Apply In-Person:

1. The applicant has to reach out to Local income tax return for the application. Contact details are mentioned in “Office Locations & Contacts” of this page. Or here is the Contact Link
2. An application form is also available at the following Link
3. The applicant should make sure to carry all the documents that are mentioned under the “Required Documents” section of this page (Both photocopies and originals).
4. Applicant has to fill in all the necessary details in the form and attach the photocopies of the documents that are needed along with the application form before submitting.
5. There is no fee required for this procedure.
6. Concerned authorities will look into the application form and submitted documents before providing the permit.
7. Payment will be provided within 60 days.
8. If the approval has not been given within 60 days, the applicant can visit the office to know status of their application.

• Application form
• The applicant must file (certain Foreign Financial Institutions (FFIs) and U.S. payers that report on Form(s) 1099 to satisfy their Internal Revenue Code chapter 4 reporting requirements).
• Gross distribution (if needed)
• Federal income tax withheld (if needed)
• Employee contributions/ Designated Roth contributions or insurance premiums (if needed)

Customer Support: 866-455-7438 or 304-263-8700
Hearing or speech impairment: 304-579-4827
Contact Link

Note:
Provide the applicant zip code to find nearest local office.

• The plan participant’s death.
• The participant reaches age 59½.
• The participant, if an employee, separates from service.
• The participant, if a self-employed individual, becomes totally and permanently disabled.

• There is no fee required for this procedure.

• Lump sum is a one-time payment so the validity is when the applicant received payment.

• An application form is available at the following Link

Please attach sample completed documents that would help other people.

• Payment will be provided within 60 days.

Videos explaining the procedure or to fill the applications.
Attach videos using the following tag <&video type='website'>video ID|width|height<&/video&>
from external websites.
Please remove the '&' inside the emptags during implementation.
Website = allocine, blip, dailymotion, facebook, gametrailers, googlevideo, html5, metacafe, myspace, revver,
sevenload, viddler, vimeo, youku, youtube
width = 560, height = 340, Video ID = Can be obtained from the URL of webpage where the video is displayed.
e.gIn the following url 'http://www.youtube.com/watch?v=Y0US7oR_t3M' Video ID is 'Y0US7oR_t3M'.

• Instructions for Form Link

The information needed to be filled in the application form are listed below:

• Payer’s name
• Street address
• City or town
• State or province
• Country
• ZIP or foreign postal code
• Telephone no
• Payer’s and Recipient Tin
• Recipient’s Name
• Street address
• Amount allocable to IRR within 5 years
• 1st year of design. Roth contrib.
• Account number
• FATCA filing requirement
• Date of payment
• Gross distribution
• Taxable amount
• Taxable amount not determined
• Total distribution
• Capital gain
• Federal income tax withheld
• Employee contributions/Designated Roth contributions or insurance premiums
• Net unrealized appreciation in employer’s securities
• Distribution code
• State tax withheld
• percentage of total distribution
• Total employee contributions
• State/Payer’s state no
• State distribution
• Local tax withheld
• Name of locality
• Local distribution

• A lump-sum distribution is when a plan participant's entire balance from all of the employer's qualifying plans is distributed or paid to him or her in a single tax year.

• For more information Link

• The Certificate is also uses for:
  • Annuities
  • Retirement
  • Profit-Sharing Plans
  • Individual retirement account
  • Insurance Contracts

Place some external links which might help.

More information which might help people.