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Form   W-4V                                      Voluntary Withholding Request 
(Rev. February 2018)
                             (For unemployment compensation and certain Federal Government and other payments.)
Department of the Treasury                     ▶ Go to www.irs.gov/FormW4V for the latest information.
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. 
If you receive any government payment shown below, you may use           Line 3. If your address is outside the United States or the U.S. 
Form W-4V to ask the payer to withhold federal income tax.               possessions, enter on line 3 the city, province or state, and name of the 
• Unemployment compensation (including Railroad Unemployment             country. Follow the country’s practice for entering the postal code. 
Insurance Act (RUIA) payments).                                          Don’t abbreviate the country name. 
• Social security benefits.                                              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 equivalent Tier 1 railroad retirement benefits.        social security number under which a claim is filed or benefits are paid 
• Commodity Credit Corporation loans.                                    (for example, 123-45-6789A or 123-45-6789B6). The letter or          
• Certain crop disaster payments under the Agricultural Act of 1949 or   letter/number combination suffix that follows the claim number identifies 
under Title II of the Disaster Assistance Act of 1988.                   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 
• 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 
Consult your payer if you’re uncertain whether your payment is           other government payments, consult your payer for the correct claim or 
eligible for voluntary withholding.                                      identification number format.
You aren’t required to have federal income tax withheld from these       Line 5. If you want federal income tax withheld from your  
payments. Your request is voluntary.                                     unemployment compensation, check the box on line 5. The payer will 
Note. Payers may develop their own form for you to request federal       withhold 10% from each payment. 
income tax withholding. If a payer gives you its own form instead of     Line 6. If you receive any of the payments listed on line 6, check the box 
Form W-4V, use that form.                                                to indicate the percentage (7%, 10%, 12%, or 22%) you want withheld 
                                                                         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 
payments is more convenient than making quarterly estimated tax          Sign this form. Form W-4V is not considered valid unless you sign it. 
payments. However, if you have other income that isn’t subject to        When Will My Withholding Start? 
withholding, consider making estimated tax payments. For more details, 
see Form 1040-ES, Estimated Tax for Individuals.                         Ask your payer exactly when income tax withholding will begin. The 
                                                                         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%, 12%, or 22%       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 

Form      W-4V                                   Voluntary Withholding Request 
                                                                                                                           OMB No. 1545-0074 
(Rev. February 2018)        (For unemployment compensation and certain Federal Government and other payments.) 
Department of the Treasury  
Internal Revenue Service                     ▶ Give this form to your payer. Do not send it to the IRS. 
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%                12%              22% 

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

Your signature ▶                                                                        Date ▶
For Privacy Act and Paperwork Reduction Act Notice, see page 2.                       Cat. No. 22891V               Form  W-4V  (Rev. 2-2018) 



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Form W-4V (Rev. 2-2018)                                                                                                                      Page  2 
Privacy Act and Paperwork Reduction Act                                           You aren’t 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 
We ask for the information on Form W-4V to carry out the Internal                 instructions must be retained as long as their contents may become 
Revenue laws of the United States. You are required to provide this               material in the administration of any Internal Revenue law. Generally, tax 
information only if you wish to have federal income tax withheld from             returns and return information are confidential, as required by Code 
certain payments for which withholding is not required by law. If you             section 6103. 
choose to request voluntary withholding of federal income tax, you’re             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             averages, see the instructions for your income tax return. 
don't provide a completed form that is signed, the payer can’t 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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