Fillable Form 1042-S (2021)

What is Form 1042-S?

Form 1042-S, Foreign Person’s U.S. Source Income Subject to Withholding, is a form used to report income and amounts withheld, the specified federal procurement payments paid to foreign individuals that are subject to withholding, and the distribution of connected income by a publicly traded partnership.

How to fill out Form 1042-S?

Form 1042-S has several copies. The following instructions below are applicable to all the copies:

• Copy A for Internal Revenue Service (IRS)
• Copy B for Recipient
• Copy C for Recipient
  • This copy must be attached to any Federal tax return that will be filed.
• Copy D for Recipient
  • This copy must be attached to any state tax return that will be filed.
• Copy E for Withholding Agent

To fill out Form 1042-S, one must provide the following information:

Item 1. Income Code

Enter the income code.

Item 2. Gross Income

Enter the gross income.

Item 3. Chapter Indicator

Enter the chapter indicator. The applicant may enter either “3” or “4.”

Item 3a. Exemption Code

Enter the exemption code for Chapter 3.

Item 3b. Tax Rate

Enter the tax rate for Chapter 3.

Item 4a. Exemption Code

Enter the exemption code for Chapter 4.

Item 4b. Tax Rate

Enter the tax rate for Chapter 4.

Item 5. Withholding Allowance

Enter the amount of withholding allowance.

Item 6. Net Income

Enter the amount of net income.

Item 7a. Federal Tax Withheld

Enter the amount of federal tax withheld.

Item 7b

Mark the box if the federal tax withheld was not deposited with the Internal Revenue Service (IRS) because escrow procedures were applied.

Item 7c

Mark the box if the withholding occurred in a subsequent year with respect to a partnership interest.

Item 8. Tax Withheld by Other Agents

Enter the amount of tax withheld by other agents.

Item 9. Overwithheld Tax Repaid to Recipient Pursuant to Adjustment Procedures

Enter the amount of overwithheld tax repaid to the recipient pursuant to any adjustment procedures.

Item 10. Total Withholding Credit

Enter the total amount of withholding credit by combining items 7a, 8, and 9.

Item 11. Tax Paid by Withholding Agent

Have the withholding agent enter the amount of tax paid by the withholding agent.

Item 12a. Withholding Agent’s Employer Identification Number (EIN)

Have the withholding agent enter his or her Employer Identification Number (EIN).

Item 12b. Chapter 3 Status Code

Have the withholding agent enter the status code of Chapter 3.

Item 12c. Chapter 4 Status Code

Have the withholding agent enter the status code of Chapter 4.

Item 12d. Withholding Agent’s Name

Have the withholding agent enter his or her full legal name.

Item 12e. Withholding Agent’s Global Intermediary Identification Number (GIN)

Have the withholding agent enter his or her Global Intermediary Identification Number (GIN).

Item 12f. Country Code

Have the withholding agent enter his or her country code.

Item 12g. Foreign Tax Identification Number (FTIN)

Have the withholding agent enter his or her Foreign Tax Identification Number (FTIN).

Item 12h. Address

Have the withholding agent enter his or her address.

Item 12i. City or Town, State or Province, Country, ZIP or Foreign Postal Code

Have the withholding agent enter his or her city or town, state or province, country, ZIP code or foreign postal code.

Item 13a. Recipient’s Name

Have the recipient enter his or her full legal name.

Item 13b. Recipient’s Country Code

Have the recipient enter his or her country code.

Item 13c. Address

Have the recipient enter his or her address.

Item 13d. City or Town, State or Province, Country, ZIP or Foreign Postal Code

Have the recipient enter his or her city or town, state or province, country, ZIP code or foreign postal code.

Item 13e. Recipient’s U.S. Tax Identification Number (TIN)

Have the recipient enter his or her U.S. tax identification number (TIN).

Item 13f. Chapter 3 Status Code

Have the recipient enter the status code of Chapter 3.

Item 13g. Chapter 4 Status Code

Have the recipient enter the status code of Chapter 4.

Item 13h. Recipient’s Global Intermediary Identification Number (GIIN)

Have the recipient enter his or her Global Intermediary Identification Number (GIIN).

Item 13i. Recipient’s Foreign Tax Identification Number (FTIN)

Have the recipient enter his or her Foreign Tax Identification Number (FTIN).

Item 13j. Limitation on Benefit (LOB) Code

Have the recipient enter his or her Limitation on Benefit (LOB) code.

Item 13k. Recipient’s Account Number

Have the recipient enter his or her account number.

Item 13l. Recipient’s Date of Birth

Have the recipient enter his or her date of birth using the format: Year-Month-Day.

Item 14a. Primary Withholding Agent’s Name

Have the primary withholding agent enter his or her full legal name.

Item 14b. Primary Withholding Agent’s Employer Identification Number (EIN)

Have the primary withholding agent enter his or her employee identification number (EIN).

Item 15

Mark the box if the primary withholding agent used pro-rata basis reporting.

Item 15a. Intermediary or Flow-Through Entity’s Employer Identification Number (EIN)

Have the intermediary or flow-through entity enter his or her employee identification number (EIN).

Item 15b. Chapter 3 Status Code

Have the intermediary or flow-through entity enter the status code of Chapter 3.

Item 15c. Chapter 4 Status Code

Have the intermediary or flow-through entity enter the status code of Chapter 4.

Item 15d. Intermediary or Flow-Through Entity’s Name

Have the intermediary or flow-through entity enter his or her full legal name.

Item 15e. Intermediary or Flow-Through Entity’s Global Intermediary Identification Number (GIIN)

Have the intermediary or flow-through entity enter his or her Global Intermediary Identification Number (GIIN).

Item 15f. Country Code

Have the intermediary or flow-through entity enter his or her country code.

Item 15g. Foreign Tax Identification Number (FTIN)

Have the intermediary or flow-through entity enter his or her Foreign Tax Identification Number (FTIN).

Item 15h. Address

Have the intermediary or flow-through entity enter his or her address.

Item 15i. City or Town, State or Province, Country, ZIP or Foreign Postal Code

Have the intermediary or flow-through entity enter his or her city or town, state or province, country, ZIP code or foreign postal code.

Item 16a. Payer’s Name

Have the payer enter his or her full legal name.

Item 16b. Payer’s Tax Identification Number (TIN)

Have the payer enter his or her tax identification number (TIN).

Item 16c. Payer’s Global Intermediary Identification Number (GIIN)

Have the payer enter his or her Global Intermediary Identification Number (GIIN).

Item 16d. Chapter 3 Status Code

Have the payer enter the status code of Chapter 3.

Item 16e. Chapter 4 Status Code

Have the payer enter the status code of Chapter 4.

Item 17a. State Income Tax Withheld

Have the payer enter his or her state income with the tax withheld.

Item 17b. Payer’s State Tax Number

Have the payer enter his or her state tax number.

Item 17c. Name of State

Have the payer enter the name of the state.

Explanation of Codes

Box 1. Income Code

• Types of Income
  • 01 - Interest paid by U.S. obligors
  • 02 - Interest paid on real property mortgages
  • 03 - Interest paid to controlling foreign corporations
  • 04 - Interest paid by foreign corporations
  • 05 - Interest on tax-free covenant bonds
  • 22 - Interest paid on deposit with a foreign branch of a domestic corporation or partnership
• Interest
  • 29 - Deposit interest
  • 30 - Original issue discount (OID)
  • 31 - Short-term OID
  • 33 - Substitute payment which is interest
  • 51 - Interest paid on certain actively traded or publicly offered securities
  • 54 - Substitute payments which is interest from certain actively traded or publicly offered securities
• Dividend
  • 06 - Dividends paid by U.S. corporations
  • 07 - Dividends qualifying for direct dividend rate
  • 08 - Dividends paid by foreign corporations
  • 34 - Substitute payment which are dividends
  • 40 - Other dividend equivalents
  • 52 - Dividends paid on certain actively traded or publicly offered securities
  • 53 - Substitute payments which are dividends from certain actively traded or publicly offered securities
• Other
  • 09 - Capital gains
  • 10 - Industrial royalties
  • 11 - Motion picture or television copyright royalties
  • 12 - Other royalties
  • 13 - Royalties paid on certain publicly offered securities
  • 14 - Real property income and natural resources royalties
  • 15 - Pensions, annuities, alimony, and/or insurance premiums
  • 16 - Scholarship or fellowship grants
  • 17 - Compensation for independent personal services
  • 18 - Compensation for dependent personal services
  • 19 - Compensation for teaching
  • 20 - Compensation during studying and training
  • 23 - Other income
  • 24 - Qualified investment entity (QIE) distributions of capital gains
  • 25 - Trust distributions
  • 26 - Unserved growing crops and timber distributions by a trust subject
  • 27 - Publicly traded partnership distributions
  • 28 - Gambling winnings
  • 32 - Notional principal contract income
  • 35 - Substitute payment
  • 36 - Capital gains distributions
  • 37 - Return of capital
  • 38 - Eligible deferred compensation items
  • 39 - Distributions from a non-grantor trust
  • 41 - Guarantee of indebtedness
  • 42 - Earnings as an artist or athlete without a central withholding agreement
  • 43 - Earnings as an artist or athlete with a central withholding agreement
  • 44 - Specified federal procurement payments
  • 50 - Income previously reported under escrow procedure
  • 55 - Taxable death benefits on life insurance contracts

Boxes 3a and 4a. Exemption Code

• Authority for Exemption - Chapter 3
  • 01 - Effectively connected income
  • 02 - Exempt
  • 03 - Income not from U.S. sources
  • 04 - Exempt under tax treaty
  • 05 - Exempt portfolio interest
  • 06 - QI that assumes primary withholding responsibility
  • 07 - WFP or WFT
  • 08 - U.S. branch treated as U.S. person
  • 09 - Territory FI treated as U.S. person
  • 10 - QI that represents exempt income
  • 11 - QSL that assumes primary withholding responsibility
  • 12 - Payee subjected to chapter 4 withholding
  • 22 - QDD that assumes primary withholding responsibility
  • 23 - Exempt under section 897
  • 24 - Exempt under section 892
• Chapter 4
  • 13 - Grandfathered payment
  • 14 - Effectively connected income
  • 15 - Payee not subject to chapter 4 withholding
  • 16 - Excluded nonfinancial payment
  • 17 - Foreign entity that assumes primary withholding compliant FFI
  • 18 - U.S. payees
  • 19 - Exempt from withholding
  • 20 - Dormant account
  • 21 - Other payments not subject to chapter 4 withholding

Boxes 12b, 12c, 13f, 15b, 15c, 16d, and 16e. Withholding Agent, Recipient, Intermediary, and Payer Chapter 3 and Chapter 4 Status Codes

• Type of Recipient, Withholding Agent, Payer or Intermediary - Chapter 3
  • 03 - Territory FI treated as U.S. person
  • 04 - Territory FI not treated as U.S. person
  • 05 - U.S. branch treated as U.S. person
  • 06 - U.S. branch not treated as U.S. person
  • 07 - U.S. branch with ECI presumption applied
  • 08 - Partnership other than withholding foreign partnership
  • 09 - Withholding foreign partnership
  • 10 - Trust other than withholding foreign trust
  • 11 - Withholding foreign trust
  • 12 - Qualified intermediary
  • 13 - Qualified securities lender - qualified intermediary
  • 14 - Qualified securities - other
  • 15 - orporation
  • 16 - Individual
  • 17 - Estate
  • 18 - Private foundation
  • 19 - International organization
  • 20 - Tax exempt organization
  • 21 - Unknown recipient
  • 22 - Artist or athlete
  • 23 - Pension
  • 24 - Foreign central bank of issue
  • 25 - Nonqualified intermediary
  • 26 - Hybrid entity making treaty claim
  • 35 - Qualified derivatives dealer
  • 36 - Foreign government - integral part
  • 37 - Foreign government - controlled entity
• Pooled Reporting Codes
  • 27 - General withholding rate pool
  • 28 - Exempt organization withholding rate pool
  • 29 - General PAI withholding rate pool
  • 30 - Exempt organization PAI withholding rate pool
  • 31 - General agency withholding rate pool
  • 32 - Exempt organization agency withholding rate pool
• Chapter 4 Status Codes
  • 01 - FI U.S. withholding agent
  • 02 - Other U.S. withholding agent
  • 03 - Territory FI not treated as U.S. person
  • 04 - Territory FI treated as U.S. person
  • 05 - Other participating FFI
  • 06 - Reporting model 2 participating FFI
  • 07 - Reporting model 1 registered deemed-compliant FFI
  • 08 - Sponsored entity registered deemed-compliant FFI
  • 09 - Other registered deemed-compliant FFI
  • 10 - Other certified deemed-compliant FFI
  • 11 - FFI with low value accounts certified deemed-compliant FFI
  • 12 - Non-registered local bank certified deemed-compliant FFI
  • 13 - Sponsored entity certified deemed-compliant FFI
  • 14 - Investment entity that does not maintain financial accounts certified deemed-compliant FFI
  • 15 - Nonparticipating FFI
  • 16 - Owner-documented FFI
  • 17 - U.S. branch treated as U.S. person
  • 18 - U.S. branch not treated as U.S. person
  • 19 - Passive NFFE identifying substantial U.S. owners
  • 20 - Passive NFFE with no substantial U.S. owners
  • 21 - Publicly traded NFFE or affiliate of publicly traded NFFE
  • 22 - Active NFE
  • 23 - Individual
  • 24 - Section 501 entities
  • 25 - Excepted territory NFFE
  • 26 - Excepted NFFE - other
  • 27 - Exempt beneficial owner
  • 28 - Entity wholly owned by exempt beneficial owners
  • 29 - Unknown recipient
  • 30 - Recalcitrant account holder
  • 31 - Nonreporting IGA FFI
  • 32 - Direct reporting NFFE
  • 33 - U.S reportable account
  • 34 - Non-consenting U.S. account
  • 35 - Sponsored direct reporting NFFE
  • 36 - Excepted inter-affiliate FFI
  • 37 - Undocumented preexisting obligation
  • 38 - U.S. branch - ECI presumption applied
  • 39 - Account holder of excluded financial account
  • 40 - Passive NFFE reported by FFI
  • 41 - NFFE subject to 1472 withholding
  • 50 - U.S. withholding subject - foreign branch of FI

• Pooled Reporting Codes
  • 42 - Recalcitrant pool - no U.S. Indicia
  • 43 - Recalcitrant pool - U.S. Indicia
  • 44 - Recalcitrant pool - dormant account
  • 45 - Recalcitrant pool - U.S. persons
  • 46 - Recalcitrant pool - passive NFFEs
  • 47 - Nonparticipating FFI pool
  • 48 - U.S. payees pool
  • 49 - QI-recalcitrant pool - general

Box 13j. LOB Code

• LOB Treaty Category

• • 02 - Government contracting state or political subdivision or local authority
  • 03 - Tax exempt pension trust or pension fund
  • 04 - Tax exempt or charitable organization
  • 05 - Publicly traded corporation
  • 06 - Subsidiary of publicly traded corporation
  • 07 - Company that meets the ownership and base erosion test
  • 08 - Company that meets the derivative benefits test
  • 09 - Company with an item of income that meet the active trade or business test
  • 10 - Discretionary determination
  • 11 - Other