IRS Form W4 – Employee Withholding

Employee Name

First Name and Middle Initial

Ex. John H

Last Name

Ex. Smith

Employee Address

Street Address

Ex. 123 Main Street

City, State, and Zip Code

Ex. New York, NY 11354

Filing Status

Employee's Filing Status

Employee's Filing Status Single -OR- Married Filing SeparatelyMarried Filing Jointly -OR- Qualifying Surviving SpouseHead of Household (unmarried and pay more than half of the costs of keeping up a home for yourself and a qualifying child/dependent. Spouses or partners usually do not qualify as dependents.)

SSN/ITIN

Employee's Social Security Number

If you do not have a Social Security Number, enter your ITIN.

Multiple Jobs

Do you have more than 1 job -OR- Are you married filing jointly and your spouse also is employed?

Do you have more than 1 job -OR- Are you married filing jointly and your spouse also is employed? YesNo

Only count the number of jobs with standard employment — where you would submit a W4 and receive a W2.

How many jobs do you have (or do you and your spouse have, if filing jointly)?

How many jobs do you have (or do you and your spouse have, if filing jointly)? There are 2 jobs total.There are MORE than 2 jobs.

Only count the number of jobs with standard employment — where you would submit a W4 and receive a W2.

Is the salary of the lower paying job more than half (50%) the salary of the higher paying job?

Is the salary of the lower paying job more than half (50%) the salary of the higher paying job? YesNo

The IRS recommends that you use the Multiple Jobs Worksheet and enter the result in Extra Withholdings

The IRS recommends that you use the Multiple Jobs Worksheet and enter the result in Extra Withholdings I understand

Access the Multiple Jobs Worksheet on page 3.

Acknowledgement

If you have 2 jobs or your spouse also works and you're married filing jointly, the IRS suggests that you should only complete Dependents, Other Income and Deductions on the W4 for the highest-paying job. If this W4 is not for the highest-paying job, you can skip the next 3 sections at your discretion.

Dependents

Is your total income more than $200,000?

Is your total income more than $200,000? YesNo

Is your total income (including you and your spouse) more than $400,000?

Is your total income (including you and your spouse) more than $400,000? YesNo

The IRS does not allow employees earning more than $200,000 to claim any dependents.

The IRS does not allow employees earning more than $200,000 to claim any dependents. I understand.

The IRS does not allow employees earning more than $400,000 (filing jointly) to claim any dependents.

The IRS does not allow employees earning more than $400,000 (filing jointly) to claim any dependents. I understand.

Do you have any dependents (children or other) to claim?

Do you have any dependents (children or other) to claim? YesNo

Multiply the number of qualifying children under 17 that you will claim as a dependent by $2,000:

$2,000 x (Number of Children) = $(line 3a)

Multiply the number of OTHER qualifying individuals that you will claim as dependents by $500:

$500 x (Number of Other Dependents) = $(line 3b)

This credit can be claimed for:

-Dependents of any age, including those who are age 18 or older.

-Dependents who have Social Security numbers or Individual Taxpayer Identification numbers.

-Dependent parents or other qualifying relatives supported by the taxpayer.

-Dependents living with the taxpayer who aren't related to the taxpayer.

A taxpayer's spouse cannot be claimed as a dependent.

Add up the TOTALS for Children and Other Dependents (above) and enter it here.

(line 3a) + (line 3b) = $

Other Income

Is there any additional income (like retirement, dividends, or interest) that you will make this year?

Is there any additional income (like retirement, dividends, or interest) that you will make this year? YesNo

Do NOT include self-employment income.

Other Income

Do NOT include self-employment income.

Additional Deductions

Do you want to enter any Additional Deductions to REDUCE the amount of tax your employer withholds?

Do you want to enter any Additional Deductions to REDUCE the amount of tax your employer withholds? YesNo

Additional deductions would mean that you itemize deductions and/or have adjustments to income on your tax return which reduce taxes owed. Examples of adjustments to income include student loan interest or deductible IRA contributions.

Additional Deductions

Use these instructions from the IRS to CALCULATE the amount of Additional Deductions:

1. Estimate your 2023 itemized deductions (from Schedule A (Form 1040)). Deductions may include qualifying home mortgage interest, charitable contributions, state and local taxes (up to $10,000), and medical expenses in excess of 7.5% of your income.

$_______________

2. Enter:

$27,700 if you're married filing jointly or a qualifying surviving spouse
$20,800 if you're head of household
$13,850 if you're single or married filing separately

$_______________

3. If #1 is greater than #2, subtract #2 from #1 and list the result. If #2 is greater than #1, this is zero.

$_______________

4. List an estimate of your student loan interest, deductible IRA contributions, and certain other adjustments (from Part II of Schedule 1 (Form 1040)).

$_______________

5. Add lines 3 and 4, and enter the result above.

Extra Withholdings

Do you want to withhold any ADDITIONAL tax from each paycheck?

Do you want to withhold any ADDITIONAL tax from each paycheck? YesNo

Withholding additional tax means your employer reduces your paycheck, and you will either owe less on your return or receive a larger refund at tax time. Taxpayers usually do this if they have other income or self-employment income to offset what they would owe when they file taxes, and they don’t want to make estimated tax payments.

Enter any additional tax that you want withheld during each pay period.

This is the extra amount to be withheld from every paycheck. Consult your employer for pay frequencies.

Signature

Sign your name:

Clear

Please draw your signature.

Signature Date

(Usually today's date)

Instructions

After saving, it is recommended to send a copy to your employer.

After saving, it is recommended to send a copy to your employer. I understand

Save and finish later