What Is this Form for
To determine allocation of tax withholdings for non-residents of New York State performing services within New York State.
Download the Forms:
Use to determine your tax withholding allocations if you work in NYS, NYC, or Yonkers but are not a resident of New York State.
Is This Form Mandatory?
This form is only mandatory for employees that are not residents of New York State but are working or performing services within New York State.
When to Submit
Complete this form within 10 days of any change in the percentage of the services performed within New York State or change in status from non-resident to resident of New York State.
How to Complete This Form
This form is fillable.
- Fill in the employee and employer information.
- Check the appropriate boxes in Parts 1-3.
- Print the form.
- Sign the form.
- Send the signed, original form to the BSC.
Where to Submit This Form
BSC Payroll Administration
W. Averell Harriman State Office Campus
1220 Washington Avenue
Building 5, Floor 4
Albany, NY 12226-1900
Contact the BSC Payroll Admin Team
Still have questions? Try the BSC Help Center where you can send a question to our support team or search a database of FAQs.