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                                                                                                                                                            WT-4
          Employee’s Wisconsin Withholding Exemption Certificate/New Hire Reporting
Employee’s Section (Print clearly)
Employee’s legal name (first name, middle initial, last name)                               Social security number
                                                                                                                                Single
Employee’s address (number and street)                                                      Date of birth                       Married
                                                                                                                                Married, but withhold at higher Single 
                                                                                                                                rate.
City                                             State        Zip code                      Date of hire                        Note:  If married, but legally separated, 
                                                                                                                                check the Single box.
FIGURE YOUR TOTAL WITHHOLDING EXEMPTIONS BELOW
Complete Lines 1 through 3
  1.  (a)  Exemption for yourself – enter 1  .......................................................
    (b)  Exemption for your spouse – enter 1   ...................................................
    (c)  Exemption(s) for dependent(s) – you are entitled to claim an exemption for each dependent   ........
    (d)  Total – add lines (a) through (c)   .......................................................
  2.  Additional amount per pay period you want deducted (if your employer agrees)  ......................
  3.  I claim complete exemption from withholding (see instructions).  Enter “Exempt”  .....................
I CERTIFY that the number of withholding exemptions claimed on this certificate does not exceed the number to which I am entitled.  If claiming complete exemption from 
withholding, I certify that I incurred no liability for Wisconsin income tax for last year and that I anticipate that I will incur no liability for Wisconsin income tax for this year.
Signature                                                                              Date Signed                                                ,

EMPLOYEE INSTRUCTIONS:
WHO MUST COMPLETE: 
  Effective  on  or  after  January  1,  2020,  every  newly‑hired  employee  is         be withheld if you claim every exemption to which you are entitled, you may 
  required to provide a completed Form WT‑4 to each of their employers.                  increase your withholding by claiming a smaller number of exemptions on 
  Form WT‑4 will be used by your employer to determine the amount of                     lines 1(a)‑(c) or you may enter into an agreement with your employer to have 
  Wisconsin income tax to be withheld from your paychecks. If you have                   additional amounts withheld (see instruction for line 2).
  more than one employer, you should claim a smaller number or no ex‑                    (c) Dependents – Those persons who qualify as your dependents for federal 
  emptions on each Form WT‑4 provided to employers other than your                       income tax purposes may also be claimed as dependents for Wisconsin 
  principal employer so that the total amount withheld will be closer to your            purposes.  The term “dependents” does not include you or your spouse.  
  actual income tax liability.                                                           Indicate the number of dependents that you are claiming in the space provided.
  You must complete and provide your employer a new Form WT‑4 within 
  10 days if the number of exemptions previously claimed DECREASES.                    LINE 2: 
  You may complete and provide to your employer a new Form WT‑4 at any                   Additional withholding – If you have claimed “zero” exemptions on line 1, but 
  time if the number of your exemptions INCREASES.                                       still expect to have a balance due on your tax return for the year, you may 
                                                                                         wish to request your employer to withhold an additional amount of tax for each 
  Your employer may also require you to complete this form to report your                pay period. If your employer agrees to this additional withholding, enter the 
  hiring to the Department of Workforce Development.                                     additional amount you want deducted from each of your paychecks on line 2.
UNDER WITHHOLDING:                                                                   LINE 3: 
  If sufficient tax is not withheld from your wages, you may incur additional            Exemption from withholding – You may claim exemption from withholding of 
  interest charges under the tax laws. In general, 90% of the net tax shown              Wisconsin income tax if you had no liability for income tax for last year, and 
  on your income tax return should be withheld.                                          you expect to incur no liability for income tax for this year. You may not claim 
OVER WITHHOLDING:                                                                      exemption if your return shows tax liability before the allowance of any credit 
  If you are using Form WT‑4 to claim the maximum number of exemptions                   for  income  tax  withheld.  If  you  are  exempt,  your  employer  will  not  withhold 
  to which you are entitled and your withholding exceeds your expected                   Wisconsin income tax from your wages.
  income tax liability, you may use Form WT‑4A to minimize the over                      You must revoke this exemption (1) within 10 days from the time you expect 
  withholding.                                                                           to incur income tax liability for the year or (2) on or before December 1 if you 
                                                                                         expect to incur Wisconsin income tax liabilities for the next year. If you want to 
WT-4 Instructions   – Provide your information in the employee section.                  stop or are required to revoke this exemption, you must complete and provide 
LINE 1:                                                                                a new Form WT‑4 to your employer showing the number of withholding exemp‑
  (a)‑(c) Number of exemptions – Do not claim more than the correct number               tions you are entitled to claim. This certificate for exemption from withholding 
  of exemptions. If you expect to owe more income tax for the year than will             will expire on April 30 of next year unless a new Form WT‑4 is completed and 
                                                                                         provided to your employer before that date.

Employer’s Section
Employer’s name                                                                                                                 Federal Employer ID Number

Employer’s payroll address (number and street)                                         City                            State    Zip code

Completed by                                     Title                                 Phone number                    Email
                                                                                       (    )
EMPLOYER INSTRUCTIONS for Department of Revenue:                                       EMPLOYER INSTRUCTIONS for New Hire Reporting:
•  If you do not have a Federal Employer Identification Number (FEIN), contact         •  This  report  contains  the  required  information  for  reporting  a  New  Hire  to 
  the Internal Revenue Service to obtain a FEIN.                                         Wisconsin. If you are reporting new hires electronically, you do not need to 
•  If the employee has claimed more than 10 exemptions OR has claimed com‑               forward a copy of this report to the Department of Workforce Development. 
  plete exemption from withholding and earns more than $200.00 a week or is              Visit https://dwd.wi.gov/uinh/ to report new hires.
  believed to have claimed more exemptions than they are entitled to, mail a           •  If you do not report new hires electronically, mail the original form to the Depart‑
  copy of this certificate to:  Wisconsin Department of Revenue, Audit Bureau,           ment of Workforce Development, New Hire Reporting, PO Box 14431, Madison 
  PO Box 8906, Madison WI  53708 or fax  (608) 267‑0834.                                 WI  53708‑0431 or fax toll free to 1‑800‑277‑8075.
•  Keep a copy of this certificate with your records.  If you have questions about the •  If you have questions about New Hire requirements, call toll free (888) 300‑HIRE 
  Department of Revenue requirements, call (608) 266‑2772 or (608) 266‑2776.             (888‑300‑4473).  Visit dwd.wi.gov/uinh/ for more information.
W‑204 (R. 7‑22)                                                                                                                             Wisconsin Department of Revenue



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                                            Applicable Laws and Rules
This document provides statements or interpretations of the following laws and regulations enacted as of July 5, 2022: 
sec. 71.66, Wis. Stats., and sec. Tax 2.92, Wis. Adm. Code.

The address will be displayed appropriately in a left window envelope.

DEPARTMENT OF WORKFORCE DEVELOPMENT
NEW HIRE REPORTING
PO BOX 14431
MADISON WI  53708-0431






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