worksheet B.                                   4. $      4,803.00
5. Enter adjustments to income shown on line 4 of Worksheet B.                           5.        0.00
6. Enter sum of lines 4 and 5.                                                           6. $      4,803.00
7. Subtract line 6 from line 3 and enter difference on line 7.                           7. $  21,197.00
8. Compute the tax liability for the amount on line 7.
                      Use the 2022 tables for single from Worksheet C under  
                      the entry covering $21,197 (over $9,325 but not over $22,107). 
                      Compute 2.200% of the amount over $9,325 
                      ([$21,197 –  $9,325] x 0.02200 = $261.18). $ 261.18 
                      Additional (PLUS) tax amount.              $ 102.58
                      Enter the total on line 13.                Total  $ 363.76         8.      $ 363.76
9. Enter the amount for one personal exemption on line 9 (1 x $141.90).                  9.      $ 141.90
10. Subtract line 9 from line 8 and enter the difference on line 10.                     10.     $ 221.86
11. Enter any tax credits that will be allowed for 2022 (see FTB Form 540).              11.       0.00
12. Subtract line 11 from line 10 and enter the difference on line 12. This is your
   total estimated tax liability.                                                        12.     $ 221.86
13. Calculate the tax withheld and estimated to be withheld during 2022.
                      Withholding on the pension of $1,500 a month claiming single  
                      with one withholding allowance based on the California withholding 
                      schedule for 2022 is $4.90 x 12 = $58.80.  
                      Enter that amount on line 13.                                      13.     $ 58.80
14. Subtract line 13 from line 12. Enter difference on line 14.                          14.     $ 163.06
15. Divide line 14 by the number of pay periods remaining in the year.
                      ($163.06 ÷ 12 = $13.59)                                            15.     $ 13.59
                                                    Enter $13.59 on line 3 of the DE 4P.

DE 4P Rev. 41 (12-21) (INTERNET)                                 Page 5 of 5

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