Fill - Free fillable 2019 Form OR-W-4 Important information (CITY OF ST HELENS) PDF form

—Provide this form to your employer—

19611901010000

Oregon Department of Revenue

2019 Form OR-W-4

Oregon Withholding

Office use only

Page 1 of 4, 150-101-402 (Rev. 12-18)

Last nameFirst name and initial

Employer’s name

Employee’s signature (This form isn’t valid unless signed.)

Employer. Complete the following:

Social Security number (SSN)

Federal employer identication number (FEIN)

Date

Separate here and give Form OR-W-4 to your employer. Keep the worksheets for your records.

Oregon Employee’s Withholding Allowance Certificate

Form OR-W-4 2019

Address

Employer’s address

City

State

ZIP code

Note: Your eligibility to claim a certain number of allowances or an exemption from withholding is subject to review by the Oregon

Department of Revenue. Your employer may be required to send a copy of this form to the department for review.

1. Select one: Single Married Married, but withholding at the higher single rate.

Note: If married, but legally separated, or if your spouse is a nonresident alien, check the “Single” box.

2. Allowances. Total number of allowances you’re claiming on line A4, B15, or C5. If you meet a

qualification to skip the worksheets and you aren’t exempt, enter -0- ...................................................2.

3. Additional amount, if any, you want withheld from each paycheck ...................................................... 3.

4. Exemption from withholding. I certify that my wages are exempt from withholding and I meet

the conditions for exemption as stated on page 2 of the instructions. Complete both lines below:

• Enter the corresponding exemption code. (See instructions) ........................................................... 4a.

• Write “Exempt” ................................................................................................................................... 4b.________________________

Sign here. Under penalty of false swearing, I declare that the information provided is true, correct, and complete.

Important information

Complete Form OR-W-4 if:

• You’re a new employee.

• You filed a 2018 or 2019 federal Form W-4 with your

employer and didn’t file a separate Oregon form specify-

ing a different number of allowances for Oregon.

• You weren’t satisfied with your prior year Oregon tax-to-

pay or refund amount.

• You’ve had a recent personal or financial change that may

affect your tax situation, such as a change in your income,

filing status, or number of dependents.

Specific information to consider:

• Do you (including your spouse) have another job?

• Do you expect your wages or adjusted gross income

(AGI) on your 2019 return to be more than $100,000 (or

$200,000 if filing using the married filing jointly or quali-

fied widow(er) filing status)?

• Are you making mid-year changes to your withholding?

• Do you receive pension or annuity payments?

• Are you a part-year resident, nonresident, or nonresident alien?

If you answered yes to any of these questions, read

the “Specific information” section in the instructions

before filling out the corresponding worksheets or

Form OR-W-4. The online Oregon Withholding Calculator

at www.oregon.gov/dor may provide more accurate results.

If you use the online calculator, you don’t need to complete

any of the corresponding worksheets.

Otherwise, read the instructions and complete all applicable

worksheets before filling out the Form OR-W-4 and giving

it to your employer.

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A1. Enter “1” for yourself, if no one else can claim you as a dependent. Otherwise, enter -0- ................ A1.

A2. Enter “1” for your spouse, if your spouse doesn’t work. Otherwise, enter -0- .................................. A2.

A3. Enter the number of dependents you will claim on your Oregon tax return ....................................... A3.

A4. Add lines A1 through A3. Enter the result here and follow the instructions below .............................. A4.

Complete all worksheets that apply.

• Worksheet B—Use this worksheet if you plan to do any of the following on your 2019 Oregon return:

o Itemize your Oregon deductions or claim additional standard deduction amounts.

o Claim federal adjustments to income, or Oregon additions, subtractions, or credits (other than personal exemption credits).

o Report nonwage income.

• Worksheet C—Use this worksheet if you (including your spouse) have more than one job and the combined earnings from

all jobs exceed $20,000.

If neither of the above worksheets apply, stop here and enter the number from line A4 on Form OR-W-4, line 2.

19611901020000

Oregon Department of Revenue

2019 Form OR-W-4

Oregon Withholding

Worksheet A—Personal allowances

Office use only

Page 2 of 4, 150-101-402 (Rev. 12-18)

Worksheet A—Personal allowances

– Keep this worksheet for your records –

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Use this worksheet if you plan to do any of the following on your 2019 Oregon return:

• Itemize your Oregon deductions or claim additional standard deduction amounts.

• Claim federal adjustments to income, or Oregon additions, subtractions, or credits (other than personal exemption credits).

• Report nonwage income.

Having your prior year’s Oregon tax return on hand may help you when completing this worksheet.

Don’t list numbers as negative unless instructed. For example, write a $1,000 Oregon subtraction as “$1,000”, not “($1,000)”.

B1. Enter your estimated 2019 nonwage income (such as dividends or interest) .............B1.

B2. Enter your estimated 2019 Oregon additions ...............................................................B2.

B3. Add lines B1 and B2 .............................................................................................................................B3.

B4. Enter your estimated 2019 Oregon deductions. (See instructions) ..............................B4.

B5. Enter the standard deduction based on your anticipated 2019 filing status: ..............B5.

• Single or Married Filing Separately: $2,270.

• Head of Household: $3,655.

• Married Filing Jointly or Qualifying Widow(er): $4,545.

B6. Line B4 minus line B5. If the result is zero or less, enter -0- ................................................................B6.

B7. Enter your estimated 2019 federal adjustments to income and Oregon subtractions

(exception—don’t include the federal tax subtraction) ........................................................................B7.

B8. Add lines B6 and B7 .............................................................................................................................B8.

B9. Line B8 minus line B3. If less than zero, enter as a negative amount ..................................................B9.

B10. Line B9 divided by $2,700. Round to one decimal place. If less than zero,

enter as a negative amount.................................................................................................................B10.

B11. Enter your estimated 2019 Oregon standard, carryforward, or refundable

credits (exception—don’t include personal exemption credits) ..................................B11.

B12. Divide line B11 by $206. Round to one decimal place .......................................................................B12.

B13. Add lines B10 and B12. If less than zero, enter as a negative amount. Round down to

a whole number by eliminating the decimal value ..............................................................................B13.

B14. Enter the number from Worksheet A, line A4 ....................................................................................B14.

B15. Add lines B13 and B14. If zero or less, enter -0-. (See instructions) ..................................................B15.

If you plan to use Worksheet C, also enter the result from line B15 on Worksheet C, line C1.

Otherwise,

stop here and enter the result from line B15 on Form OR-W-4, line 2.

– Keep this worksheet for your records –

19611901030000

Oregon Department of Revenue

2019 Form OR-W-4

Oregon Withholding

Worksheet B—Deductions, adjustments, credits, and nonwage income

Office use only

Page 3 of 4, 150-101-402 (Rev. 12-18)

Worksheet B—Deductions, adjustments, credits, and nonwage income

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If you (including your spouse) have three or more jobs, consider using the Oregon Withholding Calculator at www.oregon.gov/dor

for a more accurate calculation of allowances.

If you don’t use the online calculator, use this worksheet to estimate the number of allowances to claim on your highest paying job.

Allowances should only be claimed for your highest paying job. Claim zero allowances on Form OR-W-4, line 2 for all your (or your

spouse’s) other jobs to prevent underwithholding.

Only complete this worksheet if you (including your spouse) have more than one job and the combined earnings from all jobs exceed $20,000.

C1. Enter the number from Worksheet B, line B15, if used. Otherwise, enter the

number from Worksheet A, line A4 ..................................................................................................... C1.

C2. Enter the number below based on your 2019 anticipated filing status ........................ C2.

• Single, Head of Household, or Married Filing Separately: Enter “2”;

however, if two of your jobs individually exceed $40,000, enter “4”.

• Married Filing Jointly or Qualifying Widow(er): Enter “3”; however,

if two of your jobs individually exceed $50,000, enter “6”.

C3. If you (including your spouse) will have three or more jobs at any point

during the year, enter the number below based on your 2019 anticipated

filing status. Otherwise, enter -0- .................................................................................. C3.

• Single, Head of Household, or Married Filing Separately: Enter “2”.

• Married Filing Jointly or Qualifying Widow(er): Enter “3”.

C4. Add lines C2 and C3 .............................................................................................................................C4.

C5. Is line C1 less than line C4?

• Yes. Enter -0- on line C5 and on Form OR-W-4, line 2. Complete lines C6 through C8 below

to figure the additional withholding amount necessary to avoid a year-end tax bill.

• No. Line C1 minus line C4. Enter the result on line C5 (if zero, enter -0-) and on Form OR-W-4,

line 2. Don’t complete the rest of this worksheet.. ...........................................................................C5.

C6. Line C4 minus line C1 ...........................................................................................................................C6.

C7. Line C6 multiplied by $206 ...................................................................................................................C7.

C8. Line C7 divided by the number of paychecks remaining in 2019 for the highest paying job and

rounded to the nearest dollar. Enter the result here and on Form OR-W-4, line 3. This is the

additional amount to be withheld from each paycheck ....................................................................... C8.

– Keep this worksheet for your records –

19611901040000

Oregon Department of Revenue

2019 Form OR-W-4

Oregon Withholding

Worksheet C—Two-earners / multiple jobs

Office use only

Page 4 of 4, 150-101-402 (Rev. 12-18)

Worksheet C—Two-earners / multiple jobs

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150-101-402 (Rev. 12-18)

1 of 3

General information

What is Oregon income tax withholding?

Oregon income tax withholding refers to the amount of

Oregon personal income taxes that are withheld from your

paychecks to cover your anticipated Oregon tax liability for

the year. By law, your employer must withhold a portion of

your wages based on your allowances and send the funds

to the Department of Revenue.

How is the amount of Oregon income tax

withholding determined?

You report your marital status, withholding allowances, and

any additional amount you want withheld to your employer

by completing Form OR-W-4. This information, along with

Publication 150-206-436, Oregon Withholding Tax Formulas,

which estimates the tax due on your wages, is used by your

employer to withhold a specific amount per pay period.

If you have too much tax withheld, you may have a refund

when you file your tax return. If you have too little tax

withheld, you may owe tax when you file your tax return,

including penalty and interest. See Publication OR-17 for

penalty and interest information.

Why has Oregon created Form OR-W-4?

In prior years, Oregon employees were able to use the fed-

eral Form W-4 to determine the number of Oregon allow-

ances needed. However, due to federal tax law changes,

the federal form no longer calculates the correct number of

Oregon allowances. Form OR-W-4 will help you calculate

allowances for Oregon income tax withholding.

Form OR-W-4 is designed to approximate the amount of

tax you will need to have withheld for Oregon. Your 2019

tax return may still result in a tax due or refund. For a more

accurate calculation, use the Oregon Withholding Calcula-

tor at www.oregon.gov/dor to calculate your allowances

for Oregon.

How often do I need to complete Form OR-W-4?

Complete a new Form OR-W-4 when you start a new job

and whenever your personal or financial situation changes,

affecting your tax situation. This includes changes in your

income, marital status, and number of dependents.

Specific information

Two-earners or multiple jobs. If you and your spouse work

or if you have more than one job, do the following on the

Form OR-W-4 for the highest paying job only:

• Enter the allowances from Worksheet C, line C5 on Form

OR-W-4, line 2.

• Enter the additional per-period amount to withhold, if any,

from Worksheet C, line C8 on Form OR-W-4, line 3.

For all other (lower-paying) jobs, skip the worksheets and

claim -0- allowances on Form OR-W-4 line 2, and -0- addi-

tional amount to be withheld on line 3.

If you (including your spouse) have more than two jobs, use

the online calculator for more accurate results.

Wages or adjusted gross income (AGI) that exceed the

threshold. Do you expect to have wages or AGI on your 2019

return that are more than $100,000 (or $200,000 if using the

married filing jointly or the qualifying widow(er) filing sta-

tus)? Consider using the online calculator to determine the

correct amounts to claim on your Form OR-W-4. Otherwise,

skip the worksheets. Check the appropriate box on line 1

for your marital status and enter -0- on line 2. You may owe

additional tax when you file your return.

Helpful tip: AGI. Your AGI is your total income minus federal

adjustments to income. The amount on your 2018 federal

Form 1040, line 7, may help you estimate your 2019 AGI.

Mid-year changes. If you’re changing your allowances part-

way through the year and you claimed too many allowances

for the first part of the year, use the online calculator to

determine the additional amount you need withheld to make

up for the shortage you had during the first part of the year.

Otherwise, you may owe tax, penalties, and interest when

you file your return. See Publication OR-17 for penalty and

interest information.

Pension or annuity payments. Form OR-W-4 can be used to

designate the amount of withholding on your pension or

annuity payments. Generally, whenever Form OR-W-4 or

the instructions refer to jobs or wages, substitute these terms

with “pension or annuity” or “pension or annuity payment.”

If your pension or annuity payment is required to be with-

held at a certain percentage, you are not able to claim allow-

ances on Form OR-W-4, line 2; however, you are able to claim

additional withholding on Form OR-W-4, line 3.

Part-year and nonresidents. If you’re a part-year or nonresi-

dent of Oregon, complete the applicable worksheets based

on amounts that will be included in the Oregon column of

your Oregon return.

Nonresident alien. If you’re a nonresident alien, you don’t

qualify to claim certain items on your Oregon return. There-

fore, we recommend that you mark “Single” on Form OR-W-

4, line 1 and enter -0- on line 2.

Exemption from withholding. If you’re exempt from with-

holding, skip the worksheets. Complete line 4 and sign Form

OR-W-4. See additional instructions for line 4 on page 2 of

the instructions.

Oregon Withholding Instructions

2019

Form OR-W-4

150-101-402 (Rev. 12-18)

2 of 3

Form OR-W-4 line instructions

Type or clearly print your name, Social Security number

(SSN), and home address.

Note. You must enter an SSN. You can’t use an individual

taxpayer identification number (ITIN).

Line 1. If you anticipate using the single, married filing

separately, or head of household filing status when you file

your 2019 return, mark “Single.”

If you anticipate using the married filing jointly, or qualify-

ing widow(er) filing status when you file your 2019 return,

mark “Married.” If you meet the married filing jointly quali-

fications, but want to withhold at the higher “single” rate,

mark “Married, but withholding at the higher single rate.”

For the qualifications of each filing status, see federal

Publication 501, Exemptions, Standard Deduction, and Filing

Information.

Line 2. Complete all applicable worksheets. Use the allow-

ances from Worksheet A, line A4, Worksheet B, line B15, or

Worksheet C, line C5.

Line 3. If you choose to have an additional amount withheld

from your pay, enter the amount that you want withheld

from each paycheck. If you completed Worksheet C, line C8

may direct you to claim an additional amount per paycheck.

Line 4. If you’re claiming exemption from withholding, you

must meet one of the below requirements:

• Your wages must be exempt from Oregon taxation, or

• You must meet the qualification for having no tax liability.

To claim exemption due to no tax liability, you must meet

both of the following conditions:

• Last year you had the right to a refund of all Oregon tax

withheld because you had no tax liability, and

• This year you expect a refund of all Oregon income tax

withheld because you expect to have no tax liability.

To claim exempt, enter the corresponding code from the fol-

lowing Exemption chart on line 4a. Only enter one exemp-

tion code. Also write “Exempt” on line 4b.

Exemption chart

Exemption Code

Air carrier employee A

American Indian enrolled tribal member living and

working in Indian country.

Amtrak Act worker C

Casual laborer D

Domestic service worker E

Hydroelectric dam worker at the Bonneville, John Day,

McNary, or The Dalles dams.

Military pay for nonresidents stationed in Oregon and

their spouses, residents stationed outside Oregon,

and service members whose Defense Finance and

Accounting Services (DFAS) address is outside Oregon.

Minister who is duly ordained, commissioned, or licensed

and performing duties in their ministry, or a member of a

religious order performing duties required by their order.

Nonresident alien who is exempt from federal

withholding and has submitted federal Form 2833

or other specially required documentation with their

employer to claim federal withholding exemption.

Real estate salesperson under a written contract not

to be treated as an employee.

Waterway worker K

No tax liability. See above for definition. L

Sign and date Form OR-W-4. Submit Form OR-W-4 (page

1) to your employer. Don’t complete the employer’s name,

FEIN, and address boxes; your employer will complete these.

Keep the worksheets (pages 2–4) with your tax records.

Worksheet instructions

Worksheet A—Personal allowances

Line A3. Dependents. List the total of all qualifying children

and qualifying relatives you are able to claim as a dependent

on your Oregon return. See the “Exemption credit” section

of Publication OR-17 for qualifications.

Worksheet B—Deductions, adjustments, credits,

and nonwage income

Line B1. If you have large amounts of nonwage income,

such as interest, dividends, or self-employment income,

consider making estimated tax payments using Publication

OR-ESTIMATE. Otherwise, you may owe additional tax.

Line B2. Additions are items the federal government doesn’t

tax but Oregon does. See Publication OR-17 for a list of addi-

tions and instructions.

Line B4. Enter your anticipated 2019 Oregon deductions. If

you don’t know your anticipated 2019 deductions, enter the

standard deduction for your anticipated filing status.

The 2019 standard deduction for each filing status is:

• $2,270 for single or married filing separately.

• $3,655 for head of household.

• $4,545 for married filing jointly or qualifying widow(er).

If you qualify for an additional standard deduction amount

because you or your spouse are age 65 or older or blind, and

you don’t plan to itemize your deductions, enter your total

2019

Form OR-W-4

Oregon Withholding Instructions

150-101-402 (Rev. 12-18)

3 of 3

estimated standard deduction amount for 2019. See Publica-

tion OR-17 for standard deduction information.

Itemized deductions include items such as: medical expenses

in excess of 10% of your adjusted gross income, qualifying

home mortgage interest, charitable contributions, state and

local taxes (limited to $10,000, and excluding Oregon income

taxes), and certain miscellaneous deductions. If you plan

to itemize your deductions, enter your estimated Oregon

itemized deductions. See Schedule OR-A for additional

information.

Line B7. Adjustments to income are claimed on your federal

return and reduce your federal taxable income. See federal

Form 1040 instructions for details on claiming adjustments

to income on your federal return and see Publication OR-17

for details on claiming these items on your Oregon return.

Subtractions are items the federal government taxes but Ore-

gon doesn’t. See Publication OR-17 for a list of subtractions

and instructions. Don’t include your federal tax subtraction.

Line B10. Divide line B9 by $2,700. Round to one decimal

place. For example, round 4.84 to 4.8 and 4.85 to 4.9. This

calculation converts the amount from line B9 to allowances.

Line B11. Credits reduce the amount of tax you must pay.

Standard and carryfoward credits can reduce your tax down

to zero but can’t be refunded to you. Refundable credits,

however, can reduce your tax down to zero and also result

in a refund of any remaining amount. See Publication OR-17

for a list of credits and instructions.

Enter an estimate of the credits you will claim on your 2019

Oregon return. Don’t include your exemption credits.

Line B12. Divide line B11 by $206. Round using one decimal

place. For example, round 4.84 to 4.8 and 4.85 to 4.9. This

calculation converts the amount from B11 to allowances.

Line B13. Add lines B10 and B12. Round down to a whole

number by eliminating the decimal value. For example, round

4.3 or 4.8 to 4 and round -3.3 or -3.7 to -3.

Example 1. Roger entered -3.1 on line B10. He entered 2.4 on

line B12. He will enter -0- on line B13 (-3.1 + 2.4 = -0.7, which

rounds down to -0-).

Line B15. If the result on line B15 is less than zero, consider

making quarterly estimated tax payments to avoid a tax

liability and penalties and interest when you file your return.

See Publication OR-ESTIMATE for information on how to

make quarterly estimated payments.

Worksheet C—Two earners / multiple jobs

Line C5. For your highest paying job, enter the result of

Worksheet C, line C5 on Form OR-W-4, line 2. All lower

paying jobs should claim zero allowances.

Line C8. For your highest paying job, enter the result of

Worksheet C, line C8 on Form OR-W-4, line 3. Round to the

nearest whole dollar. All lower paying jobs should claim zero

as the additional amount to have withheld.

Example 2. Todd is completing this form in January and

has entered $824 on line C7. For his highest paying job, he

is paid every two weeks and has 25 paychecks left for the

year. Todd will enter $33 on line C8 and Form OR-W-4, line

3 ($824 divided by 25 = $32.96, which is rounded up to the

nearest whole dollar).

Employer instructions

Enter the business name, federal employer identification num-

ber (FEIN), and address. Keep this form with your records.

You’re required to send Form OR-W-4 to the Department of

Revenue within 20 days of receiving it if the employee claims

any of the following:

• More than ten allowances.

• Exemption from withholding and you expect the employ-

ee’s income to be more than $200 per week for both federal

and state purposes.

• Exemption from withholding for state purposes, but not

for federal purposes.

Send form(s) to:

W-4 Project Manager

Oregon Department of Revenue

PO Box 14560

Salem, OR 97309

For additional information regarding Form OR-W-4, see

Publication 150-211-602, W-4 Information for Employers.

Additional resources

For additional information, refer to the following publications:

• Publication 150-206-436, Oregon Withholding Tax Formulas.

• Publication OR-17, Oregon Individual Income Tax Guide.

• Publication OR-ESTIMATE, Instructions for Estimated Income Tax.

• Publication 150-211-602, W-4 Information for Employers.

• Federal Pub. 501, Exemptions, Standard Deduction, and Filing Information.

• Federal Form 2833, Exemption From Withholding on Compensa-

tion for Independent (and Certain Dependent) Personal Services

of a Nonresident Alien Individual.

• Federal Form 1040 Instructions.

Do you have questions or need help?

www.oregon.gov/dor

(503) 378-4988 or (800) 356-4222

questions.dor@ oregon.gov

languages.

Oregon Withholding Instructions

2019

Form OR-W-4

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