Fillable Form 4852

What is Form 4852?

Form 4852, Substitute for Form W-2, Wage and Tax Statement, or Form 1099R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRA's Insurance Contracts, Etc, is an Internal Revenue Service (IRS) form used by taxpayers as a substitute for missing or incorrectly issued Forms W-2, Form W-2c, and Form 1099-R, among other forms.

It should be noted that Form 4852 is meant to serve as a last resort backup in the event that the filer is unable to obtain their Form W-2, Form W-2c, or Form 1099-R from their employer or payer.

Who needs to use Form 4852?

IRS Form 4852 is used by taxpayers or their representatives in either of the following situations:

• Their employer or payer does not give them a Form W-2 or Form 1099-R.
• Their employer or payer has issued an incorrect Form W-2 or Form 1099-R.

Taxpayers must make sure that it is not possible for them to obtain the necessary forms with a reasonable amount of time left to file their tax returns before filing Form 4852. The necessary steps to ensure that this is the case will be explained in the instructions below.

How to fill out Form 4852?

Tax form 4852 is a very simple form to fill out. Make sure to download it in PDF format to ensure that its format and all information entered remain intact regardless of how it is opened or submitted. It may also be beneficial to have the relevant documents prepared to make sure that all information entered is updated and correct.

If more information on the form is needed, you may consult the instructions for Form 8806 on pages 1 and 2 of this form.

Important note: The following must have been done before filing Form 4852 IRS:

• Contact your employer or payer and request your Form W-2, Form W-2c, or Form 1099-R (original or corrected) from them.
• If you don’t receive the missing or corrected form from your employer or payer by the end of February, you may call the IRS at 800-829-1040 for assistance. Provide the following information:
  • Name
  • Address (Including ZIP Code)
  • Social Security Number (SSN)
  • Dates of Employment
  • Employer or Payer’s Name
  • Employer or Payer’s Address (Including ZIP Code)
  • Employer or Payer’s Phone Number

The IRS will contact your employer or payer and request that they provide the missing form. If the form is still not provided to you by your employer or payer with sufficient time to file your tax return in a timely fashion (typically by April 15), the IRS will send you the 4852 tax form to file alongside your return.

Line 1 - Name(s) Shown on Return

Enter your name as shown on the relevant return.

Line 2 - Social Security Number

Enter your SSN.

Line 3 - Address

Enter your address information.

Line 4 - Year and Check Boxes

Enter the end of the tax year this form is being filed for in the space provided, then check one of the following boxes that indicates which form you are unable to obtain or received an incorrect copy of. You may check one of the following:

• Form W-2
• Form 1099-R

Line 5 - Employer or Payer’s Name, Address, and ZIP Code

Enter your employer or payer’s name, address information, and ZIP code.

Line 6 - Employer or Payer’s Taxpayer Identification Number (If Known)

Enter your employer or payer’s Taxpayer Identification Number (TIN) if it is known to you.

Line 7 - Form W-2

Enter wages, tips, other compensation, and taxes withheld in the spaces below.

Line 7a

Enter the amount of wages, tips, and other compensation paid.

Line 7b

Enter the amount of social security wages paid.

Line 7c

Enter the amount of medicare wages and tips paid.

Line 7d

Enter the amount of Social Security Tips paid.

Line 7e

Enter the amount of Federal Income Tax Withheld.

Line 7f

Enter the amount of State Income Tax withheld, and the name of the state.

Line 7g

Enter the amount of Local Income Tax withheld, and the name of the locality.

Line 7h

Enter the amount of Social Security Tax withheld.

Line 7i

Enter the amount of Medicare Tax withheld.

Line 8 - Form 1099-R

Enter distributions from pensions, annuities, retirement or profit-sharing plans, IRAs, insurance contracts, and et cetera in the spaces below.

Line 8a

Enter the amount of gross distribution.

Line 8b

Enter the taxable amount.

Line 8c

If the taxable amount has not been determined, check the box provided.

Line 8d

If the amounts above are the total distribution, check the box provided.

Line 8e

Enter the amount of capital gain included on Line 8b.

Line 8f

Enter the amount of Federal Income Tax withheld.

Line 8g

Enter the amount of State Income Tax withheld, and the name of the state.

Line 8h

Enter the amount of Local Income Tax withheld, and the name of the locality.

Line 8i

Enter the amount of employee contributions.

Line 8j

Enter any relevant distribution codes.

Line 9

Enter a short explanation of how the amounts written above were determined. It may be beneficial to attach the relevant documents, if any.

Line 10

Enter a short explanation of your efforts to obtain Form W-2, Form 1099-R (original or corrected), or Form W-2c, Corrected Wage and Tax Statement. It may be beneficial to attach the relevant documents or communication records to serve as evidence that you did attempt to obtain these forms before deciding to fill out Form 4852 IRS.

Tips when filling out Form 4852

While the 4852 form is very simple to fill out, it is important to make sure that all information entered is accurate and complete, so it may be beneficial to double-check the form after it has been accomplished.

Make sure all information entered is correct, and that the form is submitted to the appropriate place on time. This will help avoid any legal consequences for submitting the wrong information to the IRS and ensure that filing the form goes smoothly.

Practice good contract management. Make sure to keep a copy of the form in a safe and organized area, or even copy it again in order to be doubly sure that you have a backup in case the original is damaged in some way. This will be useful for possible legal purposes in the future, or even simply as a record.