Form W-4v - Voluntary Withholding Request Page 2
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Form W-4V (Rev. 08-2014)
Page
Privacy Act and Paperwork Reduction Act
You are not required to provide the information requested on a form
that is subject to the Paperwork Reduction Act unless the form displays
Notice
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
We ask for the information on Form W-4V to carry out the Internal
material in the administration of any Internal Revenue law. Generally, tax
Revenue laws of the United States. You are required to provide this
returns and return information are confidential, as required by Code
information only if you wish to have federal income tax withheld from
section 6103.
certain payments for which withholding is not required by law. If you
choose to request voluntary withholding of federal income tax, you are
The average time and expenses required to complete and file this
required by Internal Revenue Code sections 3402(p) and 6109 and their
form will vary depending on individual circumstances. For estimated
regulations to provide the information requested on this form. If you do
averages, see the instructions for your income tax return.
not provide a completed form that is signed, the payer cannot withhold
If you have suggestions for making this form simpler, we would be
federal income tax from your payment. Providing false or fraudulent
happy to hear from you. See the instructions for your income tax return.
information may subject you to penalties.
Routine uses of this information include giving it to the Department of
Justice for civil and criminal litigation, and to cities, states, the District of
Columbia, and U.S. commonwealths and possessions for use in
administering their tax laws. We may also disclose this information to
other countries under a tax treaty, to federal and state agencies to
enforce federal non-tax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
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