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

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Download this version of IRS Form W-4S for the current year.

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  • Actual and valid for filing 2022 taxes;
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W-4S
Request for Federal Income Tax
OMB No. 1545-0074
Withholding From Sick Pay
Form
2021
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
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 IRS.)
1 Enter amount of adjusted gross income that you expect in 2021
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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
2021 .
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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 2021 Tax Rate Schedule X, Y-1, Y-2, or Z on page 2. Do not
use any tax tables, worksheets, or schedules in the 2020 Instructions for Forms 1040 and 1040-SR
.
4
5 Credits (child tax and higher education credits, credit for child and dependent care expenses, etc.) .
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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 2021 or paid or to be paid with 2021 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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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 IRS.
• 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
(2021)
Cat. No. 10226E
W-4S
Request for Federal Income Tax
OMB No. 1545-0074
Withholding From Sick Pay
Form
2021
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
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 IRS.)
1 Enter amount of adjusted gross income that you expect in 2021
.
.
.
.
.
.
.
.
.
.
.
.
.
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
2021 .
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.
.
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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 2021 Tax Rate Schedule X, Y-1, Y-2, or Z on page 2. Do not
use any tax tables, worksheets, or schedules in the 2020 Instructions for Forms 1040 and 1040-SR
.
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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.
.
.
.
.
.
.
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.
.
.
.
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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 2021 or paid or to be paid with 2021 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 IRS.
• 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
(2021)
Cat. No. 10226E
2
Form W-4S (2021)
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 $1,350 is allowed for a married
a written notice to the payer of your sick pay. To revoke your
individual (filing jointly or separately) or a qualifying widow(er) who is
previous Form W-4S, complete a new Form W-4S and write
65 or older or blind, $2,700 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 $2,700 is allowed on a joint
return. If both spouses are 65 or older and blind, an additional $5,400
Specific Instructions for Worksheet
is allowed on a joint return. Additional standard deductions are also
allowed on your separate return for your spouse who is 65 or older
You may use the worksheet on page 1 to estimate the amount of
and/or blind if your spouse has no gross income and can’t be claimed
federal income tax that you want withheld from each sick pay
as a dependent by another taxpayer. An additional $1,700 is allowed
payment. Use your tax return for last year and the worksheet as a
for an unmarried individual (single or head of household) who is 65 or
basis for estimating your tax, tax credits, and withholding for this
older or blind, $3,400 if 65 or older and blind. See the 2021 Estimated
year.
Tax Worksheet—Line 2 Standard Deduction Worksheet in Pub. 505.
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. For exceptions, see Pub. 519, U.S.
mortgage interest, charitable contributions, state and local taxes (up
Tax Guide for Aliens.
to $10,000), and medical expenses in excess of 7.5% of your
• An individual filing a return for a period of less than 12 months
adjusted gross income. See Pub. 505 for details.
because of a change in his or her annual accounting period.
Standard deduction. For 2021, the standard deduction amounts are:
Line 5—Credits
Standard
Include on this line any tax credits that you’re entitled to claim, such
Filing Status
Deduction
as the child tax credit and credit for other dependents, higher
Married filing jointly or qualifying widow(er) .
.
.
.
. $25,100*
education credits, credit for child and dependent care expenses,
earned income credit, or credit for the elderly or the disabled. See
Head of household
.
.
.
.
.
.
.
.
.
.
.
. $18,800*
the Tax Credits table in Pub. 505 for more information.
Single or Married filing separately .
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.
.
.
.
.
. $12,550*
Line 7—Tax Withholding and Estimated Tax
* If you’re age 65 or older or blind, add to the standard deduction
amount the additional amount that applies to you as shown in the
Enter the federal income tax that you expect will be withheld this
next paragraph. If you can be claimed as a dependent on another
year on income other than sick pay and any payments made or to be
person’s return, see Limited standard deduction for dependents,
made with 2021 estimated tax payments. Include any federal income
later.
tax already withheld or to be withheld from wages and pensions.
2021 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
$9,950
$0
$14,200
9,950
40,525
995 + 12%
9,950
14,200
54,200
1,420 + 12%
14,200
40,525
86,375
4,664 + 22%
40,525
54,200
86,350
6,220 + 22%
54,200
86,375
164,925
14,751 + 24%
86,375
86,350
164,900
13,293 + 24%
86,350
164,925
209,425
33,603 + 32%
164,925
164,900
209,400
32,145 + 32%
164,900
47,843 + 35%
209,425
46,385 + 35%
209,400
209,425
523,600
209,400
523,600
523,600
and greater
157,804.25 + 37%
523,600
523,600
and greater
156,355 + 37%
523,600
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
$19,900
$0 + 10%
$0
$0
$9,950
$0 + 10%
$0
1,990 + 12%
19,900
995 + 12%
9,950
19,900
81,050
9,950
40,525
81,050
172,750
9,328 + 22%
81,050
40,525
86,375
4,664 + 22%
40,525
29,502 + 24%
172,750
14,751 + 24%
86,375
172,750
329,850
86,375
164,925
329,850
418,850
67,206 + 32%
329,850
164,925
209,425
33,603 + 32%
164,925
418,850
628,300
95,686 + 35%
418,850
209,425
314,150
47,843 + 35%
209,425
628,300
and greater
168,993.50 + 37%
628,300
314,150
and greater
84,496.75 + 37%
314,150
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 States.
as required by Code section 6103.
You are not required to provide the information requested on a
The average time and expenses required to complete and file this
form that is subject to the Paperwork Reduction Act unless the form
form will vary depending on individual circumstances. For estimated
displays a valid OMB control number. Books or records relating to a
averages, see the instructions for your income tax return.
form or its instructions must be retained as long as their contents
If you have suggestions for making this form simpler, we would be
may become material in the administration of any Internal Revenue
happy to hear from you. See the instructions for your income tax return.
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