Federal Free Printable 2017 Form W-4S for 2017 Federal Request for Federal Income Tax Withholding From Sick Pay

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Request for Federal Income Tax Withholding From Sick Pay
2017 Form W-4S

Form W-4S Request for Federal Income Tax Withholding From Sick Pay OMB No. 1545-0074 2017 ▶ Give this form to the third-party payer of your sick pay. Department of the Treasury ▶ Information about Form W-4S is available at www.irs.gov/w4s. 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 2017 . . . . . . . . . . . . . . . 2 If you plan to itemize deductions on Schedule A (Form 1040), enter the estimated total of your deductions. For 2017, you may have to reduce your itemized deductions if your income is over $313,800 and you’re married filing jointly or you’re a qualifying widow(er); $287,650 if you’re head of household; $261,500 if you’re single, not head of household and not a qualifying widow(er); or $156,900 if you’re married filing separately. 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 amounts for age and blindness.) . . . . . . . 1 3 Subtract line 2 from line 1 . . . . . . . . . . . . . 4 Exemptions. Multiply $4,050 by the number of personal exemptions . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 4 5 Subtract line 4 from line 3 . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 6 Tax. Figure your tax on line 5 by using the 2017 Tax Rate Schedule X, Y, or Z on page 2. Don’t use the Tax Table or Tax Rate Schedule X, Y, or Z in the 2016 Form 1040, 1040A, or 1040EZ instructions . . . . . . . . 6 7 Credits (child tax and higher education credits, credit for child and dependent care expenses, etc.) 8 Subtract line 7 from line 6 . . . . . . . . . . . . . . . . . . . . . . 7 8 . . . . . . . . 9 Estimated federal income tax withheld or to be withheld from other sources (including amounts withheld due to a prior Form W-4S) during 2017 or paid or to be paid with 2017 estimated tax payments . . . . . . . . 10 Subtract line 9 from line 8 . . . . . . . . . . . . . . . . . . . . . . . . 11 Enter the number of sick pay payments you expect to receive this year to which this Form W-4S will apply . . . . 12 Divide line 10 by line 11. 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 . . . . . . . . . . General Instructions Purpose of form. Give this form to the third-party payer of your sick pay, such as an insurance company, if you want federal income tax withheld from the payments. You aren’t required to have federal income tax withheld from sick pay paid by a third party. However, if you choose to request such withholding, Internal Revenue Code sections 3402(o) and 6109 and their regulations require you to provide the information requested on this form. Don’t use this form if your employer (or its agent) makes the payments because employers are already required to withhold federal income tax from sick pay. Note: If you receive sick pay under a collective bargaining agreement, see your union representative or employer. Definition. Sick pay is a payment that you receive: • Under a plan to which your employer is a party, and • In place of wages for any period when you’re temporarily absent from work because of your sickness or injury. Amount to be withheld. Enter on this form the amount that you want withheld from each payment. The amount that you enter: • Must be in whole dollars (for example, $35, not $34.50). • Must be at least $4 per day, $20 per week, or $88 per month based on your payroll period. For Paperwork Reduction Act Notice, see page 2. 9 10 11 12 • Must not reduce the net amount of each sick pay payment that you receive to less than $10. For payments larger or smaller than a regular full payment of sick pay, the amount withheld will be in the same proportion as your regular withholding from sick pay. For example, if your regular full payment of $100 a week normally has $25 (25%) withheld, then $20 (25%) will be withheld from a partial payment of $80. Caution: You may be subject to a penalty if your tax payments during the year aren’t at least 90% of the tax shown on your tax return. For exceptions and details, see Pub. 505, Tax Withholding and Estimated Tax. You may pay tax during the year through withholding or estimated tax payments or both. To avoid a penalty, make sure that you have enough tax withheld or make estimated tax payments using Form 1040-ES, Estimated Tax for Individuals. You may estimate your federal income tax liability by using the worksheet above. Sign this form. Form W-4S is not valid unless you sign it. Statement of income tax withheld. After the end of the year, you’ll receive a Form W-2, Wage and Tax Statement, reporting the taxable sick pay paid and federal income tax withheld during the year. These amounts are reported to the Internal Revenue Service. (continued on back) Cat. No. 10226E Form W-4S (2017) Page 2 Form W-4S (2017) Changing your withholding. Form W-4S remains in effect until you change or revoke it. You may do this by giving a new Form W-4S or a written notice to the payer of your sick pay. To revoke your previous Form W-4S, complete a new Form W-4S and write “Revoked” in the money amount box, sign it, and give it to the payer. Specific Instructions for Worksheet You may use the worksheet on page 1 to estimate the amount of federal income tax that you want withheld from each sick pay payment. Use your tax return for last year and the worksheet as a basis for estimating your tax, tax credits, and withholding for this year. You may not want to use Form W-4S if you already have your total tax covered by estimated tax payments or other withholding. If you expect to file a joint return, be sure to include the income, deductions, credits, and payments of both yourself and your spouse in figuring the amount you want withheld. Caution: If any of the amounts on the worksheet change after you give Form W-4S to the payer, you should use a new Form W-4S to request a change in the amount withheld. Line 2—Deductions Itemized deductions. For 2017, you may have to reduce your itemized deductions if your income is over $313,800 and you’re married filing jointly or you’re a qualifying widow(er); $287,650 if you’re head of household; $261,500 if you’re single, not head of household and not a qualifying widow(er); or $156,900 if you’re married filing separately. See Pub. 505 for details. Standard deduction. For 2017, the standard deduction amounts are: Standard Filing Status Deduction Married filing jointly or qualifying widow(er) . . . . . . $12,700* Head of household . . . . . . . . . . . . . $9,350* Single or Married filing separately . . . . . . . . $6,350* *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 next paragraph. If you can be claimed as a dependent on another person’s return, see Limited standard deduction for dependents, later. Additional amount for the elderly or blind. An additional standard deduction of $1,250 is allowed for a married individual (filing jointly or separately) or qualifying widow(er) who is 65 or older or blind, $2,500 if 65 or older and blind. If both spouses are 65 or older or blind, an additional $2,500 is allowed on a joint return ($2,500 on a separate return if you can claim an exemption for your spouse). If both spouses are 65 or older and blind, an additional $5,000 is allowed on a joint return ($5,000 on a separate return if you can claim an exemption for your spouse). An additional $1,550 is allowed for an unmarried individual (single or head of household) who is 65 or older or blind, $3,100 if 65 or older and blind. Limited standard deduction for dependents. If you can be claimed as a dependent on another person’s return, your standard deduction is the greater of (a) $1,050 or (b) your earned income plus $350 (up to the regular standard deduction for your filing status). If you’re 65 or older or blind, see Pub. 505 for additional amounts that you may claim. Certain individuals not eligible for standard deduction. For the following individuals, the standard deduction is zero. • A married individual filing a separate return if either spouse itemizes deductions. • A nonresident alien individual. • An individual filing a return for a period of less than 12 months because of a change in his or her annual accounting period. Line 7—Credits Include on this line any tax credits that you’re entitled to claim, such as the child tax and higher education credits, credit for child and dependent care expenses, earned income credit, or credit for the elderly or the disabled. Line 9—Tax Withholding and Estimated Tax 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 be made with 2017 estimated tax payments. Include any federal income tax already withheld or to be withheld from wages and pensions. 2017 Tax Rate Schedules Schedule X—Single If line 5 is: Over— $0 9,325 37,950 91,900 191,650 416,700 418,400 But not over— $9,325 37,950 91,900 191,650 416,700 418,400 and greater Schedule Z—Head of household The tax is: $0 + 10% 932.50 + 15% 5,226.25 + 25% 18,713.75 + 28% 46,643.75 + 33% 120,910.25 + 35% 121,505.25 + 39.6% of the amount over— If line 5 is: Over— $0 9,325 37,950 91,900 191,650 416,700 418,400 $0 13,350 50,800 131,200 212,500 416,700 444,550 But not over— $13,350 50,800 131,200 212,500 416,700 444,550 and greater The tax is: $0 + 10% 1,335 + 15% 6,952.50 + 25% 27,052.50 + 28% 49,816.50 + 33% 117,202.50 + 35% 126,950 + 39.6% of the amount over— $0 13,350 50,800 131,200 212,500 416,700 444,550 Schedule Y-1—Married filing jointly or Qualifying widow(er) Schedule Y-2—Married filing separately If line 5 is: If line 5 is: Over— $0 18,650 75,900 153,100 233,350 416,700 470,700 But not over— $18,650 75,900 153,100 233,350 416,700 470,700 and greater The tax is: $0 + 10% 1,865 + 15% 10,452.50 + 25% 29,752.50 + 28% 52,222.50 + 33% 112,728 + 35% 131,628 + 39.6% of the amount over— $0 18,650 75,900 153,100 233,350 416,700 470,700 Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax Over— But not over— The tax is: of the amount over— $0 9,325 37,950 76,550 116,675 208,350 $9,325 37,950 76,550 116,675 208,350 235,350 $0 + 10% 932.50 + 15% 5,226.25 + 25% 14,876.25 + 28% 26,111.25 + 33% 56,364 + 35% $0 9,325 37,950 76,550 116,675 208,350 235,350 and greater 65,814 + 39.6% 235,350 returns and return information are confidential, as required by Code section 6103. The average time and expenses required to complete and file this form will vary depending on individual circumstances. For estimated averages, see the instructions for your income tax return. If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return.
Extracted from PDF file 2016-federal-form-w-4s.pdf, last modified December 2016

More about the Federal Form W-4S Other TY 2016

We last updated the Request for Federal Income Tax Withholding From Sick Pay in May 2017, so this is the latest version of Form W-4S, fully updated for tax year 2016. You can download or print current or past-year PDFs of Form W-4S directly from TaxFormFinder. You can print other Federal tax forms here.

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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form W-4S from the Internal Revenue Service in May 2017.

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Historical Past-Year Versions of Federal Form W-4S

We have a total of six past-year versions of Form W-4S in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2016 Form W-4S

2017 Form W-4S

Request for Federal Income Tax Withholding From Sick Pay 2015 Form W-4S

2016 Form W-4S

Request for Federal Income Tax Withholding From Sick Pay 2014 Form W-4S

2015 Form W-4S

Request for Federal Income Tax Withholding From Sick Pay 2013 Form W-4S

2013 Form W-4S

Request for Federal Income Tax Withholding From Sick Pay 2012 Form W-4S

2013 Form W-4S

Request for Federal Income Tax Withholding From Sick Pay 2011 Form W-4S

2012 Form W-4S


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