| Box | Description |
| Box 1 | Income code - represents the type of income reported. The types currently used at UCLA:
10 – Industrial Royalties
11 – Motion Picture and Television Royalties
12 – Copyright Royalties
15 - Scholarship or fellowship grant
16 - Compensation for independent personal services
17 – Dependent Personal Services
18 - Compensation
19 - Student Employment
20 – Earnings as an Artist or Athlete
50 – Other Income |
| Box 2 | Gross income - reportable gross amount paid. |
| Box 3 | Withholding allowances - amount of allowance for individuals claiming a personal withholding allowance on the W-4. Amounts entered are only for income codes 15 and 16. Currently, not in use at UCLA. |
| Box 4 | Net income - the difference between Gross Income Paid and the Withholding Allowance. Only used when an amount appears in Box 3. |
| Box 5 | Tax rate - the rate applicable for the type of income. The rates at UCLA are:
00 - amount is exempt from tax withholding
14 - nonresident with an F or J visa and has a scholarship
30 - all other nonresident |
| Box 6 | Exemption code - the reason for the tax rate. The codes used at UCLA:
00 - tax rate is above zero
01 – Income effectively connected with business in the US
02 - exempt under IRS code
04 - Exempt under a tax treaty |
| Box 7 | Federal tax withheld - amount of federal tax withholdings. |
| Box 8 | Withholding by other agents - not applicable to UCLA |
| Box 9 | Total withholding credit - not applicable to UCLA |
| Box 10 | Amount repaid to recipient - not applicable to UCLA |
| Box 11 | Withholding agent's EIN - Employer Identification Number assigned to UCLA by the IRS. |
| Box 12a | Withholding Agent’s name - UCLA and Payroll Services. |
| Box 12b | Address (number and street) - not applicable to UCLA |
| Box 12c | Additional address line (room or suite no.) - not applicable to UCLA |
| Box 12d | City or town, province or state, country, ZIP or foreign postal code - not applicable to UCLA |
| Box 13a | Recipient’s Name - Name of the recipient for which income is reported. |
| Box 13b | Recipient Code - type of recipient/entity receiving payment. Most common at UCLA are:
01 – Individuals
02 – Corporation
03 – Partnership
05 – Trust
06 – Government or International Organization
07 – Tax Exempt Organization (IRC Section 501a)
08 – Foundation
09 – Artist or Athlete
10 - Estate |
| Box 13c | Address (number and street) - not applicable to UCLA |
| Box 13d | Additional address line (room or suite no.) - not applicable to UCLA |
| Box 13e | City or town, province or state, country, ZIP or foreign postal code - not applicable to UCLA |
| Box 14 | Recipient's U.S. TIN, if any - Recipient’s U.S. Tax Payer Identification Number.
• Individuals - this is the Social Security Number or ITIN number
• Entities - this is the Employer Identification Number (EIN) |
| Box 15 | Recipient's foreign tax identifying number, if any - not applicable to UCLA |
| Box 16 | Country Code - Corresponding code of the individual’s country of residence |
| Box 17 | NQI's/Flow-Through Entity's Name, if any - not applicable to UCLA |
| Box 18 | Country Code - Corresponding code of the NQI's country of residence |
| Box 19a | NQI's/Entity's address (number and street) - not applicable to UCLA |
| Box 19b | Additional address line (room or suite no.) - not applicable to UCLA |
| Box 19c | City or town, province or state, country, ZIP or foreign postal code - not applicable to UCLA |
| Box 20 | NQI's/Entity's U.S. TIN, if any - not applicable to UCLA |
| Box 21 | Payer's name and TIN (if different from withholding agent's) - not applicable to UCLA |
| Box 22 | Recipient account number (optional) - not applicable to UCLA |
| Box 23 | State income tax withheld - Amount of state tax withholdings. UCLA does not include the state income tax withholding on Form 1042-S. Instead, state income tax is reported as follows:
• For employees – reported on Form W-2
• For independent personal service payments over $1,500 – reported on Form 592-B |
| Box 24 | Payer's state tax no. - California state identification number assigned to UCLA. |
| Box 25 | Name of state - State location of withholding agent. |
