2022 IA W-4P 
                                                  Withholding Certificate for Pension or Annuity Payments 
                                                                                                 tax.iowa.gov 
                                                Instructions 
Eligibility requirements                                       Low income exemption 
Military retirement pay  for service in the United States  Taxpayers 65 years of age or older are exempt if: 
Armed Forces, the Armed Forces Military Reserve, or the        • You are single and your  net  income is $24,000 or 
National Guard  is  eligible  for  exemption  from  Iowa        less. 
income tax.  Only military retirement pay received from        • Your filing status is other than single and your total 
the Defense Finance and Accounting Service (DFAS), or           net income is  $32,000 or less.  Only one spouse 
a similar source is eligible for the exemption.                 must be 65 or older to qualify for this exemption. 
Railroad Retirement benefits paid by the Railroad              Note: Pension exclusion and any  reportable Social 
Retirement Board are not taxable on the Iowa return.           Security  amount  must  be  added  to  net  income  for 
If you or your  spouse  are qualified Iowa residents and       purposes of determining the low-income exemption. 
receive a pension, an annuity, a self-employed retirement      Taxpayers under 65 are exempt if: 
plan, deferred compensation,  IRA distribution, or other       • Your  net  income  is  less  than  $5,000  and  you  are 
retirement plan benefits, you may be eligible for a partial     claimed  as  a  dependent on  another person’s  Iowa 
exemption.  You  must  be  55  years  of  age  or  older  or    return. 
disabled  to  qualify.  If  you  are  a  surviving  spouse  or • You are single and your net income is $9,000 or less 
survivor of an individual who would have qualified for the      and you are not claimed as a dependent on another 
exclusion  you may also  be  eligible  for a  partial           person’s Iowa return. 
exemption.  To  be considered  disabled you  must  be          • Your filing status is other than single and your total 
receiving  retirement  income  on  the  basis  of  a            net income is $13,500 or less. 
documented disability or you must meet federal or state        Claiming no exemption 
criteria for disability. Federal Civil Service annuitants who  Iowa income tax will be withheld on the entire amount 
want Iowa  tax withheld from federal  pensions  should  of taxable  benefits received  if  the  box is checked 
contact  the Office  of Personnel  Management at  below. 
888-767-6738 or retire@opm.gov.                                Withholding choices 
Withholding rates                                              Unmarried Iowa residents may choose to have Iowa 
Payers have the option of  withholding at a rate of 5%,  tax withheld on the annual taxable amount excluding 
using  the  withholding  formula,  or  using  the  withholding  up  to  $6,000.  Married  taxpayers  may  exclude  up  to 
tables.                                                        $12,000 from the annual taxable amount. 

Name:  _____________________________________________________________________________________  
Social Security Number (SSN): __________________________________________________________________  
Address: ____________________________________________________________________________________  
City: ______________________________________________  State: ____________  ZIP:  __________________  
Iowa income tax is withheld from pension and annuity payments for Iowa residents only. Are you an Iowa 
resident? Yes ☐ No  ☐
I choose not to have Iowa income tax withheld from my pension/annuity. .............................................................. ☐ 
I choose to have Iowa income tax withheld from my pension/annuity. Select one of the following: 
  • claiming no exemption (see instructions) ........................................................................................................  ☐
  • excluding $6,000 in benefits each year ...........................................................................................................  ☐
  • excluding $12,000 in benefits each year (married – status 2, 3, or 4) .............................................................  ☐
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 (10/14/2021)