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Request for Federal Income Tax OMB No. 1545-0074
Form W-4S Withholding From Sick Pay
Department of the Treasury Give this form to the third-party payer of your sick pay.
Internal Revenue Service Go to www.irs.gov/FormW4S for the latest information. 2024
Your first name and middle initial Last name Your social security number

Home address (number and street or rural route)

City or town, state, and ZIP code

Claim or identification number (if any) . . . . . . . . . . . . . . . . . . . . . . . .
I request federal income tax withholding from my sick pay payments. I want the following amount to be
withheld from each payment. (See Worksheet below.) . . . . . . . . . . . . . . . . . . $

Employee’s signature: Date:
Separate here and give the top part of this form to the payer. Keep the lower part for your records.
Worksheet (Keep for your records. Do not send to the IRS.)
1 Enter amount of adjusted gross income that you expect in 2024 . . . . . . . . . . . . . 1
2 If you plan to itemize deductions on Schedule A (Form 1040), enter the estimated total of your deductions.
See Pub. 505 for details. If you don’t plan to itemize deductions, enter the standard deduction. (See the
instructions on page 2 for the standard deduction amount, including additional standard deductions for
age and blindness.) Note: There is no deduction for personal exemptions for 2024 . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Tax. Figure your tax on line 3 by using the 2024 Tax Rate Schedule X, Y-1, Y-2, or Z on page 2. Do not
use any tax tables, worksheets, or schedules in the 2023 Instructions for Form 1040 . . . . . . 4
5 Credits (child tax and higher education credits, credit for child and dependent care expenses, etc.) . . 5
6 Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Estimated federal income tax withheld or to be withheld from other sources (including amounts withheld
due to a prior Form W-4S) during 2024 or paid or to be paid with 2024 estimated tax payments . . . 7
8 Subtract line 7 from line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Enter the number of sick pay payments you expect to receive this year to which this Form W-4S will
apply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Divide line 8 by line 9. Round to the nearest dollar. This is the amount that should be withheld from
each sick pay payment. Be sure it meets the requirements for the amount that should be withheld, as
explained under Amount to be withheld below. If it does, enter this amount on Form W-4S above . . 10
General Instructions For payments larger or smaller than a regular full payment of sick
pay, the amount withheld will be in the same proportion as your
Purpose of form. Give this form to the third-party payer of your sick regular withholding from sick pay. For example, if your regular full
pay, such as an insurance company, if you want federal income tax payment of $100 a week normally has $25 (25%) withheld, then $20
withheld from the payments. You aren’t required to have federal (25%) will be withheld from a partial payment of $80.
income tax withheld from sick pay paid by a third party. However, if
you choose to request such withholding, Internal Revenue Code Caution: You may be subject to a penalty if your tax payments during
sections 3402(o) and 6109 and their regulations require you to the year aren’t at least 90% of the tax shown on your tax return. For
provide the information requested on this form. Don’t use this form if exceptions and details, see Pub. 505, Tax Withholding and Estimated
your employer (or its agent) makes the payments because employers Tax. You may pay tax during the year through withholding or
are already required to withhold federal income tax from sick pay. estimated tax payments or both. To avoid a penalty, make sure that
you have enough tax withheld or make estimated tax payments using
Note: If you receive sick pay under a collective bargaining Form 1040-ES, Estimated Tax for Individuals. You may estimate your
agreement, see your union representative or employer. federal income tax liability by using the worksheet above.
Definition. Sick pay is a payment that you receive: Sign this form. Form W-4S is not valid unless you sign it.
• Under a plan to which your employer is a party, and Statement of income tax withheld. After the end of the year, you’ll
• In place of wages for any period when you’re temporarily absent receive a Form W-2, Wage and Tax Statement, reporting the taxable
from work because of your sickness or injury. sick pay paid and federal income tax withheld during the year.
Amount to be withheld. Enter on this form the amount that you These amounts are reported to the IRS.
want withheld from each payment. The amount that you enter: Changing your withholding. Form W-4S remains in effect until you
• Must be in whole dollars (for example, $35, not $34.50). change or revoke it. You may do this by giving a new Form W-4S or
a written notice to the payer of your sick pay. To revoke your
• Must be at least $4 per day, $20 per week, or $88 per month previous Form W-4S, complete a new Form W-4S and write
based on your payroll period. “Revoked” in the money amount box, sign it, and give it to the payer.
• Must not reduce the net amount of each sick pay payment that (continued on back)
you receive to less than $10.
For Paperwork Reduction Act Notice, see page 2. Cat. No. 10226E Form W-4S (2024)

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Form W-4S (2024) Page 2
Specific Instructions for Worksheet spouses are 65 or older or blind, an additional $3,100 is allowed on
a joint return. If both spouses are 65 or older and blind, an
You may use the worksheet on page 1 to estimate the amount of additional $6,200 is allowed on a joint return. Additional standard
federal income tax that you want withheld from each sick pay deductions are also allowed on your separate return for your spouse
payment. Use your tax return for last year and the worksheet as a who is 65 or older and/or blind if your spouse has no gross income
basis for estimating your tax, tax credits, and withholding for this year. and can’t be claimed as a dependent by another taxpayer. An
You may not want to use Form W-4S if you already have your additional $1,950 is allowed for an unmarried individual (single or
total tax covered by estimated tax payments or other withholding. head of household) who is 65 or older or blind, $3,900 if 65 or older
If you expect to file a joint return, be sure to include the income, and blind. See the 2024 Estimated Tax Worksheet—Line 2
deductions, credits, and payments of both yourself and your spouse Standard Deduction Worksheet in Pub. 505.
in figuring the amount you want withheld. Limited standard deduction for dependents. If you are a
Caution: If any of the amounts on the worksheet change after you dependent of another person, your standard deduction is the greater
give Form W-4S to the payer, you should use a new Form W-4S to of (a) $1,300 or (b) your earned income plus $450 (up to the regular
request a change in the amount withheld. standard deduction for your filing status). If you’re 65 or older or
blind, see Pub. 505 for additional amounts that you may claim.
Line 2—Deductions Certain individuals not eligible for standard deduction. For the
Itemized deductions. Itemized deductions include qualifying home following individuals, the standard deduction is zero.
mortgage interest, charitable contributions, state and local taxes (up • A married individual filing a separate return if either spouse
to $10,000), and medical expenses in excess of 7.5% of your itemizes deductions.
adjusted gross income. See Pub. 505 for details.
• A nonresident alien individual. For exceptions, see Pub. 519, U.S.
Standard deduction.For 2024, the standard deduction amounts are: Tax Guide for Aliens.
Standard • An individual filing a return for a period of less than 12 months
Filing Status Deduction because of a change in his or her annual accounting period.
Married filing jointly or qualifying surviving spouse . . . $29,200*
Head of household . . . . . . . . . . . . $21,900* Line 5—Credits
Single or Married filing separately . . . . . . . . $14,600* Include on this line any tax credits that you’re entitled to claim, such
as the child tax credit and credit for other dependents, higher
* If you’re age 65 or older or blind, add to the standard deduction education credits, credit for child and dependent care expenses,
amount the additional amount that applies to you as shown in the earned income credit, or credit for the elderly or the disabled. See
next paragraph. If you can be claimed as a dependent on another the Tax Credits table in Pub. 505 for more information.
person’s return, see Limited standard deduction for dependents, later.
Line 7—Tax Withholding and Estimated Tax
Additional standard deduction for the elderly or blind. An
additional standard deduction of $1,550 is allowed for a married Enter the federal income tax that you expect will be withheld this
individual (filing jointly or separately) or a qualifying surviving spouse year on income other than sick pay and any payments made or to be
who is 65 or older or blind, $3,100 if 65 or older and blind. If both made with 2024 estimated tax payments. Include any federal income
tax already withheld or to be withheld from wages and pensions.
2024 Tax Rate Schedules
Schedule X—Single Schedule Z—Head of household
If line 3 is: The tax is: of the If line 3 is: The tax is: of the
But not amount But not amount
Over— over— over— Over— over— over—
$0 $11,600 $0 + 10% $0 $0 $16,550 $0 + 10% $0
11,600 47,150 1,160 + 12% 11,600 16,550 63,100 1,655 + 12% 16,550
47,150 100,525 5,426 + 22% 47,150 63,100 100,500 7,241 + 22% 63,100
100,525 191,950 17,168.50 + 24% 100,525 100,500 191,950 15,469 + 24% 100,500
191,950 243,725 39,110.50 + 32% 191,950 191,950 243,700 37,417 + 32% 191,950
243,725 609,350 55,678.50 + 35% 243,725 243,700 609,350 53,977 + 35% 243,700
609,350 and greater 183,647.25 + 37% 609,350 609,350 and greater 181,954.50 + 37% 609,350
Schedule Y-1—Married filing jointly or Schedule Y-2—Married filing separately
Qualifying surviving spouse
If line 3 is: The tax is: of the If line 3 is: The tax is: of the
But not amount But not amount
Over— over— over— Over— over— over—
$0 $23,200 $0 + 10% $0 $0 $11,600 $0 + 10% $0
23,200 94,300 2,320 + 12% 23,200 11,600 47,150 1,160 + 12% 11,600
94,300 201,050 10,852 + 22% 94,300 47,150 100,525 5,426 + 22% 47,150
201,050 383,900 34,337 + 24% 201,050 100,525 191,950 17,168.50 + 24% 100,525
383,900 487,450 78,221 + 32% 383,900 191,950 243,725 39,110.50 + 32% 191,950
487,450 731,200 111,357 + 35% 487,450 243,725 365,600 55,678.50 + 35% 243,725
731,200 and greater 196,669.50 + 37% 731,200 365,600 and greater 98,334.75 + 37% 365,600
Paperwork Reduction Act Notice. We ask for the information on law. Generally, tax returns and return information are confidential,
this form to carry out the Internal Revenue laws of the United States. as required by Code section 6103.
You are not required to provide the information requested on a The average time and expenses required to complete and file this
form that is subject to the Paperwork Reduction Act unless the form form will vary depending on individual circumstances. For estimated
displays a valid OMB control number. Books or records relating to a averages, see the instructions for your income tax return.
form or its instructions must be retained as long as their contents If you have suggestions for making this form simpler, we would be
may become material in the administration of any Internal Revenue happy to hear from you. See the instructions for your income tax return.

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