W-4 Federal Tax Withholding Form

Employee federal tax withholding form for collecting filing status, dependents, additional withholding, and signature information.

Employee Information

• Full Name
• Employee ID
• Home Address
• SSN Last 4 Digits
  Only collect if needed by your payroll process. Do not enter a full SSN.

Federal Withholding Election

• Filing Status
• Do you have multiple jobs or does your spouse work?
• Total Credit for Dependents
  Enter the total amount of dependent credit you are claiming, if any.
• Other Income
  Enter additional income amount, if you want extra withholding based on other income.
• Deductions
  Enter deduction amount, if applicable.
• Extra Withholding per Pay Period
  Enter any additional amount you want withheld from each paycheck.

Employee Certification

• I certify that the information provided is true, correct, and complete to the best of my knowledge.
• Employee Signature
• Date Signed