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Run: W-4 Federal Tax Withholding Form

Use this W-4 Federal Tax Withholding Form to collect an employee’s filing status, dependents, extra withholding, and signed certification in one place. It he...

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Employee Information

Full Name (required)

Employee ID (required)

Work Email

Optional. Used only if payroll needs to contact you about this form.

Federal Withholding Election

Federal Filing Status (required)

Do you have multiple jobs or is your spouse employed? (required)

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.

Yes No N/A

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. (required)

Yes No N/A

Employee Signature (required)

Date Signed (required)

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Email (required)

Your name (optional)

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