Form W-4

Step 1 of 2

User Email*
Employer Information
Employer Name*
First
Employer Address*
Street Address City State / Province / Region ZIP / Postal Code
Employer's Tax Id (EIN)*

Employee Information
Employee Name*
First Last
Employee Address*
Street Address City State / Province / Region ZIP / Postal Code
SSN*
First Date of Employment*
MM slash DD slash YYYY
Marital Status*
- Single
- Married
- Married, but filing separately
- Head of household
Claim Dependents
Number of Children Under Age 17
Number of Other Dependents
Claim Deductions
Other Income (Not From This Job)
If the you want tax withheld for any other income you expect this year, enter the amount here.
Extra Withholding
If you want additional tax withheld each pay period (paycheck), enter the amount here.
Claimed Deductions*
- Standard Deduction
- Other
You can choose to take the standard deduction or enter the total amount of itemized deductions you expect to claim this year.

FormW-4

(Rev. December 2020) Department of the Treasury Internal Revenue Service

Employee's WIthholdIng Certificate

▶ Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.

▶ Give Form W-4 to your employer.

▶ Your withholding is subject to review by the IRS.

OMB No. 1545-0074

2021

Step 1: Enter Personal Information

(a) First name and middle initial

Last name

(b) Social security number

Address

▶ Does your name match the name on your social security card? If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov.

City or town, state, and ZIP code

(c)	Single or Married filing separately Married filing jointly or Qualifying widow(er) Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)

Form W-4

Step 1 of 2

Employer Information

Employee Information

Claim Dependents

Claim Deductions

Employee's WIthholdIng Certificate

2021

Employee's WIthholdIng Certificate

2021