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Get CA UBEN 106 2021-2023

TAX WITHHOLDING ELECTION FOR UNIVERSITY OF CALIFORNIA RETIREMENT PLAN UCRP INCOME UBEN 106 R9/15 University of California Human Resources The laws and UC policies governing tax withholding vary according to the type of payments you are receiving your residency status and where your payments are sent. This form is available on the UCnet website ucnet. universityofcalifornia.edu/forms/pdf/ uben-106. pdf or call the Retirement Administration Service Center at 800-888-8267 to request a form. If your payment is to be delivered to a foreign address that is not a U.S. possession tax will be withheld automatically you may not elect no withholding. WHEN TO USE THIS FORM Use this form to elect or change your withholding for UCRP monthly retirement income survivor income or disability income. You may wish to refer to IRS form W-4P and California state form DE-4P to help determine your tax withholding. UC will also accept these forms instead of this form for your tax withholding election* There are penalties for not paying enough tax during the year either through monthly withholding or estimated federal tax payments. IRS Publication 505 explains the estimated tax requirements and penalties in detail* IRS Publication 575 provides general information on the taxability of annuities. These publications are available from the Internal Revenue Service www*irs*gov IRS Western Distribution Center Rancho Cordova CA 95743-0001 telephone number 800-829-3676. SECTION 1 PERSONAL INFORMATION Please provide all the information requested on the form* Be sure to inform UC Human Resources of future address changes. Send to UC RASC Retirement Administration P. O. Box 24570 Oakland CA 94623-1570 SECTION 2 TAX WITHHOLDING ELECTION Federal Income Tax If you made no previous tax withholding election UC automatically withholds federal income tax from your monthly payments based on the tax table for a married individual claiming three allowances. If you prefer to have a different amount withheld or to have no tax withheld complete Section 2A. California State Income Tax California Residents If you made no previous tax withholding election UC automatically withholds California tax from your monthly Non-California Residents Effective January 1996 states are prohibited from taxing nonresident pensions. If you previously elected to have until you change it. You may wish to consult a tax advisor regarding your individual situation* UC does not withhold income tax for states other than California* CHANGES TO YOUR ELECTION Your election will remain in effect until you change it by submitting another Tax Withholding Election for UCRP Income form* You may make changes as often as you like and will be notified annually of your right to do so. Submitting a new form automatically revokes your previous election* If Retirement Administration receives the form by the 12th day of the month your election will be effective with the check normally paid on the first of the following month. 1. PERSONAL INFORMATION NAME Last First Middle Initial SOCIAL SECURITY NUMBER MAILING ADDRESS Number Street City State ZIP Country DAYTIME PHONE Status check one UCRP Member Survivor or Contingent Annuitant Former Spouse PERS Plus 5 Member PERS Plus 5 Survivor PERS Plus 5 Former Spouse 415 m Restoration A.

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