IRS Form W-4S 2019 Request for Federal Income Tax Withholding From Sick Pay

IRS Form W-4S is a U.S. Department of the Treasury - Internal Revenue Service - issued form also known as the "Request For Federal Income Tax Withholding From Sick Pay".

A PDF of the latest IRS Form W-4S can be downloaded below or found on the U.S. Department of the Treasury - Internal Revenue Service Forms and Publications website.

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W-4S
Request for Federal Income Tax
OMB No. 1545-0074
Withholding From Sick Pay
Form
2019
Give this form to the third-party payer of your sick pay.
Department of the Treasury
Go to www.irs.gov/FormW4S for the latest information.
Internal Revenue Service
Type or print your first name and middle initial
Last name
Your social security number
Home address (number and street or rural route)
City or town, state, and ZIP code
Claim or identification number (if any) .
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I request federal income tax withholding from my sick pay payments. I want the following amount to be
$
withheld from each payment. (See Worksheet below.)
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Employee’s signature
Date
Separate here and give the top part of this form to the payer. Keep the lower part for your records.
Worksheet (Keep for your records. Do not send to the Internal Revenue Service.)
1 Enter amount of adjusted gross income that you expect in 2019
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1
2 If you plan to itemize deductions on Schedule A (Form 1040), enter the estimated total of your
deductions. See Pub. 505 for details. If you don’t plan to itemize deductions, enter the standard
deduction. (See the instructions on page 2 for the standard deduction amount, including additional
standard deductions for age and blindness.) Note: There is no deduction for personal exemptions
for 2019 .
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2
3 Subtract line 2 from line 1 .
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3
4 Tax. Figure your tax on line 3 by using the 2019 Tax Rate Schedule X, Y-1, Y-2, or Z on page 2. Do
not use any tax tables, worksheets, or schedules in the 2018 Form 1040 instructions
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4
5 Credits (child tax and higher education credits, credit for child and dependent care expenses, etc.) .
5
6 Subtract line 5 from line 4 .
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6
7 Estimated federal income tax withheld or to be withheld from other sources (including amounts
withheld due to a prior Form W-4S) during 2019 or paid or to be paid with 2019 estimated tax
payments
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7
8 Subtract line 7 from line 6 .
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9 Enter the number of sick pay payments you expect to receive this year to which this Form W-4S will
apply .
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9
10 Divide line 8 by line 9. Round to the nearest dollar. This is the amount that should be withheld from
each sick pay payment. Be sure it meets the requirements for the amount that should be withheld,
as explained under Amount to be withheld below. If it does, enter this amount on Form W-4S above
10
General Instructions
• Must not reduce the net amount of each sick pay payment that
you receive to less than $10.
Purpose of form. Give this form to the third-party payer of your sick
For payments larger or smaller than a regular full payment of sick
pay, such as an insurance company, if you want federal income tax
pay, the amount withheld will be in the same proportion as your
withheld from the payments. You aren’t required to have federal
regular withholding from sick pay. For example, if your regular full
income tax withheld from sick pay paid by a third party. However, if
payment of $100 a week normally has $25 (25%) withheld, then $20
you choose to request such withholding, Internal Revenue Code
(25%) will be withheld from a partial payment of $80.
sections 3402(o) and 6109 and their regulations require you to
Caution: You may be subject to a penalty if your tax payments
provide the information requested on this form. Don’t use this form if
during the year aren’t at least 90% of the tax shown on your tax
your employer (or its agent) makes the payments because employers
return. For exceptions and details, see Pub. 505, Tax Withholding
are already required to withhold federal income tax from sick pay.
and Estimated Tax. You may pay tax during the year through
Note: If you receive sick pay under a collective bargaining
withholding or estimated tax payments or both. To avoid a penalty,
agreement, see your union representative or employer.
make sure that you have enough tax withheld or make estimated
Definition. Sick pay is a payment that you receive:
tax payments using Form 1040-ES, Estimated Tax for Individuals.
You may estimate your federal income tax liability by using the
• Under a plan to which your employer is a party, and
worksheet above.
• In place of wages for any period when you’re temporarily absent
Sign this form. Form W-4S is not valid unless you sign it.
from work because of your sickness or injury.
Statement of income tax withheld. After the end of the year, you’ll
Amount to be withheld. Enter on this form the amount that you
receive a Form W-2, Wage and Tax Statement, reporting the taxable
want withheld from each payment. The amount that you enter:
sick pay paid and federal income tax withheld during the year.
• Must be in whole dollars (for example, $35, not $34.50).
These amounts are reported to the Internal Revenue Service.
• Must be at least $4 per day, $20 per week, or $88 per month
(continued on back)
based on your payroll period.
W-4S
For Paperwork Reduction Act Notice, see page 2.
Form
(2019)
Cat. No. 10226E
W-4S
Request for Federal Income Tax
OMB No. 1545-0074
Withholding From Sick Pay
Form
2019
Give this form to the third-party payer of your sick pay.
Department of the Treasury
Go to www.irs.gov/FormW4S for the latest information.
Internal Revenue Service
Type or print your first name and middle initial
Last name
Your social security number
Home address (number and street or rural route)
City or town, state, and ZIP code
Claim or identification number (if any) .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
I request federal income tax withholding from my sick pay payments. I want the following amount to be
$
withheld from each payment. (See Worksheet below.)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Employee’s signature
Date
Separate here and give the top part of this form to the payer. Keep the lower part for your records.
Worksheet (Keep for your records. Do not send to the Internal Revenue Service.)
1 Enter amount of adjusted gross income that you expect in 2019
.
.
.
.
.
.
.
.
.
.
.
.
1
2 If you plan to itemize deductions on Schedule A (Form 1040), enter the estimated total of your
deductions. See Pub. 505 for details. If you don’t plan to itemize deductions, enter the standard
deduction. (See the instructions on page 2 for the standard deduction amount, including additional
standard deductions for age and blindness.) Note: There is no deduction for personal exemptions
for 2019 .
.
.
.
.
.
.
.
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.
.
.
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2
3 Subtract line 2 from line 1 .
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.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
3
4 Tax. Figure your tax on line 3 by using the 2019 Tax Rate Schedule X, Y-1, Y-2, or Z on page 2. Do
not use any tax tables, worksheets, or schedules in the 2018 Form 1040 instructions
.
.
.
.
.
4
5 Credits (child tax and higher education credits, credit for child and dependent care expenses, etc.) .
5
6 Subtract line 5 from line 4 .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
6
7 Estimated federal income tax withheld or to be withheld from other sources (including amounts
withheld due to a prior Form W-4S) during 2019 or paid or to be paid with 2019 estimated tax
payments
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
7
8 Subtract line 7 from line 6 .
8
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
9 Enter the number of sick pay payments you expect to receive this year to which this Form W-4S will
apply .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
9
10 Divide line 8 by line 9. Round to the nearest dollar. This is the amount that should be withheld from
each sick pay payment. Be sure it meets the requirements for the amount that should be withheld,
as explained under Amount to be withheld below. If it does, enter this amount on Form W-4S above
10
General Instructions
• Must not reduce the net amount of each sick pay payment that
you receive to less than $10.
Purpose of form. Give this form to the third-party payer of your sick
For payments larger or smaller than a regular full payment of sick
pay, such as an insurance company, if you want federal income tax
pay, the amount withheld will be in the same proportion as your
withheld from the payments. You aren’t required to have federal
regular withholding from sick pay. For example, if your regular full
income tax withheld from sick pay paid by a third party. However, if
payment of $100 a week normally has $25 (25%) withheld, then $20
you choose to request such withholding, Internal Revenue Code
(25%) will be withheld from a partial payment of $80.
sections 3402(o) and 6109 and their regulations require you to
Caution: You may be subject to a penalty if your tax payments
provide the information requested on this form. Don’t use this form if
during the year aren’t at least 90% of the tax shown on your tax
your employer (or its agent) makes the payments because employers
return. For exceptions and details, see Pub. 505, Tax Withholding
are already required to withhold federal income tax from sick pay.
and Estimated Tax. You may pay tax during the year through
Note: If you receive sick pay under a collective bargaining
withholding or estimated tax payments or both. To avoid a penalty,
agreement, see your union representative or employer.
make sure that you have enough tax withheld or make estimated
Definition. Sick pay is a payment that you receive:
tax payments using Form 1040-ES, Estimated Tax for Individuals.
You may estimate your federal income tax liability by using the
• Under a plan to which your employer is a party, and
worksheet above.
• In place of wages for any period when you’re temporarily absent
Sign this form. Form W-4S is not valid unless you sign it.
from work because of your sickness or injury.
Statement of income tax withheld. After the end of the year, you’ll
Amount to be withheld. Enter on this form the amount that you
receive a Form W-2, Wage and Tax Statement, reporting the taxable
want withheld from each payment. The amount that you enter:
sick pay paid and federal income tax withheld during the year.
• Must be in whole dollars (for example, $35, not $34.50).
These amounts are reported to the Internal Revenue Service.
• Must be at least $4 per day, $20 per week, or $88 per month
(continued on back)
based on your payroll period.
W-4S
For Paperwork Reduction Act Notice, see page 2.
Form
(2019)
Cat. No. 10226E
2
Form W-4S (2019)
Page
Changing your withholding. Form W-4S remains in effect until you
Additional standard deduction for the elderly or blind. An
change or revoke it. You may do this by giving a new Form W-4S or
additional standard deduction of $1,300 is allowed for a married
a written notice to the payer of your sick pay. To revoke your
individual (filing jointly or separately) or qualifying widow(er) who is
previous Form W-4S, complete a new Form W-4S and write
65 or older or blind, $2,600 if 65 or older and blind. If both spouses
“Revoked” in the money amount box, sign it, and give it to the payer.
are 65 or older or blind, an additional $2,600 is allowed on a joint
return ($2,600 on a separate return if your spouse is your
Specific Instructions for Worksheet
dependent). If both spouses are 65 or older and blind, an additional
$5,200 is allowed on a joint return ($5,200 on a separate return if
You may use the worksheet on page 1 to estimate the amount of
your spouse is your dependent). An additional $1,650 is allowed for
federal income tax that you want withheld from each sick pay
an unmarried individual (single or head of household) who is 65 or
payment. Use your tax return for last year and the worksheet as a
older or blind, $3,300 if 65 or older and blind. See Pub. 505,
basis for estimating your tax, tax credits, and withholding for this year.
Worksheet 2-4.
You may not want to use Form W-4S if you already have your
Limited standard deduction for dependents. If you are a
total tax covered by estimated tax payments or other withholding.
dependent of another person, your standard deduction is the greater
If you expect to file a joint return, be sure to include the income,
of (a) $1,100 or (b) your earned income plus $350 (up to the regular
deductions, credits, and payments of both yourself and your spouse
standard deduction for your filing status). If you’re 65 or older or
in figuring the amount you want withheld.
blind, see Pub. 505 for additional amounts that you may claim.
Caution: If any of the amounts on the worksheet change after you
Certain individuals not eligible for standard deduction. For the
give Form W-4S to the payer, you should use a new Form W-4S to
following individuals, the standard deduction is zero.
request a change in the amount withheld.
• A married individual filing a separate return if either spouse
Line 2—Deductions
itemizes deductions.
Itemized deductions. Itemized deductions include qualifying home
• A nonresident alien individual.
mortgage interest, charitable contributions, state and local taxes (up
• An individual filing a return for a period of less than 12 months
to $10,000), and medical expenses in excess of 10% of your
because of a change in his or her annual accounting period.
adjusted gross income. See Pub. 505 for details.
Line 5—Credits
Standard deduction. For 2019, the standard deduction amounts are:
Include on this line any tax credits that you’re entitled to claim, such
Standard
as the child tax and higher education credits, credit for child and
Filing Status
Deduction
dependent care expenses, earned income credit, or credit for the
Married filing jointly or qualifying widow(er) .
.
.
.
. $24,400*
elderly or the disabled. See Pub. 505, Table 1-2, for credits.
Head of household
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. $18,350*
Line 7—Tax Withholding and Estimated Tax
Single or Married filing separately .
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. $12,200*
Enter the federal income tax that you expect will be withheld this
year on income other than sick pay and any payments made or to
* If you’re age 65 or older or blind, add to the standard deduction
be made with 2019 estimated tax payments. Include any federal
amount the additional amount that applies to you as shown in the next
income tax already withheld or to be withheld from wages and
paragraph. If you can be claimed as a dependent on another person’s
pensions.
return, see Limited standard deduction for dependents, later.
2019 Tax Rate Schedules
Schedule X—Single
Schedule Z—Head of household
If line 3 is:
The tax is:
If line 3 is:
The tax is:
of the
of the
But not
amount
But not
amount
Over—
over—
over—
Over—
over—
over—
$0 + 10%
$0
$0 + 10%
$0
$0
$9,700
$0
$13,850
970.00 + 12%
9,700
1,385 + 12%
13,850
9,700
39,475
13,850
52,850
39,475
84,200
4,543.00 + 22%
39,475
52,850
84,200
6,065 + 22%
52,850
84,200
160,725
14,382.50 + 24%
84,200
84,200
160,700
12,962 + 24%
84,200
32,748.50 + 32%
160,725
31,322 + 32%
160,700
160,725
204,100
160,700
204,100
45,210 + 35%
204,100
204,100
510,300
46,628.50 + 35%
204,100
204,100
510,300
510,300
and greater
153,798.50 + 37%
510,300
510,300
and greater
152,380 + 37%
510,300
Schedule Y-2—Married filing separately
Schedule Y-1—Married filing jointly or Qualifying widow(er)
If line 3 is:
The tax is:
If line 3 is:
The tax is:
of the
of the
But not
amount
But not
amount
Over—
over—
over—
Over—
over—
over—
$0
$19,400
$0 + 10%
$0
$0
$9,700
$0 + 10%
$0
19,400
78,950
1,940 + 12%
19,400
9,700
39,475
970.00 + 12%
9,700
9,086 + 22%
78,950
4,543.00 + 22%
39,475
78,950
168,400
39,475
84,200
168,400
321,450
28,765 + 24%
168,400
84,200
160,725
14,382.50 + 24%
84,200
321,450
408,200
65,497 + 32%
321,450
160,725
204,100
32,748.50 + 32%
160,725
408,200
612,350
93,257 + 35%
408,200
204,100
306,175
46,628.50 + 35%
204,100
164,709.50 + 37%
612,350
82,354.75 + 37%
306,175
612,350
and greater
306,175
and greater
Paperwork Reduction Act Notice. We ask for the information on
law. Generally, tax returns and return information are confidential,
this form to carry out the Internal Revenue laws of the United
as required by Code section 6103.
States.
The average time and expenses required to complete and file this
You are not required to provide the information requested on a
form will vary depending on individual circumstances. For estimated
form that is subject to the Paperwork Reduction Act unless the form
averages, see the instructions for your income tax return.
displays a valid OMB control number. Books or records relating to a
If you have suggestions for making this form simpler, we would
form or its instructions must be retained as long as their contents
be happy to hear from you. See the instructions for your income tax
may become material in the administration of any Internal Revenue
return.

Download IRS Form W-4S 2019 Request for Federal Income Tax Withholding From Sick Pay

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