Lines 1 to 3: filer
Name shown on the return, social security number and current address.
4852
Substitute for Form W-2, Wage and Tax Statement, or Form 1099-R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
- Agency
- IRS
- Revision
- Rev. September 2020
- Fillable fields
- 34
- Pages
- 2
- Official source
- IRS form page
- Checked
- October 21, 2026
Form 4852: Substitute for Form W-2, Wage and Tax Statement, or Form 1099-R
Form 4852 serves as a substitute for Form W-2, Form W-2c and Form 1099-R (original or corrected). The About page says it is completed by taxpayers or their representatives when their employer or payer does not give them a Form W-2 or Form 1099-R, or when an employer or payer has issued an incorrect one.
The form lists steps to take first: try to get the missing or corrected form from the employer or payer, and if it has not arrived by the end of February, call the IRS at 800-829-1040 for assistance. The IRS then contacts the employer or payer and sends a Form 4852.
The form is attached to Form 1040, 1040-SR or 1040-X, at the back of the return before any supporting forms or schedules. The amounts on it are the filer's best estimates of wages or payments and tax withheld. You can fill out the PDF free in your browser on this page and download it without an account.
What's on Form 4852
Line 4: year and form type
The tax year and a box for Form W-2 or Form 1099-R, with a statement that the IRS has been notified.
Lines 5 and 6: employer or payer
Name, address and ZIP code of the employer or payer, and its TIN if known.
Line 7: Form W-2 amounts
Wages, social security and Medicare wages, social security tips, and federal, state, local, social security and Medicare tax withheld.
Line 8: Form 1099-R amounts
Gross distribution, taxable amount, capital gain, tax withheld, employee contributions and distribution codes.
Lines 9 and 10: explanations
How the amounts were determined, and the efforts made to get the missing or corrected form.
How to fill out Form 4852
- 1
Lines 1 to 4
Enter the name, social security number and address, then the year the form was not received or was incorrect, and check Form W-2 or Form 1099-R.
- 2
Lines 5 and 6
Enter the employer's or payer's name and address. For line 6, the instructions say to use the EIN from the prior year's form if it was the same employer or payer, or another known TIN.
- 3
Line 7
Enter correct amounts from the Form W-2 received, or use the final pay stub. Line 7a includes wages, noncash income, tips reported and other pay before deductions.
- 4
Line 8
Enter correct Form 1099-R amounts, or use a distribution statement from the plan trustee. Check 8c if the taxable amount cannot be computed, and leave 8b blank.
- 5
Lines 9 and 10
Explain how the amounts were determined, for example estimates, pay stubs or a distribution statement, and describe the attempts made to get the form.
- 6
Attach and keep a copy
Attach it to the back of the return before supporting forms or schedules. The instructions suggest keeping a copy until social security benefits begin.
Why fill Form 4852 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the IRS, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes, what to try first and penalties
Where it goes
The form says to attach it to Form 1040, 1040-SR or 1040-X.
What to try first
The form says to attempt to get the form from the employer or payer first, and that you may call the IRS at 800-829-1040 if it has not arrived by the end of February.
If the real form arrives later
If a Form W-2, W-2c or 1099-R received after filing shows the return was incorrect, the instructions say to amend it on Form 1040-X.
Penalties
The instructions list accuracy-related penalties equal to 20% and civil fraud penalties equal to 75% of the taxes that should have been paid, and a $5,000 civil penalty for a frivolous return or specified frivolous submission.
Checking the earnings record
After September 30 following the year on line 4, the instructions point to a Social Security online account at www.SSA.gov/myaccount or a local SSA office to verify reported wages.
Related forms
W-2
Wage and Tax Statement
568 fields, 11 pages
W-2c
Corrected Wage and Tax Statement
540 fields, 9 pages
1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
257 fields, 9 pages
1040
U.S. Individual Income Tax Return
199 fields, 2 pages
1040-X
Amended U.S. Individual Income Tax Return
166 fields, 2 pages
4972
Tax on Lump-Sum Distributions
58 fields, 4 pages
Who fills out Form 4852?
The instructions say it is completed by the taxpayer or the taxpayer's representatives, and it goes to the IRS attached to the income tax return.
Official sources and the blank
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Questions about Form 4852
When is Form 4852 used?
The About page says when an employer or payer does not give a Form W-2 or Form 1099-R, or has issued an incorrect one.
Is the employer contacted first?
The form says to attempt to get the form from the employer or payer first. If it has not arrived by the end of February, it says you may call the IRS at 800-829-1040.
What is Form 4852 attached to?
Form 1040, 1040-SR or 1040-X. The instructions say to attach it to the back of the return before any supporting forms or schedules.
What if the Form W-2 arrives after filing?
If it shows the original return was incorrect, the instructions say to amend the return on Form 1040-X.
How are the amounts estimated?
The instructions mention the final pay stub for wages, or a distribution statement from the plan trustee for a Form 1099-R distribution. Line 9 explains how the amounts were found.
Who fills it out?
The taxpayer or the taxpayer's representative, according to the form and the About page.