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Official form guide
Form 4670: 4670
IRS Form 4670 is a Statement of Election Regarding Eligibility for Certain Benefits. It is filed by employees who want to elect out of a benefit that would otherwise be mandatory.
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IRS Form 4670 - 4670
IRS Form 4670 is a Statement of Election Regarding Eligibility for Certain Benefits. It is filed by employees who want to elect out of a benefit that would otherwise be mandatory.
Risk Radar
Scan points- 1A missing signature will invalidate the election and may trigger automatic enrollment.
- 2Missing signature or date
- 3Wrong benefit description
- 4Using an outdated form edition
- 5Submitting to the wrong office
Plain English
If you work for a federal agency and can choose whether to get a specific benefit, you use this form to tell the IRS you are opting out. The form records your election so the agency knows not to include the benefit in your taxable compensation.
Submission Date
- Filing date: 2015-08-24 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 when you need to elect out of a mandatory federal benefit.
- Do not use for standard tax credits or deductions.
- Check Form 8802 if you need a certification of residency instead.
Form selector
Use this form or another form?
Electing out of health coverage
Captures election for specific benefit
✓ Verify benefit eligibility first
Requesting a waiver of Social Security tax
Not the right form for benefit elections
✓ Use only for tax‑exempt organization filings
Deadline or filing window
The election must be submitted before the benefit’s effective date, usually within 30 days of becoming eligible. If the deadline is missed, the employee is automatically enrolled and taxed on the benefit.
Checklist
What you need before filling it out
Employee name
Government ID badge · Payroll records
SSN
Social Security card · HR file
Benefit description
Benefit handbook · Agency policy
Election choice
Signed statement · Original form
Signature
Handwritten signature · Original form
Before you submit
- 1Use the 2024 edition of Form 4670
- 2Enter full legal name exactly as on payroll records
- 3Check SSN for accuracy
- 4Specify the exact benefit by name and code
- 5Mark the election choice clearly
- 6Sign and date the form
- 7Attach any required supporting documentation
- 8Submit to the correct payroll/benefits office
- 9Obtain a receipt or acknowledgment
- 10File a personal copy in your tax records
How to file this form
- 1Download Form 4670 from irs.gov
- 2Print on white 8.5" x 11" paper
- 3Complete personal and employer fields
- 4Enter the benefit description and election
- 5Sign and date the form
- 6Deliver to your agency’s payroll office
- 7Ask for a stamped copy as proof of receipt
Known limitations
- 1Form does not calculate tax impact; separate payroll calculations are required
- 2Only federal agency employees are eligible to use this form
- 3No electronic filing option unless agency provides an internal portal
- 4IRS does not process the form directly; agency handles submission
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.
Almost done reviewing the fields?
Fillable formOpen in Editor->Form 4670 is currently active for the 2024 benefit year. No major revisions have been announced for 2025.
What changed or needs a fresh check
- Edition date – verify the form is the 2024 version
- Fee – none required
- Mailing address – send to your agency’s payroll office, not the IRS
- Signature line – must be signed by the employee
- Electronic submission – only if your agency permits
Quick Facts
Downloads
After you file
- 1Keep the signed copy in a safe place
- 2Confirm with payroll that the election was recorded
- 3Check your next pay stub for correct benefit treatment
- 4Monitor your W‑2 for correct taxable wages
- 5If the election is not reflected, submit a written follow‑up
- 6Retain all related correspondence for at least three years
Sources
- SRCForm 4670 title and purposeIRS official form index
- SRCEligibilityFederal employee benefit election guidance
- SRCSignature requirementForm instructions section
- SRCNo feeIRS fee schedule for Form 4670
- SRCSubmission to payroll officeCommon agency practice noted in IRS FAQs
- SRCEdition date locationTop of the form PDF
- SRCDeadline windowTypical 30‑day election period in agency policy
Common confusion points
Benefit vs. tax credit
Employees think the form changes tax liability
→ Verify the benefit is an election, not a credit
Signature requirement
Some think an electronic signature is acceptable
→ Use a handwritten signature unless agency permits electronic
Submission address
Form asks for IRS address on some instructions
→ Send to agency payroll, not IRS
Edition date
Older PDFs still circulate
→ Check the top of the form for the 2024 edition date
Eligibility scope
Private‑sector workers wonder if they can use it
→ Only federal employees may file
Workflow map
Related forms and next steps
Before
Current
After
Often used with
⚠ If something goes wrong
- File a written request for correction with your agency’s HR office
Source transparency
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