Fill - Free fillable UW Employee Self-Identification and W-4 Withholding Forms (University of Wisconsin

University of Wisconsin Shared Services Human Resource System

H322.20140324

UW Employee Self-Identification and W-4 Withholding Forms

The University is required to collect data on race and ethnicity from its employees to comply with federal record keeping

and reporting requirements. The information obtained will be kept confidential and will be used for summary federal

reporting purposes and to support institutional affirmative action efforts. Providing this information is voluntary.

The University also needs your W-4 Withholding Form so you have the appropriate taxes taken.

Last Name:

First Name:

Middle Initial:

Empl ID: (if known)

National ID Type:

Social Security Number Individual Tax ID Number

SSN or ITIN:

Date of Birth:

Sex:

Routing Instructions: Submit to your local HR/Payroll Office. (If at UW-Madison, submit to 21 North Park Street, Suite

5101.)

Ethnicity and Heritage Code

Ethnicity is considered Hispanic/Latino if a person is of Cuban, Mexican, Puerto Rican, South or Central American, or

other Spanish culture or origin, regardless of race.

Is your ethnicity Hispanic/Latino?

Yes

Please identify yourself as one or more of the following races:

Black or African American

A person having origins in any of the black racial groups of Africa

Asian

A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent,

including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand,

and Vietnam.

American Indian or Alaska Native

A person having origins in any of the original peoples of North and South America (including Central America) who

maintains cultural identification through tribal affiliation or community attachment.

White

A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Native Hawaiian or other Pacific Islander

A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Signat

ure: Date:

_____________________________________________________________________ _______________________

For Of

fice Use Only | Empl ID: ___________________ Empl Rcd#: _______________

mm/dd/yyyy

2020 Form W-4

__________________________ __________________

Voluntary Self-Identification of Disability

Form CC-305

OMB Control Number 1250-0005

Expires 1/31/2020

Page 1 of 2

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to

qualified people with disabilities

To help us measure how well we are doing, we are asking you to tell us if you

have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will

choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used

against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may

become disabled at any time, we are required to ask all of our employees to update their information every five

years. You may voluntarily self-identify as having a disability on this form without fear of any punishment

because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that

substantially limits a major life activity, or if you have a history or record of such an impairment or medical

condition.

Disabilities include, but are not li

mited to:

Blindness

Deafness

Cancer

Diabetes

Epilepsy

Autism

Cerebral palsy

HIV/AIDS

Schizophrenia

Muscular

dystrophy

Bipolar disorder

Major depression

Multiple sclerosis (MS)

Missing limbs or

partially missing limbs

Post-traumatic stress disorder (PTSD)

Obsessive compulsive disorder

Impairments requiring the use of a wheelchair

Intellectual disability (previously called mental

retardation)

Please check one of the boxes below:

☐

YES, I HAVE A DISABILITY (or previously had a disability)

☐

NO, I DON’T HAVE A DISABILITY

☐

I DON’T WISH TO ANSWER

Your

Name

Today’s D

ate

Voluntary Self-Identification of Disability

Form CC-305

OMB Control Number 1250-0005

Expires 1/31/2020

Page 2 of 2

Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities.

Please tel

l us if you require a reasonable accommodation to apply for a job or to perform your job. Examples

of reasonable accommodation include making a change to the application process or work procedures,

providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal

employment ob

ligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract

Compliance Programs (OFCCP) website at

www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required

to respond to a collection of information unless such collection displays a valid OMB control number. This

survey should take about 5 minutes to complete.

University of Wisconsin Shared Services Human Resource System

H322.20140324

Veteran Self-Identification

Last Name: First Name: Middle Initial:

This employer is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by

the Jobs for Veterans Act of 2002, 38 U.S.C. 4212

(VEVRAA), which requires Government contractors to take affirmative action to

employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge

veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:

• A “disabled veteran” is one of the following:

o a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of

military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or

o a person who was discharged or released from active duty because of a service-connected disability.

• A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran's

discharge or release from active duty in the U.S. military, ground, naval, or air service.

• An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground,

naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the

laws administered by the Department of Defense.

• An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval

or air service, participated in a United States military operation for which an Armed Forces service medal was awarded

pursuant to Executive Order 12985

Protected veterans may have additional rights under USERRA—the Uniformed Services Employment and Reemployment Rights Act. In

particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be

reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service.

For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-

USA-DOL.

As a Government contractor subject to VEVRAA, we are required to submit a report to the United States Department of Labor each

year identifying the number of our employees belonging to each specified “protected veteran” category. If you believe you belong to any

of the categories of protected veterans listed above, please indicate by checking the appropriate box below.

I belong to the following classifications of protected veterans (choose all that apply):

Disabled veteran

Recently separated veteran

Active wartime or campaign badge veteran

Armed forces service medal veteran

I am a protected veteran, but I choose not to self-identify the classifications to which I belong.

I am a veteran, but not a protected veteran.

I am not a veteran.

If you are a disabled veteran it would assist us if you tell us whether there are accommodations we could make that would enable you

to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the way

the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist us in

making reasonable accommodations for your disability.

Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information

provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as

amended.

The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions

on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be

informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government

officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans

with Disabilities Act, may be informed.

Signature: Date:

___________________________________________________________________________ _______________________

Routing Instructions: Submit to your local HR/Payroll office. If at UW-Madison, submit to 21 N. Park Street, Suite 5101.

For Office Use Only | Empl ID: ___________________ Empl Rcd#: _______________

mm/dd/yyyy

University of Wisconsin Shared Services Human Resource System

20191125

Form W-4 Supplemental

Personal Information

First name and middle initial

Last name

Social security number

Employee ID

Date of birth (mm/dd/yyyy)

Address

City or town

State

ZIP code

Citizenship

U.S. Citizen at birth U.S. Citizen after birth (derived, acquired or naturalized) Neither. Complete the International Visitors section below.

Supplemental State Tax Information Complete this section if it applies to you.

Wisconsin Nonresident Reciprocity Declaration

I declare that while working in Wisconsin, I am a legal resident of the state indicated below, and that I am not subject to Wisconsin income tax

withholding in accordance with a reciprocal tax agreement. Check the appropriate box:

Indiana Illinois Michigan Kentucky

Important: If (a) your UW work is primarily performed outside of Wisconsin and (b) you reside outside of Wisconsin in a state that has no reciprocity

agreement with Wisconsin

, complete the following boxes. Refer to additional instructions below for Non-Wisconsin Residents.

U.S. state of

tax residence

U.S. state or foreign country

where work is performed

Wisconsin-Residents

Please complete a WI WT-4 for Wisconsin tax reporting and withholding.

https:/

/www.revenue.wi.gov/TaxForms2017through2019/w-204f.pdf

Non-Wisconsin-Residents

If (a) you reside outside of Wisconsin in a state that has no reciprocity agreement with Wisconsin, (b) you are not a Wisconsin resident, and (c) you

perform work primarily outside of Wisconsin, you are set to no tax reporting or withholding in the State of WI; however, if you earned wages while present

in Wisconsin that are over $1500 in a calendar year, submit the following form: Declaration of Wages for Non-Wisconsin-Residents

California Resident and primary work location. Please complete a CA-DE-4 for California tax reporting and withholding.

https:/

/www.edd.ca.gov/pdf_pub_ctr/de4.pdf

Illinois Resident. Please select reciprocity box above or file an IL-W-4 for Illinois tax reporting and withholding.

https:/

/www2.illinois.gov/rev/forms/withholding/Documents/currentyear/il-w-4.pdf

Minnesota Resident and primary work location. Please complete a MN-W-4 for Minnesota tax reporting and withholding.

https://www.revenue.state.mn.us/sites/default/files/2019-01/w-4mn.pdf

U.S. Citizens working outside of the U.S. may qualify for exemption from state and federal income tax by filing IRS Form 673.

All International Visitors Complete this section if it applies to you.

Are you a permanent U.S. resident (green card holder)?

Yes No

If No, enter your Visa Type

(current immigration status)

Original Date of Entry to the U.S.

on current immigration status

(mm/dd/yyyy)

Country of Citizenship

Country of Tax Residence (not U.S.)

International Visitors: Complete and deliver this form with the Form W-4. You will also be required to enter your immigration information into your UW-

issued Glacier account (which you should receive within two weeks of hire). For further information about Glacier and to identify your UW Glacier

administrator, log onto the following web address using your UW credentials. Select the Payroll Information link, the Foreign Nationals tab, and choose

your UW institution at the top left of the page. Contact information will be listed below your institution: https://uwservice.wisconsin.edu/help/payroll#foreign

Form W-4 Instructions for Nonresident Aliens: Your Form W-4 must be filled out according to the rules for nonresident aliens or will be considered

invalid and may result in the maximum level of tax withholding. You must select the Single withholding level (regardless of your actual marital status) and in

most cases must limit your allowances to one. You must also write ‘nonresident alien’ on the correct area of the form, according to the instructions in IRS

Notice 1392: https://www.irs.gov/pub/irs-pdf/n1392.pdf

Form W-4 Instructions for Resident Aliens/Permanent Residents Claiming a Tax Treaty Withholding Exemption: If treaty will be applied to a portion

of your paycheck, you may wish to submit a Form W-4 following the nonresident alien marital status and withholding allowance limits. Once you have met

your treaty’s time limit or annual dollar limit, you may submit a new Form W-4 listing the marital status/withholding allowances appropriate for your tax

situation.

This form is not valid unless you sign it. Submit your completed form to your human resources office.

Under the penalties of perjury, I declare that I have examined this certificate and to the best of my knowledge and belief, it is true, correct, and complete.

Employee Signature

Date (mm/dd/yyyy)

For Office Use Only

Empl ID: UDDS/Department ID:

Clear Selection

Form W-4

2020

Employee’s Withholding Certificate

Department of the Treasury

Internal Revenue Service

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.

Give Form W-4 to your employer.

Your withholding is subject to review by the IRS.

OMB No. 1545-0074

Step 1:

Enter

Personal

Information

(a) First name and middle initial Last name

Address

City or town, state, and ZIP code

(b) Social security number

Does your name match the

name on your social security

card? If not, to ensure you get

credit for your earnings, contact

SSA at 800-772-1213 or go to

www.ssa.gov.

(c)

Single or Married filing separately

Married filing jointly (or Qualifying widow(er))

Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)

Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can

claim exemption from withholding, when to use the online estimator, and privacy.

Step 2:

Multiple Jobs

or Spouse

Works

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse

also works. The correct amount of withholding depends on income earned from all of these jobs.

Do only one of the following.

(a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4); or

(b)

Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or

(c)

If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option

is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld .....

TIP: To be accurate, submit a 2020 Form W-4 for all other jobs. If you (or your spouse) have self-employment

income, including as an independent contractor, use the estimator.

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will

be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)

Step 3:

Claim

Dependents

If your income will be $200,000 or less ($400,000 or less if married filing jointly):

Multiply the number of qualifying children under age 17 by $2,000

Multiply the number of other dependents

by $500 . . . .

Add the amounts above and enter the total here .............

3 $

Step 4

(optional):

Other

Adjustments

(a)

Other income (not from jobs). If you want tax withheld for other income you expect

this year that won’t have withholding, enter the amount of other income here. This may

include interest, dividends, and retirement income . . . . . . . . . . . .

4(a) $

(b)

Deductions. If you expect to claim deductions other than the standard deduction

and want to reduce your withholding, use the Deductions Worksheet on page 3 and

enter the result here .....................

4(b) $

4(c)

Step 5:

Sign

Here

Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

Employee’s signature (This form is not valid unless you sign it.)

Date

Employers

Only

Employer’s name and address First date of

employment

Employer identification

number (EIN)

For Privacy Act and Paperwork Reduction Act Notice, see page 3.

Cat. No. 10220Q

Form W-4 (2020)

(mm/dd/yyyy)

(00-0000000)

Form W-4 (2020)

Page 2

General Instructions

Future Developments

For the latest information about developments related to

Form W-4, such as legislation enacted after it was published,

go to www.irs.gov/FormW4.

Purpose of Form

Complete Form W-4 so that your employer can withhold the

correct federal income tax from your pay. If too little is

withheld, you will generally owe tax when you file your tax

return and may owe a penalty. If too much is withheld, you will

generally be due a refund. Complete a new Form W-4 when

changes to your personal or financial situation would change

the entries on the form. For more information on withholding

and when you must furnish a new Form W-4, see Pub. 505.

Exemption from withholding. You may claim exemption from

withholding for 2020 if you meet both of the following

conditions: you had no federal income tax liability in 2019 and

you expect to have no federal income tax liability in 2020. You

had no federal income tax liability in 2019 if (1) your total tax on

line 16 on your 2019 Form 1040 or 1040-SR is zero (or less

than the sum of lines 18a, 18b, and 18c), or (2) you were not

required to file a return because your income was below the

filing threshold for your correct filing status. If you claim

exemption, you will have no income tax withheld from your

paycheck and may owe taxes and penalties when you file your

2020 tax return. To claim exemption from withholding, certify

that you meet both of the conditions above by writing “Exempt”

on Form W-4 in the space below Step 4(c). Then, complete

Steps 1a, 1b, and 5. Do not complete any other steps. You will

need to submit a new Form W-4 by February 16, 2021.

Your privacy. If you prefer to limit information provided in

Steps 2 through 4, use the online estimator, which will also

increase accuracy.

As an alternative to the estimator: if you have concerns

with Step 2(c), you may choose Step 2(b); if you have

concerns with Step 4(a), you may enter an additional amount

you want withheld per pay period in Step 4(c). If this is the

only job in your household, you may instead check the box

in Step 2(c), which will increase your withholding and

significantly reduce your paycheck (often by thousands of

dollars over the year).

When to use the estimator. Consider using the estimator at

www.irs.gov/W4App if you:

1. Expect to work only part of the year;

2. Have dividend or capital gain income, or are subject to

additional taxes, such as the additional Medicare tax;

3. Have self-employment income (see below); or

4. Prefer the most accurate withholding for multiple job

situations.

Self-employment. Generally, you will owe both income and

self-employment taxes on any self-employment income you

receive separate from the wages you receive as an

employee. If you want to pay these taxes through

withholding from your wages, use the estimator at

www.irs.gov/W4App to figure the amount to have withheld.

Nonresident alien. If you’re a nonresident alien, see Notice

1392, Supplemental Form W-4 Instructions for Nonresident

Aliens, before completing this form.

Specific Instructions

Step 1(c). Check your anticipated filing status. This will

determine the standard deduction and tax rates used to

compute your withholding.

Step 2. Use this step if you (1) have more than one job at the

same time, or (2) are married filing jointly and you and your

spouse both work.

Option (a) most accurately calculates the additional tax

you need to have withheld, while option (b) does so with a

little less accuracy.

If you (and your spouse) have a total of only two jobs, you

may instead check the box in option (c). The box must also be

checked on the Form W-4 for the other job. If the box is

checked, the standard deduction and tax brackets will be cut

in half for each job to calculate withholding. This option is

roughly accurate for jobs with similar pay; otherwise, more tax

than necessary may be withheld, and this extra amount will be

larger the greater the difference in pay is between the two jobs.

CAUTION

Multiple jobs. Complete Steps 3 through 4(b) on only

one Form W-4. Withholding will be most accurate if

you do this on the Form W-4 for the highest paying job.

Step 3. Step 3 of Form W-4 provides instructions for

determining the amount of the child tax credit and the credit

for other dependents that you may be able to claim when

you file your tax return. To qualify for the child tax credit, the

child must be under age 17 as of December 31, must be

your dependent who generally lives with you for more than

half the year, and must have the required social security

number. You may be able to claim a credit for other

dependents for whom a child tax credit can’t be claimed,

such as an older child or a qualifying relative. For additional

eligibility requirements for these credits, see Pub. 972, Child

Tax Credit and Credit for Other Dependents. You can also

include other tax credits in this step, such as education tax

credits and the foreign tax credit. To do so, add an estimate

of the amount for the year to your credits for dependents

and enter the total amount in Step 3. Including these credits

will increase your paycheck and reduce the amount of any

refund you may receive when you file your tax return.

Step 4 (optional).

Step 4(a). Enter in this step the total of your other

estimated income for the year, if any. You shouldn’t include

income from any jobs or self-employment. If you complete

Step 4(a), you likely won’t have to make estimated tax

payments for that income. If you prefer to pay estimated tax

rather than having tax on other income withheld from your

paycheck, see Form 1040-ES, Estimated Tax for Individuals.

Step 4(b). Enter in this step the amount from the Deductions

Worksheet, line 5, if you expect to claim deductions other than

the basic standard deduction on your 2020 tax return and

want to reduce your withholding to account for these

deductions. This includes both itemized deductions and other

deductions such as for student loan interest and IRAs.

Step 4(c). Enter in this step any additional tax you want

withheld from your pay each pay period, including any

amounts from the Multiple Jobs Worksheet, line 4. Entering an

amount here will reduce your paycheck and will either increase

your refund or reduce any amount of tax that you owe.

Form W-4 (2020)

Page 3

Step 2(b)—Multiple Jobs Worksheet (Keep for your records.)

If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only ONE

Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest paying job.

Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional

tables; or, you can use the online withholding estimator at www.irs.gov/W4App.

Two jobs. If you have two jobs or you’re married filing jointly and you and your spouse each have one

job, find the amount from the appropriate table on page 4. Using the “Higher Paying Job” row and the

“Lower Paying Job” column, find the value at the intersection of the two household salaries and enter

that value on line 1. Then, skip to line 3 ..................... 1 $

2 Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and

2c below. Otherwise, skip to line 3.

Find the amount from the appropriate table on page 4 using the annual wages from the highest

paying job in the “Higher Paying Job” row and the annual wages for your next highest paying job

in the “Lower Paying Job” column. Find the value at the intersection of the two household salaries

and enter that value on line 2a ....................... 2a

Add the annual wages of the two highest paying jobs from line 2a together and use the total as the

wages in the “Higher Paying Job” row and use the annual wages for your third job in the “Lower

Paying Job” column to find the amount from the appropriate table on page 4 and enter this amount

on line 2b .............................

2b $

c Add the amounts from lines 2a and 2b and enter the result on line 2c .......... 2c

3 Enter the number of pay periods per year for the highest paying job. For example, if that job pays

weekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc. ..... 3

Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter this

amount here and in Step 4(c) of Form W-4 for the highest paying job (along with any other additional

amount you want withheld) ......................... 4 $

Step 4(b)—Deductions Worksheet (Keep for your records.)

Enter an estimate of your 2020 itemized deductions (from Schedule A (Form 1040 or 1040-SR)). Such

deductions may include qualifying home mortgage interest, charitable contributions, state and local

taxes (up to $10,000), and medical expenses in excess of 10% of your income ........ 1 $

2 Enter:

{

• $24,800 if you’re married filing jointly or qualifying widow(er)

• $18,650 if you’re head of household

• $12,400 if you’re single or married filing separately

}

........ 2 $

3 If line 1 is greater than line 2, subtract line 2 from line 1. If line 2 is greater than line 1, enter “-0-” . . 3 $

4 Enter an estimate of your student loan interest, deductible IRA contributions, and certain other

adjustments (from Schedule 1 (Form 1040 or 1040-SR)). See Pub. 505 for more information . . . 4

5 Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4 ........... 5 $

Privacy Act and Paperwork Reduction Act Notice. We ask for the information

on this form to carry out the Internal Revenue laws of the United States. Internal

Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to

provide this information; your employer uses it to determine your federal income

tax withholding. Failure to provide a properly completed form will result in your

being treated as a single person with no other entries on the form; providing

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; to cities, states, the District of Columbia, and U.S. commonwealths and

possessions for use in administering their tax laws; and to the Department of

Health and Human Services for use in the National Directory of New Hires. We

may also disclose this information to other countries under a tax treaty, to federal

and state agencies to enforce federal nontax 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.

Form W-4 (2020)

Page 4

Married Filing Jointly or Qualifying Widow(er)

Higher Paying Job

Annual Taxable

Wage & Salary

Lower Paying Job Annual Taxable Wage & Salary

$0 -

9,999

$10,000 -

19,999

$20,000 -

29,999

$30,000 -

39,999

$40,000 -

49,999

$50,000 -

59,999

$60,000 -

69,999

$70,000 -

79,999

$80,000 -

89,999

$90,000 -

99,999

$100,000 -

109,999

$110,000 -

120,000

$0 - 9,999 $0 $220 $850 $900 $1,020 $1,020 $1,020 $1,020 $1,020 $1,210 $1,870 $1,870

$10,000 - 19,999

220 1,220 1,900 2,100 2,220 2,220 2,220 2,220 2,410 3,410 4,070 4,070

$20,000 - 29,999 850 1,900 2,730 2,930 3,050 3,050 3,050 3,240 4,240 5,240 5,900 5,900

$30,000 - 39,999

900 2,100 2,930 3,130 3,250 3,250 3,440 4,440 5,440 6,440 7,100 7,100

$40,000 - 49,999

1,020 2,220 3,050 3,250 3,370 3,570 4,570 5,570 6,570 7,570 8,220 8,220

$50,000 - 59,999 1,020 2,220 3,050 3,250 3,570 4,570 5,570 6,570 7,570 8,570 9,220 9,220

$60,000 - 69,999

1,020 2,220 3,050 3,440 4,570 5,570 6,570 7,570 8,570 9,570 10,220 10,220

$70,000 - 79,999

1,020 2,220 3,240 4,440 5,570 6,570 7,570 8,570 9,570 10,570 11,220 11,240

$80,000 - 99,999 1,060 3,260 5,090 6,290 7,420 8,420 9,420 10,420 11,420 12,420 13,260 13,460

$100,000 - 149,999

1,870 4,070 5,900 7,100 8,220 9,320 10,520 11,720 12,920 14,120 14,980 15,180

$150,000 - 239,999

2,040 4,440 6,470 7,870 9,190 10,390 11,590 12,790 13,990 15,190 16,050 16,250

$240,000 - 259,999 2,040 4,440 6,470 7,870 9,190 10,390 11,590 12,790 13,990 15,520 17,170 18,170

$260,000 - 279,999

2,040 4,440 6,470 7,870 9,190 10,390 11,590 13,120 15,120 17,120 18,770 19,770

$280,000 - 299,999

2,040 4,440 6,470 7,870 9,190 10,720 12,720 14,720 16,720 18,720 20,370 21,370

$300,000 - 319,999 2,040 4,440 6,470 8,200 10,320 12,320 14,320 16,320 18,320 20,320 21,970 22,970

$320,000 - 364,999

2,720 5,920 8,750 10,950 13,070 15,070 17,070 19,070 21,290 23,590 25,540 26,840

$365,000 - 524,999

2,970 6,470 9,600 12,100 14,530 16,830 19,130 21,430 23,730 26,030 27,980 29,280

$525,000 and over

3,140 6,840 10,170 12,870 15,500 18,000 20,500 23,000 25,500 28,000 30,150 31,650

Single or Married Filing Separately

Higher Paying Job

Annual Taxable

Wage & Salary

Lower Paying Job Annual Taxable Wage & Salary

$0 -

9,999

$10,000 -

19,999

$20,000 -

29,999

$30,000 -

39,999

$40,000 -

49,999

$50,000 -

59,999

$60,000 -

69,999

$70,000 -

79,999

$80,000 -

89,999

$90,000 -

99,999

$100,000 -

109,999

$110,000 -

120,000

$0 - 9,999 $460 $940 $1,020 $1,020 $1,470 $1,870 $1,870 $1,870 $1,870 $2,040 $2,040 $2,040

$10,000 - 19,999

940 1,530 1,610 2,060 3,060 3,460 3,460 3,460 3,640 3,830 3,830 3,830

$20,000 - 29,999 1,020 1,610 2,130 3,130 4,130 4,540 4,540 4,720 4,920 5,110 5,110 5,110

$30,000 - 39,999

1,020 2,060 3,130 4,130 5,130 5,540 5,720 5,920 6,120 6,310 6,310 6,310

$40,000 - 59,999

1,870 3,460 4,540 5,540 6,690 7,290 7,490 7,690 7,890 8,080 8,080 8,080

$60,000 - 79,999 1,870 3,460 4,690 5,890 7,090 7,690 7,890 8,090 8,290 8,480 9,260 10,060

$80,000 - 99,999

2,020 3,810 5,090 6,290 7,490 8,090 8,290 8,490 9,470 10,460 11,260 12,060

$100,000 - 124,999

2,040 3,830 5,110 6,310 7,510 8,430 9,430 10,430 11,430 12,420 13,520 14,620

$125,000 - 149,999 2,040 3,830 5,110 7,030 9,030 10,430 11,430 12,580 13,880 15,170 16,270 17,370

$150,000 - 174,999

2,360 4,950 7,030 9,030 11,030 12,730 14,030 15,330 16,630 17,920 19,020 20,120

$175,000 - 199,999

2,720 5,310 7,540 9,840 12,140 13,840 15,140 16,440 17,740 19,030 20,130 21,230

$200,000 - 249,999 2,970 5,860 8,240 10,540 12,840 14,540 15,840 17,140 18,440 19,730 20,830 21,930

$250,000 - 399,999

2,970 5,860 8,240 10,540 12,840 14,540 15,840 17,140 18,440 19,730 20,830 21,930

$400,000 - 449,999

2,970 5,860 8,240 10,540 12,840 14,540 15,840 17,140 18,450 19,940 21,240 22,540

$450,000 and over

3,140 6,230 8,810 11,310 13,810 15,710 17,210 18,710 20,210 21,700 23,000 24,300

Head of Household

Higher Paying Job

Annual Taxable

Wage & Salary

Lower Paying Job Annual Taxable Wage & Salary

$0 -

9,999

$10,000 -

19,999

$20,000 -

29,999

$30,000 -

39,999

$40,000 -

49,999

$50,000 -

59,999

$60,000 -

69,999

$70,000 -

79,999

$80,000 -

89,999

$90,000 -

99,999

$100,000 -

109,999

$110,000 -

120,000

$0 - 9,999 $0 $830 $930 $1,020 $1,020 $1,020 $1,480 $1,870 $1,870 $1,930 $2,040 $2,040

$10,000 - 19,999

830 1,920 2,130 2,220 2,220 2,680 3,680 4,070 4,130 4,330 4,440 4,440

$20,000 - 29,999 930 2,130 2,350 2,430 2,900 3,900 4,900 5,340 5,540 5,740 5,850 5,850

$30,000 - 39,999

1,020 2,220 2,430 2,980 3,980 4,980 6,040 6,630 6,830 7,030 7,140 7,140

$40,000 - 59,999

1,020 2,530 3,750 4,830 5,860 7,060 8,260 8,850 9,050 9,250 9,360 9,360

$60,000 - 79,999 1,870 4,070 5,310 6,600 7,800 9,000 10,200 10,780 10,980 11,180 11,580 12,380

$80,000 - 99,999

1,900 4,300 5,710 7,000 8,200 9,400 10,600 11,180 11,670 12,670 13,580 14,380

$100,000 - 124,999

2,040 4,440 5,850 7,140 8,340 9,540 11,360 12,750 13,750 14,750 15,770 16,870

$125,000 - 149,999 2,040 4,440 5,850 7,360 9,360 11,360 13,360 14,750 16,010 17,310 18,520 19,620

$150,000 - 174,999

2,040 5,060 7,280 9,360 11,360 13,480 15,780 17,460 18,760 20,060 21,270 22,370

$175,000 - 199,999

2,720 5,920 8,130 10,480 12,780 15,080 17,380 19,070 20,370 21,670 22,880 23,980

$200,000 - 249,999 2,970 6,470 8,990 11,370 13,670 15,970 18,270 19,960 21,260 22,560 23,770 24,870

$250,000 - 349,999

2,970 6,470 8,990 11,370 13,670 15,970 18,270 19,960 21,260 22,560 23,770 24,870

$350,000 - 449,999

2,970 6,470 8,990 11,370 13,670 15,970 18,270 19,960 21,260 22,560 23,900 25,200

$450,000 and over 3,140 6,840 9,560 12,140 14,640 17,140 19,640 21,530 23,030 24,530 25,940 27,240

Caution:

Changes to Form WT-4

The Internal Revenue Service (IRS) has redesigned Form W-4 for the year 2020. As

explained in the DRAFT posted on the IRS website, federal allowances have been

removed. Prior to this change, an employee could use Form W-4 for Wisconsin purposes

if the employee’s federal allowances equaled his or her Wisconsin exemptions. Since

federal allowances have been removed, the redesigned Form W-4 cannot be used for

Wisconsin purposes.

The following applies for Wisconsin withholding tax purposes beginning in 2020:

• All newly-hired employees must provide Form WT-4 to their employer.

• Existing employees that change the number of their Wisconsin withholding

exemptions must provide Form WT-4 to their employer.

• Existing employees are not required to provide Form WT-4 to their employer (unless

the employer requests it) if the employee wishes to maintain the same number of

Wisconsin withholding exemptions used in 2019.

EMPLOYER INSTRUCTIONS for Department of Revenue:

• If you do not have a Federal Employer Identification Number (FEIN), contact

the Internal Revenue Service to obtain a FEIN.

• If the Employee has claimed more than 10 exemptions OR has claimed

complete exemption from withholding and earns more than $200.00 a week

or is believed to have claimed more exemptions than he or she is entitled to,

mail a copy of this certificate to: Wisconsin Department of Revenue, Audit

Bureau, PO Box 8906, Madison WI 53708 or fax (608) 267‑0834.

• Keepacopyofthiscerticatewithyourrecords.Ifyouhavequestionsaboutthe

DepartmentofRevenuerequirements,call(608)266‑2772or(608)266‑2776.

EMPLOYER INSTRUCTIONS for New Hire Reporting:

• Thisreport contains the required information for reporting a New Hire to

Wisconsin. If you are reporting new hires electronically, you do not need to

forward a copy of this report to the Department of Workforce Development.

Visit https://dwd.wi.gov/uinh/ to report new hires.

• If you do not report new hires electronically, mail the original form to the Depart‑

mentofWorkforceDevelopment,NewHireReporting,POBox14431,Madison

WI 53708‑0431 or fax toll free to 1‑800‑277‑8075.

• IfyouhavequestionsaboutNewHirerequirements,calltollfree(888)300‑HIRE

(888‑300‑4473). Visit dwd.wi.gov/uinh/ for more information.

Employee’s Wisconsin Withholding Exemption Certicate/New Hire Reporting

WT- 4

W‑204 (R. 10‑19) Wisconsin Department of Revenue

EMPLOYEE INSTRUCTIONS:

• WHO MUST COMPLETE:

Effective on or after January 1, 2020, every newly‑hired employee is

requiredtoprovideacompletedFormWT‑4toeachofhisorheremploy‑

ers. Form WT‑4 will be used by your employer to determine the amount

of Wisconsin income tax to be withheld from your paychecks. If you

have more than one employer, you should claim a smaller number or no

exemptions on each Form WT‑4 provided to employers other than your

principal employer so that the total amount withheld will be closer to your

actual income tax liability.

You must complete and provide your employer a new Form WT‑4 within

10 days if the number of exemptions previously claimed DECREASES.

You may complete and provide to your employer a new form WT‑4 at any

time if the number of your exemptions INCREASES.

Youremployermayalsorequireyoutocompletethisformtoreportyour

hiring to the Department of Workforce Development.

• UNDER WITHHOLDING:

If sufficient tax is not withheld from your wages, you may incur additional

interest charges under the tax laws. In general, 90% of the net tax shown

on your income tax return should be withheld.

• OVER WITHHOLDING:

If you are using Form WT‑4 to claim the maximum number of exemptions

to which you are entitled and your withholding exceeds your expected

income tax liability, you may use Form WT‑4A to minimize the over

withholding.

WT-4 Instructions – Provide your information in the employee section.

• LINE 1:

(a)‑(c) Number of exemptions – Do not claim more than the correct number

of exemptions. If you expect to owe more income tax for the year than will

be withheld if you claim every exemption to which you are entitled, you may

increase your withholding by claiming a smaller number of exemptions on

lines 1(a)‑(c) or you may enter into an agreement with your employer to have

additional amounts withheld (see instruction for line 2).

income tax purposes may also be claimed as dependents for Wisconsin

purposes. The term “dependents” does not include you or your spouse.

Indicate the number of dependents that you are claiming in the space provided.

• LINE 2:

Additional withholding – If you have claimed “zero” exemptions on line 1, but

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

pay period. If your employer agrees to this additional withholding, enter the

additional amount you want deducted from each of your paychecks on line 2.

• LINE 3:

Exemption from withholding – You may claim exemption from withholding of

Wisconsin income tax if you had no liability for income tax for last year, and

you expect to incur no liability for income tax for this year. You may not claim

exemption if your return shows tax liability before the allowance of any credit

for income tax withheld. If you are exempt, your employer will not withhold

Wisconsin income tax from your wages.

You must revoke this exemption (1) within 10 days from the time you expect

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

stoporarerequiredtorevokethisexemption,youmustcompleteandprovide

a new Form WT‑4 to your employer showing the number of withholding exemp‑

tions you are entitled to claim. This certificate for exemption from withholding

will expire on April 30 of next year unless a new Form WT‑4 is completed and

provided to your employer before that date.

Signature Date Signed ,

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 ...................................................

(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certicate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.

Employer’s Section

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

Completed by Title Phone number Email

Employer’s name Federal Employer ID Number

( )

Employee’s Section (Print clearly)

City State Zip code Date of hire

Employee’s legal name (rst name, middle initial, last name) Social security number

Employee’s address (number and street) Date of birth

Single

Married

Married, but withhold at higher Single

rate.

Note: If married, but legally separated,

check the Single box.

Save

Clear

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

Applicable Laws and Rules

ThisdocumentprovidesstatementsorinterpretationsofthefollowinglawsandregulationsineectasofJanuary1,2019:

Section 71.66, Wis. Stats., and Section Tax 2.92, Wis. Adm. Code.

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