1042-T Annual Summary and Transmittal of Forms 1042-S

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DO NOT STAPLE
Form

1042-T

OMB No. 1545-0096

Annual Summary and Transmittal of
Forms 1042-S

Department of the Treasury
Internal Revenue Service
Name of withholding agent

2016

Ch. 4 Status Code
Ch. 3 Status Code

Employer identification number

DRAFT AS OF
June 2, 2016
DO NOT FILE

Number, street, and room or suite no.

City or town, state or province, country, and ZIP or foreign postal code

1

Type of paper Forms 1042‐S attached:
a

Chapter 4 or Chapter 3 (enter 4 or 3)

Choose only one:

b Check only one box:
c

Original

Amended

Check if pro-rata ▶

d Enter the number of paper Forms 1042‐S attached ▶

2

Total gross income reported on all paper Forms 1042-S (box 2) attached .

3

Total federal tax withheld on all paper Forms 1042-S attached:
a Total federal tax withheld under Chapter 4 .
b Total federal tax withheld under Chapter 3 .

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$

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Caution: If you have already filed a Form 1042 and an attached Form 1042-S causes the gross income or tax withheld
information shown on your previously filed Form 1042 to change, you must file an amended Form 1042. See the
instructions on page 2.
If this is your FINAL return, enter an “X” here (see instructions)

▶

Please return this entire page to the Internal Revenue Service.

Your signature
▲

Sign
Here

Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and
belief, they are true, correct, and complete.
Title

Date

For more information and the Privacy Act and Paperwork Reduction Act Notice, see Form 1042-S.

Daytime phone number

Cat. No. 28848W

Form 1042-T (2016)

Page 2

Form 1042-T (2016)

Instructions
What’s New
Withholding agent's status codes. Beginning in 2016,
withholding agents must enter both a chapter 4 and chapter 3
status code regardless of the type of payment being made.
Also, new status codes have been added under chapter 4
(code 50) and chapter 3 (code 34) for payments made by a
foreign branch of a U.S. financial institution. See Boxes 12b
and 12c, Withholding Agent's Chapter 3 and Chapter 4 Status
Code in the Form 1042-S instructions for additional information.

Line 1. You must file a separate Form 1042‐T for each type of
paper Form 1042‐S you are transmitting.
Line 1a. Withholding agents are not permitted to file a single
Form 1042‐T to transmit both chapter 4 and chapter 3 amounts.
Withholding agents must indicate either chapter 4 or chapter 3
to designate the chapter for which they are filing a given Form
1042‐T. The chapter you designate on this form must be the
same as that on all attached Forms 1042‐S. See Chapter
indicator in the Form 1042‐S instructions for additional
information.

DRAFT AS OF
June 2, 2016
DO NOT FILE

New line 1a. Withholding agents are not permitted to file a
single Form 1042-T to report both chapter 4 and chapter 3
amounts. Withholding agents must indicate either chapter 4 or
chapter 3 on new line 1a to designate the chapter for which they
are filing a given Form 1042-T. See line 1a instructions below for
additional information.

Purpose of Form

Use this form to transmit paper Forms 1042-S, Foreign Person’s
U.S. Source Income Subject to Withholding, to the Internal
Revenue Service. Use a separate Form 1042-T to transmit each
type of Form 1042-S (see the instructions for line 1 below).

Electronic Filing Requirement

If you file 250 or more Forms 1042-S, you are required to submit
them electronically. If you submit fewer than 250 Forms 1042-S,
you are encouraged to file them electronically. If you are a
financial institution, you are required to submit Forms 1042-S
electronically irrespective of the number of Forms 1042-S you
submit. If you submit Forms 1042-S electronically, do not use
Form 1042-T. See the Instructions for Form 1042 for the
definition of financial institution.

Filing Forms 1042 and 1042-S
Use of this form to transmit paper Forms 1042-S does not affect
your obligation to file Form 1042, Annual Withholding Tax
Return for U.S. Source Income of Foreign Persons.
If you have not yet filed a Form 1042 for 2016, you may send
in more than one Form 1042-T to submit paper Forms 1042-S
prior to filing your Form 1042. You may submit amended Forms
1042-S even though changes reflect differences in gross
income and tax withheld information of Forms 1042-S
previously submitted with a Form 1042-T.
If you have already filed a Form 1042 for 2016 and an
attached Form 1042-S caused the gross income or tax withheld
information previously reported on line 62c or 63e of your Form
1042 to change, you must file an amended Form 1042.

Where and When To File
File Form 1042-T (and Copy A of the paper Forms 1042-S being
transmitted) with the Ogden Service Center, P.O. Box 409101,
Ogden, UT 84409, by March 15, 2017. Send the forms in a flat
mailing (not folded).

Line Instructions
Identifying information at top of form. The name, address,
EIN, and chapter 4 and 3 status codes of the withholding agent
named on this form must be the same as those you enter on
Forms 1042 and 1042-S. See the Instructions for Form 1042 for
definition of withholding agent. See the Instructions for Form
1042-S for the withholding agent codes for the chapter 4 and 3
status codes. You must enter both a chapter 4 and a chapter 3
withholding agent status code regardless of the type of payment
being made.

Line 1b. Check either the Original or Amended box (but not
both).
Line 1c. Check the box on this line 1c if you are filing pro‐rata
Forms 1042‐S (see Form 1042‐S instructions).
As a result of the above rules, there are eight possible types
of Form 1042‐S that may be transmitted, and each type requires
a separate Form 1042‐T:
• Chapter 4, original, pro‐rata.
• Chapter 4, original, non‐pro‐rata.
• Chapter 4, amended, pro‐rata.
• Chapter 4, amended, non‐pro‐rata.
• Chapter 3, original, pro‐rata.
• Chapter 3, original, non‐pro‐rata.
• Chapter 3, amended, pro‐rata.
• Chapter 3, amended, non‐pro‐rata.
Each type must be transmitted with a separate Form 1042-T.
For example, you must transmit only Chapter 3, original, prorata Forms 1042-S with one Form 1042-T.
Line 2. Enter the total of the gross income amounts shown on
the Forms 1042-S (box 2) being transmitted with this Form
1042-T.
Line 3. Enter the total of the federal tax withheld amounts
shown on all Forms 1042-S (total of amounts in boxes 7, 8, and
9, reduced by any amount in box 11) being transmitted with this
Form 1042-T. Either box 3a or 3b must be completed, not both.
If you indicated “Chapter 4” on line 1a, complete line 3a to
report the total amounts withheld pursuant to chapter 4. If you
indicated “Chapter 3” on line 1a, complete line 3b to report the
total amounts withheld pursuant to chapter 3.
Final return. If you will not be required to file additional Forms
1042-S, including amended Forms 1042-S for the 2016 year (on
paper or electronically), enter an “X” in the “FINAL return” box.
Paperwork Reduction Act Notice. The time needed to
complete and file this form will vary depending on individual
circumstances. The estimated average time is 12 minutes.