Form W4

Form W4 - Employee's Withholding Certificate

(Rev. December 2020) Department of the Treasury Internal Revenue Service
Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Your withholding is subject to review by the IRS.
Employee First name and middle initial *
Employee Last name *
Employee Social security number *
*Does your name match the name on your social security card? If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov.
Employee Address *

Street Address

Street Address Line 2

City State

Zip Code
Please select: *

Single or Married filing separately Married filing jointly or Qualifying widow(er) Head of household Check only if you're unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual
Complete Steps 2-4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, when to use the estimator at www.irs.gov/W4App, and privacy.
Step 2: Multiple Jobs or Spouse *

I'll be completing this step as I meet one of the following criteria: (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. I do not need to complete step 2
The correct amount of withholding depends on income earned from all of these jobs.
Which of the following will you do?

(a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3-4); or (b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding (c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld
TIP: To be accurate, submit a 2021 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator.

Complete Steps 3-4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3-4(b) on the Form W-4 for the highest paying job.
Step 3: Claim dependents *

I have dependents to claim and my total income will be $200,000 or less ($400,000 or less if married filing jointly) I will not be claiming dependents
Multiply the number of qualifying children under age 17 by $2,000
Enter the number only.
Multiply the number of other dependents by $500
Enter the number only.
Step 3 total:
Step 4: Other adjustments (optional)

a) Do you have other income (not from jobs) from which you want to withhold tax (examples would be interest, dividends, retirement income)? b) Do you have deductions you expect to claim other than the standard deduction and want to reduce your withholding? c) Do you have any extra withholdings you would like to include?
(a) Other income (not from jobs). If you want tax withheld for other income you expect this year that won't have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income.
Enter number only
(b) Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here.
Enter number only
(c) Extra withholding. Enter any additional tax you want withheld each pay period.
Enter number only
Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.
Employee's signature (This form is not valid unless you sign it.) *

Clear
Date *

Month Day Year
Date
Employer Name *

First Name Last Name
Employer Address *

Street Address

Street Address Line 2

City State

Zip Code
First date of employment *

Month Day Year
Date
Employer identification number (EIN) *
Email where you would like confirmation sent:
example@example.com
Should be Empty:

Form W4 - Employee's Withholding Certificate