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Official form guide
Form 4219: Statement of Liability of Lender, Surety, or Other Person for Withholding Taxes
IRS Form 4219 is the Statement of Liability of Lender, Surety, or Other Person for Withholding Taxes. It reports liability incurred under IRC §3505 when a lender or surety pays wages or supplies funds for another employer, calculating the lesser of the unpaid balance or 25 % of the amount supplied.
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IRS Form 4219 - Statement of Liability of Lender, Surety, or Other Person for Withholding Taxes
IRS Form 4219 is the Statement of Liability of Lender, Surety, or Other Person for Withholding Taxes. It reports liability incurred under IRC §3505 when a lender or surety pays wages or supplies funds for another employer, calculating the lesser of the unpaid balance or 25 % of the amount supplied.
Risk Radar
Scan points- 1Failing to sign the form under penalty of perjury invalidates the filing.
- 2Omitting the employer’s identification number (EIN) in item 2.
- 3Entering an incorrect quarter‑end date in item 4, which must be the last day of the calendar quarter.
- 4Calculating liability without applying the lesser‑of rule (balance vs. 25 % of Item 13).
- 5Leaving the lender’s signature line blank, violating the perjury declaration.
Plain English
This form tells the IRS how much tax a lender, surety, or other person owes because they paid wages or gave money to another employer for payroll. It lists the employer’s details, the amount of wages, and the tax that should have been withheld. The filer signs under penalty of perjury.
Submission Date
- Filing date: 2014-05-29 00:00:00
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
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What this form is for
- Use this form when you are a lender, surety, or other person who has paid wages directly to employees of another employer or supplied funds for wage payment and incurred liability under IRC §3505.
- Do not use it when you are an employer as defined in IRC §3401(d)(1) or (d)(2); employers must report withholding on their own returns.
- Check Form 941 instead when you are an employer filing income tax withholding.
Form selector
Use this form or another form?
Lender paid wages directly to employees of another employer
Liability under §3505(b) must be reported
✓ Verify wage payment details and quarter.
Surety supplied funds specifically for wage payment
Liability limited to 25% of funds supplied
✓ Confirm amount supplied and calculate 25% cap.
Multiple employers in same calendar quarter
Separate form required for each employer
✓ Ensure a distinct Form 4219 for each employer.
Deadline or filing window
Not stated in the official source.
Checklist
What you need before filling it out
Employer name
Employer's name as on tax return · Form 4219, item 1
Employer identification number
Employer's EIN · Form 4219, item 2
Date quarter ended
Last day of calendar quarter wages were paid · Form 4219, item 4
Gross amount supplied for wage payment
Documentation of loan or fund transfer · Form 4219, item 13
Liability for withholding taxes
Calculation of lesser of unpaid balance or 25% of amount supplied · Form 4219, item 18
Before you submit
- 1Verify employer name matches the name used on the employment tax return.
- 2Confirm employer identification number is entered correctly.
- 3Enter the correct quarter‑end date in Item 4.
- 4Calculate the gross amount supplied for wage payment accurately for Item 13.
- 5Compute Item 18 liability as the lesser of Item 17 or 25 % of Item 13.
- 6Sum Items 19 and 20 to obtain Item 21, then add Item 22 for total liability in Item 23.
- 7Sign and date the form as the lender, surety, or other person.
- 8If a preparer other than the lender signs, have the preparer sign and date the preparer section.
- 9Prepare a check or money order for the amount shown in Item 23 payable to the United States Treasury.
- 10Attach the payment to the completed Form 4219.
- 11Make a duplicate copy of the completed form for your records.
- 12Mail the form and payment to the IRS office where the employer files its federal employment tax returns.
How to file this form
- 1Gather employer information and loan documentation.
- 2Complete Form 4219 for each employer and quarter, calculating liability as required.
- 3Prepare a check or money order for the amount in Item 23 payable to the United States Treasury.
- 4Sign the form (and preparer signature if applicable) and attach the payment.
- 5Make a duplicate copy for your records.
- 6Mail the completed form and payment to the IRS office where the employer files its employment tax returns.
- 7Retain the mailing receipt as proof of filing.
Known limitations
- 1Employers within the meaning of code section 3401(d)(1) or (d)(2) must not use Form 4219
- 2Form 4219 is required only when a lender, surety, or other person has incurred liability under section 3505
- 3A separate duplicate Form 4219 must be filed for each employer and each calendar quarter
Field map
Compact field-by-field guide
General Info
2 items
Full legal name and taxpayer identification number (SSN or EIN).
Current mailing address.
Details
2 items
Complete all applicable sections of this form according to the official IRS instructions.
Enter the relevant dollar amount if this form involves tax calculation.
Certification
1 items
Read and acknowledge any certifications required by this form.
Signatures
1 items
Sign and date. Unsigned forms cannot be processed.
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Fillable formOpen in Editor->Form 4219 is currently issued as Revision May 2014 (5‑2014); the PDF itself is the latest version indicated on the form.
What changed or needs a fresh check
- Edition date — confirm the revision reads May 2014 (5‑2014) on the form.
- Fee — Not stated in the official source.
- Mailing address — Not stated in the official source.
- Signature — confirm lender, surety, or other person signs and dates the form.
Quick Facts
Downloads
After you file
- 1Retain the duplicate copy of Form 4219 for your records
- 2Keep all books and records related to Form 4219 as long as they may become material in tax administration
- 3Include with the form a check or money order for the amount shown in item 23, payable to the United States Treasury
- 4File Form 4219 with the IRS office where the employer files its Federal employment tax returns
Sources
- SRCForm p.2 — General Instructions: Employers within code section 3401(d)(1) or (d)(2) do not use Form 4219
- SRCForm p.2 — General Instructions: File this form if you have incurred liability under section 3505
- SRCForm p.2 — Separate Form 4219 for each employer and each calendar quarter: Submit a separate duplicate for each employer and quarter
- SRCForm p.1 — header: Please file this form in duplicate
- SRCForm p.2 — Books and records: Must be retained as long as contents may become material in tax administration
- SRCForm p.2 — Payment: Include a check or money order for the amount shown in item 23 payable to the United States Treasury
- SRCForm p.2 — Where to file: File with the IRS office where the employer files Federal employment tax returns
Common confusion points
Do I need to file Form 4219?
Unclear whether I am a lender/surety or an employer
→ Verify you are a lender, surety, or other person who paid wages or supplied funds and incurred liability under section 3505
Can my company, as an employer, file Form 4219?
Misreading the filing requirement
→ Confirm you are not an employer within code section 3401(d)(1) or (d)(2); employers must not use this form
Do I file one Form 4219 for all employers I work with?
Assuming a single form covers multiple employers
→ Submit a separate duplicate Form 4219 for each employer and each calendar quarter
Where should I mail Form 4219?
The address for comments appears on the page and may be confusing
→ Send the form to the IRS office where the employer files its Federal employment tax returns
Is a payment required with the form?
Uncertain if a check or money order is needed
→ Include a remittance for the amount shown in item 23 payable to the United States Treasury
How long must I keep the form and supporting documents?
No specific time frame given
→ Retain books and records as long as they may become material in the administration of any Internal Revenue law
Workflow map
Related forms and next steps
Before
Current
After
Often used with
⚠ If something goes wrong
- Form 4219 – failure to provide required information or providing false information may result in penalties.
Questions about IRS Form 4219
What is IRS Form 4219 used for?
This form tells the IRS how much tax a lender, surety, or other person owes because they paid wages or gave money to another employer for payroll. It lists the employer’s details, the amount of wages, and the tax that should have been withheld. The filer signs under penalty of perjury.
Who must file IRS Form 4219?
A lender, surety, or other person who has paid wages directly to employees of another employer or supplied funds for those wages must file IRS Form 4219.
What information does IRS Form 4219 require?
The form collects the employer’s name, EIN, trade name, quarter‑end date and address, as well as the filer’s name and address, and calculates the withholding tax liability (the lesser of the unpaid balance or 25 % of the amount supplied) and any interest.
How do I complete IRS Form 4219?
First, enter the employer’s (borrower’s) name, EIN, trade name, quarter‑end date and address in items 1‑5. Next, provide the filer’s name and address in items 6‑7, then calculate the amounts for Items 13‑23, using the rule that liability equals the lesser of the balance or 25 % of Item 13. Finally, the lender, surety, or other person signs and dates the form, and the preparer signs if different, under penalty of perjury.
What happens if IRS Form 4219 is filed incorrectly?
Providing false information subjects the signer to perjury penalties, and paying the liability after the employer’s tax return due date triggers interest under IRC §6621.
Do I need to file Form 4219?
Unclear whether I am a lender/surety or an employer Verify you are a lender, surety, or other person who paid wages or supplied funds and incurred liability under section 3505
Can my company, as an employer, file Form 4219?
Misreading the filing requirement Confirm you are not an employer within code section 3401(d)(1) or (d)(2); employers must not use this form
Do I file one Form 4219 for all employers I work with?
Assuming a single form covers multiple employers Submit a separate duplicate Form 4219 for each employer and each calendar quarter
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