Printable Form 2026

IRS Form 4669 – Statement of Payments Received

IRS Form 4669 – Statement of Payments Received – IRS Form 4669, officially titled Statement of Payments Received, helps businesses and payers seek relief from liability for certain taxes they failed to withhold. The IRS still uses the December 2014 revision (no updates as of 2026), and it remains a key tool during employment tax audits, backup withholding reviews, or voluntary compliance efforts.

Businesses often discover missing withholding on wages, contractor payments, or other reportable income. Form 4669 allows them to prove the recipient (payee) already reported and paid the taxes, potentially avoiding or reducing the payer’s bill for the unwithheld amount.

Download the official IRS Form 4669 PDF here: https://www.irs.gov/pub/irs-pdf/f4669.pdf

This guide draws directly from the official IRS form instructions, Internal Revenue Manual (IRM 4.23.8), and related publications for accurate, up-to-date information.

What Is IRS Form 4669 and Why Does It Matter?

Form 4669 is a three-part statement that documents payments a payer made to a payee without properly withholding federal income tax, backup withholding, Additional Medicare Tax, or withholding on payments to foreign persons.

Key legal basis (per IRS instructions and IRC sections):

  • IRC 3402(d) — Relief for employers when employees have paid income tax on wages.
  • IRC 3102(f)(3) — Relief for Additional Medicare Tax (0.9%) not withheld.
  • IRC 3406 — Backup withholding on reportable payments (e.g., missing TIN).
  • Chapters 3 and 4 — Withholding on payments to foreign persons.

The payer remains liable for the tax they should have withheld unless they prove the payee reported the income and paid the tax. Form 4669 provides that proof, signed by the payee under penalties of perjury.

Important: Form 4669 does not relieve the payer of penalties or interest for the original failure to withhold.

Who Needs to Use IRS Form 4669?

  • Payers/Businesses/Employers — Anyone who issued payments subject to withholding but did not withhold (e.g., misclassified workers, contractors without valid W-9, or audit discoveries).
  • Payees (employees, independent contractors, freelancers, foreign persons) — They complete Part 2 and sign to certify they reported the income.
  • Tax professionals and IRS examiners — Frequently used in employment tax examinations.

Common scenarios include:

  • IRS audit reclassifies independent contractors as employees.
  • Backup withholding required due to missing or incorrect TIN but not performed.
  • Failure to withhold on wages, fringe benefits, or non-employee compensation.
  • Payments to foreign persons subject to 30% (or treaty-reduced) withholding.

When Should You File Form 4669?

Use Form 4669 whenever you need to request relief from assessed or potential withholding tax liability. Typical triggers:

  • During or after an IRS employment tax examination (Forms 941, 943, 944, 945, CT-1, or 1042).
  • Voluntary disclosure or self-correction of prior-year withholding failures.
  • Claim for refund after you’ve already paid the assessed withholding tax.

A separate Form 4669 is required from each payee for each tax year. You then summarize them on Form 4670 (Request for Relief of Payment of Certain Withholding Taxes, Rev. Aug 2015).

Download Form 4670: https://www.irs.gov/pub/irs-pdf/f4670.pdf

Step-by-Step: How to Complete IRS Form 4669?

The form has three parts and is only two pages long (plus instructions).

Part 1 – Completed by the Payor (Payer)

  1. Payee’s name and address.
  2. Payee’s TIN (SSN, EIN, or ITIN).
  3. Calendar year of the payments.
  4. Your (payor’s) name and address (use legal name from Form SS-4).
  5. Your EIN (not SSN or ITIN).
  6. Break down payment amounts:
    • 6a: Subject to income tax withholding.
    • 6b: Subject to backup withholding.
    • 6c: To foreign persons subject to withholding.
    • 6d: Subject to Additional Medicare Tax withholding.

Part 2 – Completed by the Payee

  • Review Part 1 and correct any errors.
  • Line 7: Name and address exactly as on their tax return.
  • Lines 8a/8b: Specify where the payments were reported (Form 1040 series, line or schedule, tax year) and confirm taxes were paid in full.
  • Line 9 (for Additional Medicare Tax): Either confirm reporting on Form 8959 or certify they were not liable (married filing jointly and under $250,000 threshold).

Part 3 – Payee Signature

  • Signed under penalties of perjury.
  • Print name, title (if any), daytime phone number, signature, and date.

Pro tip: Provide the payee with a pre-filled Part 1 to make it easy for them.

How to Submit Form 4669 (With Form 4670)?

  1. Collect signed Form 4669 from every relevant payee.
  2. Complete one Form 4670 per tax form type and per tax year.
  3. Attach:
    • All Forms 4669.
    • Copy of examination report (if applicable).
    • Amended return (e.g., Form 941-X) if tax already paid.
  4. Mail to the appropriate IRS campus (instructions on Form 4670).

Timing matters — Submit as early as possible to stop collection actions. In examinations, examiners often request these forms early and can consider them before closing the case.

Common Mistakes to Avoid

  • Incomplete fields (IRS returns incomplete forms to the payer).
  • Payee not signing under penalties of perjury.
  • Using the wrong tax year or mixing multiple years on one Form 4670.
  • Failing to attach required examination reports or amended returns.
  • Not keeping copies for your records.

FAQs About IRS Form 4669

  • Is Form 4669 still current in 2026?
    Yes. The form (Rev. 12-2014) and Form 4670 (Rev. 8-2015) remain the latest versions on IRS.gov.
  • Can I use Form 4669 for FICA or FUTA taxes?
    No. Relief applies only to federal income tax withholding, backup withholding, Additional Medicare Tax, and foreign-person withholding.
  • What if the payee refuses to sign?
    You generally cannot claim relief for that payee. Document your attempts.
  • Does Form 4669 forgive penalties?
    No. You remain liable for penalties and interest on the failure to withhold.
  • Where do I find more help?
    • Publication 15 (Circular E), Employer’s Tax Guide
    • Publication 1281, Backup Withholding
    • Publication 515, Withholding on Nonresident Aliens and Foreign Entities
    • IRM 4.23.8 (IRS Internal Revenue Manual)

Final Thoughts: Protect Your Business with Proper Documentation

IRS Form 4669 is a powerful but narrowly focused tool for shifting withholding tax liability back to the payee who already paid it. Proper use during audits or self-corrections can save businesses thousands in unnecessary tax payments — though it never eliminates penalties.

Always consult a qualified tax professional or CPA when dealing with employment tax issues, as the stakes are high and IRS scrutiny is intense in this area.

Need the form right now?
→ Download IRS Form 4669 PDF
→ Download IRS Form 4670 PDF

Stay compliant, document everything, and keep your business protected from unexpected withholding tax assessments.

This article is for informational purposes only and is not tax or legal advice. For personalized guidance, consult a tax professional or the IRS directly.