2025 Form CT-4852
Substitute for Form W-2 or Form 1099-R
Download or Print 2025 Connecticut Form CT-4852
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About Connecticut Form CT-4852
Connecticut Form CT-4852 is a substitute statement for a missing or incorrect Form W-2, Wage and Tax Statement, or Form 1099-R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. Use it when you have been unable to obtain a correct wage or pension distribution statement from an employer or payer and have notified the Internal Revenue Service.
A separate Form CT-4852 must be completed for each missing or incorrect Form W-2 or Form 1099-R. The form asks for the tax year, employer or payer information, federal and Connecticut withholding amounts, wages or payments, how you determined the amounts, and the reason the original form was not furnished or corrected.
Do not attach Form CT-4852 to your Connecticut income tax return. Complete the form and keep it with your tax records. If you received a Form W-2 showing federal wages and federal income tax withheld, attach a copy to Form CT-4852. If you filed federal Form 4852 to report federal wages and federal tax withheld, attach a copy of federal Form 4852 to Form CT-4852. Connecticut DRS may ask you to provide a copy later.
Connecticut Form CT-4852 PDF File
Click the Connecticut Form CT-4852 PDF link above to download, save, view, and print the file for the current year. This free PDF file is unaltered and is sourced directly from the publisher.
Connecticut DRS last published the Form CT-4852 PDF with a December 2023 revision date and a write-in tax year field. The current individual income tax forms page continues to list that PDF for substitute W-2 and 1099-R reporting.
Related Connecticut State Income Tax Forms
Need more state income tax forms? View the full 2025 Connecticut income tax forms list.
| Form Code | Form Name |
|---|---|
| Form CT-1040 | Connecticut Resident Income Tax Return (includes Schedules 1 through 5) |
| Form CT-1040NR/PY | Connecticut Nonresident and Part-Year Resident Income Tax Return (includes Schedules 1 through 4) |
| Form CT-1040X | Connecticut Amended Income Tax Return for Individuals |
| Form CT-3911 | Taxpayer Statement Regarding State of Connecticut Tax Refund |
Frequently Asked Questions (FAQ)
Here are answers to common questions about downloading, printing, completing, and keeping 2025 Connecticut Form CT-4852.
When should I use 2025 Connecticut Form CT-4852?
Use Form CT-4852 if you cannot obtain a correct Form W-2 or Form 1099-R from an employer or payer, and you have notified the Internal Revenue Service. Complete a separate Connecticut substitute statement for each missing or incorrect Form W-2 or Form 1099-R.
What is Connecticut Form CT-4852 used for?
Use Form CT-4852 to document estimated wages, pension distributions, federal withholding, Connecticut withholding, and Connecticut wages or payments when the original Form W-2 or Form 1099-R is missing or incorrect. The form also asks you to explain how you determined the amounts and what you did to obtain the missing or corrected statement.
Do I attach Form CT-4852 to my Connecticut income tax return?
No. Connecticut DRS says not to attach Form CT-4852 to your Connecticut income tax return. Complete the form and keep it with your tax records. Attach any required W-2 or federal Form 4852 copies to the Form CT-4852 record you keep. DRS may ask you to provide a copy later.
What should I attach to Form CT-4852?
If you received a Form W-2 showing federal wages and federal income tax withheld, attach a copy to Form CT-4852. If you did not receive a Form W-2 but filed federal Form 4852 to report federal wages and federal tax withheld, attach a copy of federal Form 4852 to Form CT-4852. Keep those documents with Form CT-4852 in your tax records unless DRS asks you to provide them.
Why does the Form CT-4852 PDF show an older revision year?
Some Connecticut forms are not revised every year. Connecticut DRS continues to publish Form CT-4852 from the current individual income tax forms page, and the PDF includes a write-in year field for the applicable tax year.
Last updated: August 1, 2026
References:
- Form CT-4852 Substitute for Form W-2 or Form 1099-R. State of Connecticut, Connecticut Department of Revenue. Retrieved August 1, 2026.
- Individual Income Tax Forms. State of Connecticut, Connecticut Department of Revenue. Retrieved August 1, 2026.
- Connecticut Resident, Part-Year Resident, and Nonresident Tax Information. State of Connecticut, Connecticut Department of Revenue. Retrieved August 1, 2026.
- About Form 4852, Substitute for Form W-2, Wage and Tax Statement, or Form 1099-R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.. Internal Revenue Service. Retrieved August 1, 2026.