To submit Form 4029, mail three copies to the Social Security Administration, Division of Earnings Adjustments, ATTENTION: Form 4029 Process, Metro West, North Building, Baltimore, Maryland 21201. Include your social security number in the space provided. If you do not have a social security number, file Form SS-5 along with Form 4029. Keep a copy of the approved form for your permanent records.

File Form 4029 at any time when you want to apply for exemption from social security and Medicare taxes. Keep track of your Form 4029 filing and approval dates for future reference.

Form 4029 serves the purpose of allowing members of recognized religious groups to apply for exemption from Social Security and Medicare taxes. By filing this form, individuals who conscientiously oppose public or private insurance benefits due to their religious beliefs can request an exemption from these taxes. The form requires certification of membership in a qualifying religious group and a waiver of all rights to Social Security and Medicare benefits, ensuring that the applicant is not eligible for these benefits based on their earnings. The exemption is intended to respect the religious beliefs of individuals and groups that have historically been opposed to participating in public insurance programs. This process also ensures that qualifying individuals and employers are in compliance with the Internal Revenue Code requirements for tax exemptions. It is important to note that this exemption is irrevocable for the period it covers, and the applicant must continuously meet the requirements to maintain their exempt status.

• 1. Name of taxpayer: Enter your full name.
• 2. Address: Provide your complete address including number, street, and P.O. box.
• 3. Social security number: Enter your social security number.
• 4. City or town, state, and ZIP code: Provide your city, state, and ZIP code.
• 5. Name of religious group: Specify the name of your religious group.
• 6. Religious district and location: Provide the religious district and location.
• 7. Day, Month, Year: Indicate the day, month, and year since you have been opposed to insurance benefits.
• 8. Signature of Applicant: Sign and date the form to certify your application.
• 9. Part II: To be completed by the authorized representative of your religious group.
• 10. Name of Authorized Representative: Enter the name of the authorized representative.
• 11. Address: Provide the address of the religious group.
• 12. Title: Specify the title of the authorized representative.
• 13. Signature of Authorized Representative: The representative must sign and date the form.

If you fail to submit Form 4029, you will be required to pay Social Security and Medicare taxes and will not be exempt from these taxes based on your earnings.

• Loss of exemption: You will lose the exemption from Social Security and Medicare taxes.
• Requirement to pay taxes: You will be required to pay the full amount of Social Security and Medicare taxes.
• Ineligibility for benefits waiver: You will not be able to waive your rights to Social Security and Medicare benefits.

• 1. Exemption application: Use this form to apply for exemption from Social Security and Medicare taxes.
• 2. Eligibility certification: Certify your membership in a recognized religious group that opposes insurance benefits.
• 3. Waiver of benefits: Waive all rights to Social Security and Medicare benefits.
• 4. Employer exemption: Employers must use this form to exempt qualifying employees.
• 5. Record keeping: Keep a copy of the approved form for your permanent records.