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STATE OF ARKANSAS
AR4P Employee’s Withholding Certificate
For Pensions and Annuity Payments

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

CHECK HERE if you do not want any Arkansas income tax withheld from your pension or annuity. (Do not complete lines 1 through 5)

1. CHECK ONE OF THE FOLLOWING and enter amount of allowances claimed.
No allowances or dependents claimed. (Enter zero on lines 1, 2, and 3)
Single and you claim yourself. (Enter one allowance)
Married and you claim yourself and your spouse. (Enter two allowances)
Head Household, and you claim yourself. of (Enter two allowances) ......................................................................1
2. NUMBER OF CHILDREN or DEPENDENTS. (Enter one allowance per dependent) ........................................................................2

3. TOT AL ALLOWANCES. (Add Lines 1 and no allowances or dependents are claimed, enter zero) 2. If .............................................3

4. Additional amount, if any you want deducted from each pension or annuity payment. , (Enter dollar amount) ...................................4
5. I qualify for the low-income tax rates. (See below for details) .............................................................................................................5

Please check filing status: Single Married Filing Jointly Head of Household

I certify that the number of allowances and dependents claimed on this certificate does not exceed the number to which I am entitled.
Signature: Date:

Instructions for Completing the
Withholding Certificate for Pension and Annuity Payments
Generally, Arkansas income tax withholding applies to the taxable 3. CHANGES IN ALLOWANCES – You may file a new certificate at
portion of payments made from pension, profit-sharing, stock bonus, an- any time if the number of allowances INCREASES. You must file a new
nuity, and certain deferred compensation plans; from individual retirement certificate within 10 days if the number of allowances previously claimed
arrangements (IRAs); and from commercial annuities. The first $6,000 per by you DECREASES for any of the following reasons:
year of a pension distribution or qualified traditional IRA distribution may (a) Your spouse for whom you have been claiming an allowance is
be tax exempt. Also, qualified distributions from a Roth IRA are nontaxable divorced or legally separated, or claims his or her own allowance
and, therefore, not subject to withholding. on a separate certificate, or
(b) The support of a dependent for whom you claimed an allowance
1. NUMBER OF ALLOWANCES – Do not claim more than the correct is expected to be less than half of the total support for the year.
number of allowances. However, if you expect to owe more income tax for OTHER DECREASES in allowances, such as the death of a
the year, you may increase your withholding by claiming a smaller number spouse or a dependent, do not affect your withholding until next
of allowances, or you may enter into an agreement with your payer to have year, but require the filing of a new certificate by December 1,
additional amounts withheld. This is especially important if you have more of the year in which they occur.
than one payer, or if both husband and wife are receiving payments.
4. Claim additional amounts of withholding tax if desired. This will apply
2. DEPENDENTS – To qualify as your dependent, a person must (a) most often when you have income other than wages.
receive more than 1/2 of their support from you for the year, (b) not be
claimed as a dependent by such person’s spouse, (c) be a citizen or 5. You qualify for the low-income tax rates if your total income from all
resident of the United States, and (d) have your home as their principle sources are as shown below:
residence and be a member of your household for the entire year or be
related to you as follows: son, daughter, grandchild, stepson, stepdaughter, (a) Single $1 ,3 055 to $15, 00 7
son-in-law or daughter-in-law; Your father, mother, grandparent, stepfather, (b) Married Filing Jointly $2 ,2 016 to $2 , 006 1
stepmother, father-in-law or mother-in-law; Your brother, sister, stepbrother, (1 or less dependents)
stepsister, half- brother, half-sister, brother-in-law or sister-in-law; Your (c) Married Filing Jointly $2 , 6 497 to $3 , 002 2
uncle, aunt, nephew or niece (but only if related by blood), or, an individual (2 or more dependents)
(other than your spouse) who, for the taxable year of the taxpayer, had the (d) Head of Household/Qualifying Widow(er) $18,561 to $22, 006
same principal place of abode as the taxpayer and was a member of the (1 or less dependents)
taxpayer’s household. (e) Head of Household/Qualifying Widow(er) $2 ,2 126 to $2 , 006 0
(2 or more dependents)
Once the filing status and number of allowances are established, use the
Arkansas Withholding Tables to determine the amount of tax to withhold For additional information consult your Plan Administrator or:
from each distribution. Arkansas Withholding Tax Section
P. O. Box 8055
Little Rock, Arkansas 72203-8055
AR4P (R 1 /1 17/202 )1

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Additional Instructions
Section references are to the Internal Revenue Code.

Withholding From Pensions and Annuities Eligible Rollover Distribution - 5% Withholding
State income tax withholding applies to the taxable part of payments made Distributions you receive from qualified pension or annuity plans (for example,
from pension, profit-sharing, stock bonus, annuity, and certain deferred 401(k) pension plans, IRAs, and section 457(b) plans maintained by a govern-
compensation plans; from individual retirement arrangements (IRAs); and mental employer) or tax-sheltered annuities that are eligible to be rolled over
from commercial annuities. The method and rate of withholding depends on tax free to an IRA or qualified plan are subject to a flat 5% state withholding
(a) the kind of payment you receive, (b) whether the payments are delivered rate. The 5% withholding rate is required, and you cannot choose not to
outside the United States or its possessions, and (c) whether the recipient have income tax withheld from eligible rollover distributions. Do not give Form
is a nonresident alien individual, a nonresident alien beneficiary, or a foreign AR4P to your payer unless you want an additional amount withheld. Then,
estate. Qualified distributions from a Roth IRA are nontaxable and, therefore, complete line 4 of Form AR4P and submit the form to your payer.
not subject to withholding. Because your tax situation may change from year
to year, you may want to refigure your withholding each year. You can change The payer will not withhold state income tax if the entire distribution is trans-
the amount to be withheld by using lines 2 and 3 of Form AR4P. ferred by the plan administrator in a direct rollover to a traditional IRA, qualified
pension plan, governmental section 457(b) plan (if allowed by the plan), or
Choosing Not To Have Income Tax Withheld tax-sheltered annuity.
You (or in the event of death, your beneficiary or estate) can choose not to Distributions that are (a) required by law, (b) one of a specified series of
have state income tax withheld from your payments by using line 1 of Form equal payments, or (c) qualifying “hardship” distributions are not “eligible
AR4P. For an estate, the election to have no income tax withheld may be made rollover distributions” and are not subject to the mandatory 5% state income
by the executor or personal representative of the decedent. Enter the estate’s tax withholding.
EIN in the area reserved for “Your social security number” on Form AR4P. You
may not make this choice for eligible rollover distributions. Changing Your “No Withholding” Choice
Periodic Payments Periodic Payments
Withholding from periodic payments of a pension or annuity is figured in the If you previously chose not to have state income tax withheld and you now
same manner as withholding from wages. Periodic payments are made in want withholding, complete another Form AR4P and submit it to your payer. If
installments at regular intervals over a period of more than 1 year. They may you want state income tax withheld at the rate set by law (married with three
be paid annually, quarterly, monthly, etc. If you submit an AR4P that does allowances), write “Revoked” next to the checkbox on line 1 of the form.
not contain your correct taxpayer identification number (TIN), the payer must
withhold as if you are single claiming zero withholding allowances even if you Nonperiodic Payments
choose not to have state income tax withheld. If you want state income tax to
be withheld, you must designate the number of withholding allowances on line If you previously chose not to have state income tax withheld and you now
3 of Form AR4P and indicate your marital status by checking the appropriate want withholding, write “Revoked” next to the checkbox on line 1 and submit
box. Under current law, you cannot designate a specific dollar amount to be Form AR4P to your payer.
withheld. However, you can designate an additional amount to be withheld on
line 5. For periodic payments, your orm AR4P stays in effect until you change F Statement of Income Tax Withheld From Your Pension or An-
or revoke it. Your payer must notify you each year of your right to choose not to nuity
have state income tax withheld (if permitted) or to change your choice. There
are some kinds of periodic payments for which you cannot use Form AR4P By January 31 of next year, your payer will furnish a statement to you on
because they are already defined as wages subject to state income tax with- Form 1099-R, Distributions From Pensions, Annuities, Retirement or Profit-
holding. These payments include retirement pay for service in the U.S. Armed Sharing Plans, IRAs, Insurance Contracts, etc., showing the total amount of
Forces and payments from certain nonqualified deferred compensation plans your pension or annuity payments and the total federal income tax withheld
and deferred compensation plans of exempt organizations described in Section during the year.
457. Your payer should be able to tell you whether Form AR4P applies. If you
do not submit Form AR4P to your payer, the payer must withhold on periodic
payments as if you are married claiming three withholding allowances.
Nonperiodic Payments - 3% Withholding
Your payer must withhold at a flat 3% rate from nonperiodic payments (but
see Eligible rollover distribution - % withholding5 ) unless you choose not to
have state income tax withheld. Distributions from an IRA that are payable on
demand are treated as nonperiodic payments. You can choose not to have
state income tax withheld from a nonperiodic payment (if permitted) by submit-
ting Form AR4P (containing your correct TIN) to your payer and checking the
box on line 1. Generally, your choice not to have state income tax withheld
will apply to any later payment from the same plan. You cannot use line 2 for
nonperiodic payments. But you may use line 5 to specify an additional amount
that you want withheld.

AR4P Instr. (R 1 /1 17/202 )1

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