Caregiver W4 & Banking

W4 & Banking Info

Please fill out completely to ensure your enrollment into the family's payroll.
W4 Step 1 - Personal Information
First Name*
Last Name*
Phone Number*
Email Address*
example@example.com
Street Address*
City*
State*
ST
Zip*
Social Security Number*
Date of Birth*

MonthDayYear
Date
Single or Married filing separatelyMarried filing jointly or Qualifying surviving spouseHead of Household
Single
Married
HoH
Filing Status of Caregiver
W4 Step 2 - Multiple Jobs of Spouse Works
Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs.
Do only one of the following.
(a) Reserved for future use.
(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below; or
(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 generally more accurate than (b) if pay at the lower paying job is more than half of the pay at the higher paying job. Otherwise, (b) is more accurate

TIP: If you have self-employment income, see page 2.
2 (c)
2C
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.)
W4 Step 3 - Claim Dependent and Other Credits
ENTER THE # OF CHILDREN / DEPENDENTS BELOW

Do not entere N/A, Names or spell out the names of children/dependents. If you do not have any Dependents you are claiming then enter 0.
# of Children under age 17
# of other dependents 17 or older
Under 17 Calculation
Over 17 Calculation
3 - Dependent Credit Total
The calculation above is derived from each child under age 17 x $2000 plus all dependents 17 and older x $500. You may add to this the amount of any other credits by changing the number above.

If you edit this field, please enter in a TOTAL DEPENDENT AMOUNT and not simply 1, 2, 3. What you are entering here is a $ amount.
W4 Step 4 (optional) - Other Adjustments
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
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
Extra Withholding
Enter any additional tax you want withheld each pay period
BANKING INFO FOR DIRECT DEPOSIT
Full Name*

First NameLast Name
Bank Name
Checking
Savings
Checking Account
Savings Account
Routing #
Account #
If you have multiple accounts you would like to split your payments into, please alert payroll@bubbiecare.com and we can have you set up with the % or amounts for each account.
Should be Empty:

W4 & Banking Info

W4 Step 1 - Personal Information

W4 Step 2 - Multiple Jobs of Spouse Works

W4 Step 3 - Claim Dependent and Other Credits

W4 Step 4 (optional) - Other Adjustments

BANKING INFO FOR DIRECT DEPOSIT