[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-303281-105":3,"detail-sidebar-cat-1-en-105":80,"doc-detail-303281-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","indiana-substitute-for-form-w-2-or-form-1099-r-form-wh-4852-instructions","Indiana Substitute for Form W-2 or Form 1099-R - Form WH-4852 - Instructions","","Instructions for completing Indiana Form WH-4852, an Indiana substitute used when a Federal Form W-2 is not received. The form requires taxpayer details, employer or payer information, and the tax year for the missing W-2 or 1099-R. Applicants must enter wage and withholding amounts drawn from Federal Form 4852, complete lines A through F, state the period worked, and explain how amounts were determined. Supporting documents must be attached, then the form signed and dated.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/indiana-substitute-for-form-w-2-or-form-1099-r-form-wh-4852-instructions/303281/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/indiana-substitute-for-form-w-2-or-form-1099-r-form-wh-4852-instructions/303281.png","ImageObject",442,249,{"name":42,"@type":43},"Margaret","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-09-26","2026-09-19",true,{"@type":52,"interactionType":53,"userInteractionCount":22},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"When is Form WH-4852 required?","Question",{"text":62,"@type":63},"Send a separate Form WH-4852 for each Form W-2 not received.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"What documents and amounts must be used to complete WH-4852?",{"text":67,"@type":63},"Use amounts from your Federal Form 4852 to complete lines A through F and provide wage, compensation, and tax withheld details.",{"name":69,"@type":60,"acceptedAnswer":70},"What evidence must be attached and how should the form be signed?",{"text":71,"@type":63},"Attach photocopies of payroll check stubs or other documents to verify the Indiana withholding claimed. Sign and date the form under penalties of perjury.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},303281,1790448768,{"code":4,"msg":81,"data":82},"success",[83,88,93,98,103,108,112,117,122],{"id":84,"doc_module":22,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},11,"Presentations",90,"presentations",{"id":89,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},12,"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":110,"slug":111},17,40,"forms",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},18,"Letters",30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":81,"data":127},{"doc_id":78,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":109,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":30,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":4},137451207643,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Instructions for Form WH-4852  \nYou must send a separate Form WH-4852 for each Form W-2 not received. We will accept a copy of your Federal Form 4852 as proof of your Indiana Income Tax withheld from your wages, otherwise you will need to complete the Indiana Form WH-4852 below.  \nTaxpayer Information  \nEnter your Social Security Number, Name, Address, City, State, and Zip Code.  \nEmployer or Payer Information  \nEnter Employer’s or payer’s ID Number (if known), Name, Address, City, State, and Zip Code.  \nEnter the tax year of the missing W-2 or 1099-R form.  \nEnter wages, compensations, and taxes withheld, or enter 1099-R information  \nComplete Lines A through F using the amounts from your Federal Form 4852.  \nEnter the period of time (month, day, year) you worked for your employer during the tax year.  \nHow did you determine amounts of wages and withholding shown on your Federal Form 4852?  \nIf from a pay stub, Check box; if “Other”, Check box and please explain.  \nAttach photocopy of payroll check stub(s) or other document(s) to verify the Indiana withholding amount(s) claimed. Please note: Arefund cannot be claimed based upon estimated withholding credits.  \nSign and Date Form.􀀆  \nFor assistance call (317) 233-4016, or you may e-mail the [Department at:](Department at: www.in. gov/dor/contactus/email.html)[ www.in. gov/dor/contactus/email.html](Department at: www.in. gov/dor/contactus/email.html)  \nForm WH-4852 State Form 48326  \nIndiana Department of Revenue  \nIndiana Substitute for Form W-2 or Form 1099-R  \n(R/ 01-03) You must send a separate Form WH-4852 for each Form W-2 not received.  \n  Tax Year  \nWe will accept your Federal Form 4852 as proof showing your Indiana Income Tax withheld from your wages.  \nTaxpayer Information  \n| Name |\n| --- |\n| Address |\n| City/State/Zip Code |\n\nEmployer or Payer Information  \nEmployer’s or payer’s ID, FID, or TID Number (if known)  \n\n| Name |\n| --- |\n| Address |\n| City/State/Zip Code |\n\nEnter wages, compensations, and taxes withheld, or enter 1099-R information.  \nComplete the following lines using the amounts from your Federal Form 4852.  \nForm 4852 Line \\#  \nA. Wages .................................... 7(A)a   \nB. State Tax Withheld ......................... g  Name of State    \nC. Local Tax Withheld ....................... h  Name of Locality    \nD. Gross Distribution   7(B)1   \nE. Taxable Amount ........................... 2a   \nF. State tax withheld .......................... 5   \nPeriod worked for employer during the tax year: From  / /  To  / /  How did you determine the amounts used on Federal Form 4852?  \n Paycheck Stub  Other explain:    \nAttach photocopy of payroll check stub (s) or other document(s) to verify the Indiana withholding amount(s) claimed.  \nUnder penalties of perjury, I declare that I have examined this statement, and to the best of my knowledge and belief, it is true, correct, and complete.  \nSignature   Date","cbCaifjGCgwlODvo","https://ap.wps.com/l/cbCaifjGCgwlODvo","pdf",43208,"English","# Taxpayer Information\n## Employer or Payer Information\n## Tax Year and Income Details\n## Completing Lines A Through F\n## Period Worked and Amount Determination\n## Attachments, Penalty Statement, Signature and Date","[{\"question\":\"When is Form WH-4852 required?\",\"answer\":\"Send a separate Form WH-4852 for each Form W-2 not received.\"},{\"question\":\"What documents and amounts must be used to complete WH-4852?\",\"answer\":\"Use amounts from your Federal Form 4852 to complete lines A through F and provide wage, compensation, and tax withheld details.\"},{\"question\":\"What evidence must be attached and how should the form be signed?\",\"answer\":\"Attach photocopies of payroll check stubs or other documents to verify the Indiana withholding claimed. Sign and date the form under penalties of perjury.\"}]","Indiana Substitute for Form W-2 or Form 1099-R - Form WH-4852 - Instructions | PDF",1789801559]