Fillable Printable Form W-4V
Fillable Printable Form W-4V
Form W-4V
Form W-4V
(Rev. August 2014)
Department of the Treasury
Internal Revenue Service
Voluntary Withholding Request
(For unemployment compensation and certain federal government and other payments.)
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Information about Form W-4V is at www.irs.gov/w4v.
Instructions
Purpose of Form
If you receive any government payment shown below, you may use
Form W-4V to ask the payer to withhold federal income tax.
• Unemployment compensation (including Railroad Unemployment
Insurance Act (RUIA) payments).
• Social security benefits.
• Social security equivalent Tier 1 railroad retirement benefits.
• Commodity Credit Corporation loans.
• Certain crop disaster payments under the Agricultural Act of 1949 or
under Title II of the Disaster Assistance Act of 1988.
• Dividends and other distributions from Alaska Native Corporations
to its shareholders.
Consult your payer if you are uncertain whether your payment is
eligible for voluntary withholding.
You are not required to have federal income tax withheld from these
payments. Your request is voluntary.
Note. Payers may develop their own form for you to request federal
income tax withholding. If a payer gives you its own form instead of
Form W-4V, use that form.
Why Should I Request Withholding?
You may find that having federal income tax withheld from the listed
payments is more convenient than making quarterly estimated tax
payments. However, if you have other income that is not subject to
withholding, consider making estimated tax payments. For more details,
see Form 1040-ES, Estimated Tax for Individuals.
How Much Can I Have Withheld?
For unemployment compensation, the payer is permitted to withhold
10% from each payment. No other percentage or amount is allowed.
For any other government payment listed above, you may choose to
have the payer withhold federal income tax of 7%, 10%, 15%, or 25%
from each payment, but no other percentage or amount.
What Do I Need To Do?
Complete lines 1 through 4; check one box on line 5, 6, or 7; sign Form
W-4V; and give it to the payer, not to the IRS.
Note. For withholding on social security benefits, give or send the
completed Form W-4V to your local Social Security Administration
office.
Line 3. If your address is outside the United States or the U.S.
possessions, enter on line 3 the city, province or state, and name of the
country. Follow the country’s practice for entering the postal code. Do
not abbreviate the country name.
Line 4. Enter the claim or identification number you use with your payer.
For withholding from social security benefits, the claim number is the
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
letter/number combination suffix that follows the claim number identifies
the type of benefit (for example, a wage earner, a spouse, or a
widow(er)). The claim number may or may not be your own social
security number. If you are unsure about what number to use, contact
the Social Security Administration at 1-800-772-1213 (toll-free). For
other government payments, consult your payer for the correct claim or
identification number format.
Line 5. If you want federal income tax withheld from your
unemployment compensation, check the box on line 5. The payer will
withhold 10% from each payment.
Line 6. If you receive any of the payments listed on line 6, check the box
to indicate the percentage (7%, 10%, 15%, or 25%) you want withheld
from each payment.
Line 7. See How Do I Stop Withholding? below.
Sign this form. Form W-4V is not considered valid unless you sign it.
When Will My Withholding Start?
Ask your payer exactly when income tax withholding will begin. The
federal income tax withholding you choose on this form will remain in
effect until you change or stop it or the payments stop.
How Do I Change Withholding?
If you are getting a payment other than unemployment compensation
and want to change your withholding rate, complete a new Form W-4V.
Give the new form to the payer.
How Do I Stop Withholding?
If you want to stop withholding, complete a new Form W-4V. After
completing lines 1 through 4, check the box on line 7, and sign and date
the form; then give the new form to the payer.
Separate here
Form W-4V
(Rev. August 2014)
Department of the Treasury
Internal Revenue Service
Voluntary Withholding Request
(For unemployment compensation and certain federal government and other payments.)
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Give this form to your payer. Do not send it to the IRS.
OMB No. 1545-0074
1 Your first name and middle initial Last name 2 Your social security number
3 Home address (number and street or rural route) City or town State ZIP code
4 Claim or identification number (if any) you use with your payer
5 I want federal income tax withheld from my unemployment compensation at a rate of 10% of each payment.
6
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):
7% 10% 15% 25%
7 I want you to stop withholding federal income tax from my payment(s).
Your signature
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Date
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For Privacy Act and Paperwork Reduction Act Notice, see page 2.
Cat. No. 22891V
Form W-4V (Rev. 08-2014)
Form W-4V (Rev. 08-2014)
Page 2
Privacy Act and Paperwork Reduction Act
Notice
We ask for the information on Form W-4V to carry out the Internal
Revenue laws of the United States. You are required to provide this
information only if you wish to have federal income tax withheld from
certain payments for which withholding is not required by law. If you
choose to request voluntary withholding of federal income tax, you are
required by Internal Revenue Code sections 3402(p) and 6109 and their
regulations to provide the information requested on this form. If you do
not provide a completed form that is signed, the payer cannot withhold
federal income tax from your payment. Providing false or fraudulent
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.
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
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.
