W-4 Federal Tax Withholding Form

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

Employee Information

• Full Name
• Employee ID
• Work Email
  Optional. Used only if payroll needs to contact you about this form.

Federal Withholding Election

• Federal Filing Status
• Do you have multiple jobs or is your spouse employed?
  If yes, additional withholding may be appropriate based on your tax situation.
• Claim exemption from federal income tax withholding
  Only select if you meet IRS exemption requirements.

Dependents and Credits

• Number of Qualifying Dependents
  Enter the number of qualifying dependents you are claiming.
• Other Dependents or Credits Amount
  Enter the total amount of other credits, if applicable.

Additional Withholding Adjustments

• Additional Federal Tax Withholding per Pay Period
  Enter an additional dollar amount to withhold from each paycheck.
• Other Adjustments or Notes
  Optional. Add any payroll notes relevant to your withholding election.

Employee Certification

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