2017 Form 1042-S
IRS Form 1042-S Foreign Person's U.S. Source Income Subject to Withholding.
For the 2016 Form 1042-S, click here.
For the 2015 Form 1042-S, click here.
| Box # | Name | Description |
|---|---|---|
| Box 1 | Income Code | Two digit code to designate type of income. Typical codes are: 16-Scholarship or Fellowship, 17-Compensation for independent personal services, 19-Compensation for teaching and research, and 20-Compensation during studying and training |
| Box 2 | Gross Income | Entire amount of payment |
| Box 3 | Chap. 3 | Exemption Code and Tax Rate based on Chapter 3 of the Internal Revenue Code |
| Box 4 | Chap. 4 | Exemption Code and Tax Rate based on Chapter 4 of the Internal Revenue Code |
| Box 3a or 4a | Exemption Code | Reason for the exemption. Typical codes are: 02-Exempt under IRS code and 04-Exempt under tax treaty |
| Box 3b or 4b | Tax Rate | Withholding rate based on type of income. |
| Box 5 | Withholding Allowances | Personal exemption amount applied to Box 2, limited to income codes listed in Box1 |
| Box 6 | Net Income | Generally left blank |
| Box 7a | Federal Tax Withheld | Total amount of federal tax withheld, including additional withholding |
| Box 7b | N/A | N/A |
| Box 8 | Withholding by Other Agents | N/A |
| Box 9 | Tax Withheld by Withholding Agent | Amount of tax paid by University and not withheld |
| Box 10 | Total Withholding Credit | Total amount of federal tax withheld, including additional withholding |
| Box 11 | Amount Repaid to Recipient | N/A |
| Box 12a | Withholding Agent’s EIN | University's EIN |
| Box 12b | Chapter 3 Status Code | Withholding Agent's Chapter 3 Status Code |
| Box 12c | Chapter 4 Status Code | Withholding Agent's Chapter 4 Status Code |
| Box 12d | Withholding agent's name | Name of withholding agent |
| Box 12e | Withholding agent's Global Intermediary Identification Numer (GIIN) | N/A |
| Box 12f | Country code | N/A |
| Box 12g | Foreign taxpayer identification number, if any | N/A |
| Box 12h | Address (number and street) | Withholding agent's address information |
| Box 12i | City or town, Providence or State, Country, Zip or Foreign Postal Code | Withholding agent's address information |
| Box 13a | Recipient's Name | Recipient's Name |
| Box 13b | Recipient's Country Code | 2 digit code designating the recipient’s country of residence |
| Box 13c | Address (number and street) | Recipient's Address |
| Box 13d | City or town, Providence or State, Country, Zip or Foreign Postal Code | Recipient's Address |
| Box 13e | Recipient’s US TIN if any | Recipient’s Social Security Number or Individual Taxpayer Identification Number |
| Box 13f | Chapter 3 Status Code | Recipient's Chapter 3 Status Code |
| Box 13g | Chapter 4 Status Code | Recipient's Chapter 4 Status Code |
| Box 13h | Recipient's GIIN | N/A |
| Box 13i | Recipient's foreign taxpayer identification number, if any | Foreign Taxpayer Identification Number |
| Box 13j | LOB Code | N/A |
| Box 13k | Recipient's Acct Code | University UID |
| Box 13l | Recipient's Date of Birth | Date of Birth |
| Box 14a | Primary Withholding Agent's Name - Chapter 4 | N/A |
| Box 14b | Primary Withholding Agent's EIN - Chapter 4 | N/A |
| Box 15a | Intermediary or flow-through entity's EIN, if any | N/A |
| Box 15b | Chapter 3 Status Code | N/A |
| Box 15c | Chapter 4 Status Code | N/A |
| Box 15d | Intermediary or flow-through entity's name | N/A |
| Box 15e | Intermediary or flow-through entity's GIIN | N/A |
| Box 15f | Country Code | N/A |
| Box 15g | Foreign tax identification number, if any | N/A |
| Box 15h | Address (number and street) | N/A |
| Box 15i | City or town, state or privince, country, ZIP or foreign postal code | N/A |
| Box 16a | Payer's name | N/A |
| Box 16b | Payer's TIN | Tax Information Number of the Payer |
| Box 16c | Payer's GIIN | N/A |
| Box 16d | Ch 3 Status Code | N/A |
| Box 16e | Ch 4 Status Codetd> | N/A |
| Box 17a | State income tax withheld | Amount of Illinois Tax Withheld |
| Box 17b | Payer's state tax no. | Payer's State EIN |
| Box 17c | Name of state | State Payer is Located |