Severance Payment (cash)

Report a cash severance payment that you or your spouse received in Schedule A. Report a cash severance payment that you will receive in the future in both Schedule A and Schedule C, Part II.

Severance Payment: Examples

For You – Received Severance Payment

Schedule A

Report the total amount of severance payments received during the reporting period if the amount is more than $200.

Block A: Provide the name of the source. If the entity is not a publicly traded company, also provide the entity’s line of business and location (city and state).

Block C: Write the word “severance” followed by the exact amount of your severance in the column labeled “Other Income” on the right side of the page.

For You – Anticipated Severance Payment

Schedule A

Report an anticipated severance payment if the anticipated value is more than $1,000.

Block A: Provide the name of the source and write “anticipated severance.” If the entity is not a publicly traded company, also provide the entity’s line of business and location (city and state).

Block B: Mark the column that corresponds to the value of the anticipated severance payment.

Block C: Mark the column labeled “None (or less than $201)” because you have not yet received the severance payment.

Schedule C, Part II

You also need to report your anticipated severance payment as a continuing agreement in Schedule C, Part II.

Terms: Provide the terms under which the severance will be paid (e.g., “quarterly payments over two years” or “lump sum”). Provide the amount of the payment. If the severance is being paid pursuant to an established agreement or company policy, also note that fact in your description. Consult your ethics official for additional assistance regarding the language.

Parties: Provide the name of the employer as well as the city and state in which the employer is located.

Date: Provide the month and year in which you became covered by an agreement or policy that provides for a severance payment.

For Your Spouse

Schedule A

If you already have reported your spouse’s employment, you do not need to report a cash severance payment that your spouse received or anticipates receiving. However, if your spouse’s employment terminated outside the reporting period, you may not have already reported your spouse’s employment. In that case, you need to report a cash severance payment of more than $1,000 that your spouse received within the reporting period or that your spouse currently anticipates receiving in the future.

In Block A identify the employer and in the “Other Income” column write either “spouse’s earnings” or “spouse’s severance.” Do not provide the amount of the severance in the “Other Income” column and do not mark a column in either Block B or Block C.

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This guide is not intended to provide investment advice, and you should not rely on statements in this guide when making investment decisions.