Fillable Form W-4v - Voluntary Withholding Request printable pdf download

W-4V

Voluntary Withholding Request

Form

(Rev. August 2014)

(For unemployment compensation and certain federal government and other payments.)

Department of the Treasury

Information about Form W-4V is at

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Internal Revenue Service

Instructions

Note. For withholding on social security benefits, give or send the

completed Form W-4V to your local Social Security Administration

Purpose of Form

office.

Line 3. If your address is outside the United States or the U.S.

If you receive any government payment shown below, you may use

possessions, enter on line 3 the city, province or state, and name of the

Form W-4V to ask the payer to withhold federal income tax.

country. Follow the country’s practice for entering the postal code. Do

• Unemployment compensation (including Railroad Unemployment

not abbreviate the country name.

Insurance Act (RUIA) payments).

Line 4. Enter the claim or identification number you use with your payer.

• Social security benefits.

For withholding from social security benefits, the claim number is the

• Social security equivalent Tier 1 railroad retirement benefits.

social security number under which a claim is filed or benefits are paid

(for example, 123-45-6789A or 123-45-6789B6). The letter or

• Commodity Credit Corporation loans.

letter/number combination suffix that follows the claim number identifies

• Certain crop disaster payments under the Agricultural Act of 1949 or

the type of benefit (for example, a wage earner, a spouse, or a

under Title II of the Disaster Assistance Act of 1988.

widow(er)). The claim number may or may not be your own social

• Dividends and other distributions from Alaska Native Corporations

security number. If you are unsure about what number to use, contact

to its shareholders.

the Social Security Administration at 1-800-772-1213 (toll-free). For

other government payments, consult your payer for the correct claim or

Consult your payer if you are uncertain whether your payment is

identification number format.

eligible for voluntary withholding.

Line 5. If you want federal income tax withheld from your

You are not required to have federal income tax withheld from these

unemployment compensation, check the box on line 5. The payer will

payments. Your request is voluntary.

withhold 10% from each payment.

Note. Payers may develop their own form for you to request federal

Line 6. If you receive any of the payments listed on line 6, check the box

income tax withholding. If a payer gives you its own form instead of

to indicate the percentage (7%, 10%, 15%, or 25%) you want withheld

Form W-4V, use that form.

from each payment.

Why Should I Request Withholding?

Line 7. See How Do I Stop Withholding? below.

You may find that having federal income tax withheld from the listed

Sign this form. Form W-4V is not considered valid unless you sign it.

payments is more convenient than making quarterly estimated tax

payments. However, if you have other income that is not subject to

When Will My Withholding Start?

withholding, consider making estimated tax payments. For more details,

Ask your payer exactly when income tax withholding will begin. The

see Form 1040-ES, Estimated Tax for Individuals.

federal income tax withholding you choose on this form will remain in

How Much Can I Have Withheld?

effect until you change or stop it or the payments stop.

For unemployment compensation, the payer is permitted to withhold

How Do I Change Withholding?

10% from each payment. No other percentage or amount is allowed.

If you are getting a payment other than unemployment compensation

For any other government payment listed above, you may choose to

and want to change your withholding rate, complete a new Form W-4V.

have the payer withhold federal income tax of 7%, 10%, 15%, or 25%

Give the new form to the payer.

from each payment, but no other percentage or amount.

How Do I Stop Withholding?

What Do I Need To Do?

If you want to stop withholding, complete a new Form W-4V. After

Complete lines 1 through 4; check one box on line 5, 6, or 7; sign Form

completing lines 1 through 4, check the box on line 7, and sign and date

W-4V; and give it to the payer, not to the IRS.

the form; then give the new form to the payer.

Separate here

W-4V

Voluntary Withholding Request

Form

OMB No. 1545-0074

(Rev. August 2014)

(For unemployment compensation and certain federal government and other payments.)

Department of the Treasury

Give this form to your payer. Do not send it to the IRS.

Internal Revenue Service

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2 Your social security number

Your first name and middle initial

Last name

Home address (number and street or rural route)

City or town

State

ZIP code

Claim or identification number (if any) you use with your payer

I want federal income tax withheld from my unemployment compensation at a rate of 10% of each payment.

I want federal income tax withheld from (a) my social security benefits, (b) my social security equivalent Tier 1 railroad retirement benefits, (c)

my Commodity Credit Corporation loans, (d) certain crop disaster payments under the Agricultural Act of 1949 or under Title II of the Disaster

Assistance Act of 1988, or (e) dividends and other distributions from Alaska Native Corporations to its shareholders, at the rate of (check one):

10%

15%

25%

I want you to stop withholding federal income tax from my payment(s).

Your signature

Date

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W-4V

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

Form

(Rev. 08-2014)

Cat. No. 22891V

Form W-4v - Voluntary Withholding Request

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