income, or two-earner/two-job situations. Com‑

consider making estimated tax payments using Form 1040-ES, Estimated Tax for Individuals.

plete all worksheets that apply. They will help

you figure the number of withholding allowances	Otherwise, you may owe additional tax.

Purpose. Complete Form W-4 so your employer you are entitled to claim. However, you may Two earners/two jobs. If you have a working

can withhold the correct Federal income tax	claim fewer (or zero) allowances.
from your pay. Because your tax situation may	Head of household. Generally, you may claim	number of allowances you are entitled to claim
change, you may want to refigure your withhold-	head of household filing status on your tax	on all jobs using worksheets from only one Form

spouse or more than one job, figure the total

ing each year.

return only if you are unmarried and pay more	W-4. Your withholding usually will be most accu‑

Exemption from withholding. If you are than 50% of the costs of keeping up a home for rate when all allowances are claimed on the

exempt, complete only lines 1, 2, 3, 4, and 7,	yourself and your dependent(s) or other qualify-	Form W-4 for the highest paying job and zero

and sign the form to validate it. Your exemption	ing individuals. See line E below.
for 2001 expires February 18, 2002.

allowances are claimed on the others.

Tax credits. You can take projected tax credits	Check your withholding. After your Form W-4

Note: You cannot claim exemption from withhold-	into account in figuring your allowable number of	takes effect, use Pub. 919 to see how the dollar
ing if (1) your income exceeds $750 and includes	withholding allowances. Credits for child or	amount you are having withheld compares to
more than $250 of unearned income (e.g., inter-	dependent care expenses and the child tax	your projected total tax for 2001. Get Pub. 919

est and dividends) and (2) another person can credit may be claimed using the Personal	especially if you used the Two-Earner/Two-Job

claim you as a dependent on their tax return.
Basic instructions. If you are not exempt, com-	How Do I Adjust My Tax Withholding? for infor-	$150,000 (Single) or $200,000 (Married).

Allowances Worksheet below. See Pub. 919, Worksheet on page 2 and your earnings exceed

plete the Personal Allowances Worksheet	mation on converting your other credits into	Recent name change? If your name on line 1 dif‑

below. The worksheets on page 2 adjust your	withholding allowances.
withholding allowances based on itemized	Nonwage income. If you have a large amount of	call 1-800-772-1213 for a new social security card.

fers from that shown on your social security card,

deductions, certain credits, adjustments to	nonwage income, such as interest or dividends,

Personal Allowances Worksheet (Keep for your records.)

A Enter “1” for yourself if no one else can claim you as a dependent

~

	

~

A

● You are single and have only one job; or

B	Enter “1” if:

● You are married, have only one job, and your spouse does not work; or
● Your wages from a second job or your spouse’s wages (or the total of both) are $1,000 or less.

B

C Enter “1” for your spouse. But, you may choose to enter -0- if you are married and have either a working spouse or

more than one job. (Entering -0- may help you avoid having too little tax withheld.)

	

C

D	Enter number of dependents (other than your spouse or yourself) you will claim on your tax return

	

D

E	Enter “1” if you will file as head of household on your tax return (see conditions under Head of household above)

E

F Enter “1” if you have at least $1,500 of child or dependent care expenses for which you plan to claim a credit

F

(Note: Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)

G	Child Tax Credit (including additional child tax credit):

●	If your total income will be between $18,000 and $50,000 ($23,000 and $63,000 if married), enter “1” for each eligible child.
●	If your total income will be between $50,000 and $80,000 ($63,000 and $115,000 if married), enter “1” if you have two eligible children, enter “2” if you have three or four eligible children, or enter “3” if you have five or more eligible children.

G

H	Add lines A through G and enter total here. (Note: This may be different from the number of exemptions you claim on your tax return.)

H

● If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions

For accuracy,

and Adjustments Worksheet on page 2.

complete all

 ● If you are single, have more than one job and your combined earnings from all jobs exceed $35,000, or if you are married and have a working spouse or more than one job and the combined earnings from all jobs exceed

worksheets

that apply.

$60,000, see the Two-Earner/Two-Job Worksheet on page 2 to avoid having too little tax withheld.

●	If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below.

Cut here and give Form W-4 to your employer. Keep the top part for your records.

Form

W-4

Employee’s Withholding Allowance Certificate

OMB No. 1545-0010

001

Department of the Treasury

Internal Revenue Service

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

1	Type or print your first name and middle initial	Last name

2 Your social security number

5

Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) Additional amount, if any, you want withheld from each paycheck

6

	

$

7

I claim exemption from withholding for 2001, and I certify that I meet both of the following conditions for exemption:
●	Last year I had a right to a refund of all Federal income tax withheld because I had no tax liability and
●	This year I expect a refund of all Federal income tax withheld because I expect to have no tax liability.

If you meet both conditions, write “Exempt” here

	

7

Under penalties of perjury, I certify that I am entitled to the number of withholding allowances claimed on this certificate, or I am entitled to claim exempt status.
Employee’s signature (Form is not valid
unless you sign it.)

Date

8	Employer’s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.)

9Office code

(optional)

 10 Employer identification number

Cat. No. 1 0220Q

Home address (number and street or rural route)

City or town, state, and ZIP code

Form W-4 (2001)

	3	□	Single	□	Married	□	Married, but withhold at higher Single rate.	
	Note: If married, but legaly separated, or spouse is a nonresident alien, check the Single box.	
	4	If your last name differs from that on your social security card,		
		check here. You must call 1-800-772-1213 for a new card	□	

5		
6		

Form W-4 (2001)

Page 2

Deductions and Adjustments Worksheet

Note: Use this worksheet only if you plan to itemize deductions, claim certain credits, or claim adjustments to income on your 2001 tax return.

1	Enter an estimate of your 2001 itemized deductions. These include qualifying home mortgage interest,

charitable contributions, state and local taxes, medical expenses in excess of 7.5% of your income, and miscellaneous deductions. (For 2001, you may have to reduce your itemized deductions if your income is over $132,950 ($66,475 if married filing separately). See Worksheet 3 in Pub. 919 for details.)

~

~

1

$

$7,600 if married filing jointly or qualifying widow(er) $6,650 if head of household

2

$

2

Enter:

$4,550 if single

$3,800 if married filing separately

3

Subtract line 2 from line 1. If line 2 is greater than line 1, enter -0-

3

$

4

Enter an estimate of your 2001 adjustments to income, including alimony, deductible IRA contributions, and student loan interest Add lines 3 and 4 and enter the total (Include any amount for credits from Worksheet 7 in Pub. 919.) Enter an estimate of your 2001 nonwage income (such as dividends or interest)
Subtract line 6 from line 5. Enter the result, but not less than -0-

4

$

5

5

$

6

	

6

$

7

	

7

$

8

Divide the amount on line 7 by $3,000 and enter the result here. Drop any fraction Enter the number from the Personal Allowances Worksheet, line H, page 1

	

8

9

	

9

10

Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earner/Two-Job Worksheet, also

enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1

10

Two-Earner/Two-Job Worksheet

Note: Use this worksheet only if the instructions under line H on page 1 direct you here.
1	Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet)
2	Find the number in Table 1 below that applies to the lowest paying job and enter it here

1

	

2

3	If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter

-0-) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet

	

3

Note: If line 1 is less than line 2, enter -0- on Form W-4, line 5, page 1. Complete lines 4–9 below to calculate

4

the additional withholding amount necessary to avoid a year end tax bill. Enter the number from line 2 of this worksheet Enter the number from line 1 of this worksheet Subtract line 5 from line 4

	

4

5

	

5

6

	

6

7

Find the amount in Table 2 below that applies to the highest paying job and enter it here

	

7

$

8

Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed
Divide line 8 by the number of pay periods remaining in 2001. For example, divide by 26 if you are paid every two weeks and you complete this form in December 2000. Enter the result here and on Form W-4,

8

$

9

line 6, page 1. This is the additional amount to be withheld from each paycheck

	

9

$

Table 1: Two-Earner/Two-Job Worksheet

14,001 - 19,000

$0 - $4,000

42375601

42,001 - 47,000

24503981

4,001 - 8,000

47,001 - 55,000

8,001 - 14,000

55,001 - 65,000

65,001 - 70,000

70,001 - 90,000

90,001 - 105,000

105,001 - 115,000

115,001 and over

$0 - $6,000

24375061

65,001 - 80,000

98

6,001 - 12,000

80,001 - 105,000

12,001 - 17,000

105,001 and over

10

17,001 - 22,000

22,001 - 28,000

28,001 - 40,000

40,001 - 50,000

50,001 - 65,000

19,001 - 25,000

25,001 - 32,000

32,001 - 38,000

38,001 - 42,000

Table 2: Two-Earner/Two-Job Worksheet

Married Filing Jointly	All Others	
Enter on
If wages from HIGHEST
paying job are—
line 7 above	Enter on
If wages from HIGHEST
paying job are—
line 7 above	
$440
$0 - $50,000
800
50,001 - 100,000
100,001 - 130,000
900
130,001 - 250,000
1,000
250,001 and over
1,100	$440
$0 - $30,000
800
30,001 -	60,000
900
60,001 - 120,000
120,001 - 270,000
1,000
270,001 and over
1,100	

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. The Internal Revenue Code requires this information under sections 3402(f)(2)(A) and 6109 and their regulations. Failure to provide a properly completed form will result in your being treated as a single person who claims no withholding allowances; providing fraudulent information may also 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, and the District of Columbia for use in administering their tax laws, and using it in the National Directory of New Hires.

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.

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

The time needed to complete this form will vary depending on individual circumstances. The estimated average time is: Recordkeeping, 46 min.; Learning about the law or the form, 13 min.; Preparing the form, 59 min. If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we would be happy to hear from you. You can write to the Tax Forms Committee, Western Area Distribution Center, Rancho Cordova, CA 95743-0001. DO NOT send the tax form to this address. Instead, give it to your employer.

Married Filing Jointly		All Others		
Enter on
Enter on
If wages from LOWEST
If wages from LOWEST
line 2 above
paying job are—
line 2 above	paying job are—	Enter on
Enter on
If wages from LOWEST
If wages from LOWEST
line 2 above	paying job are—
line 2 above
paying job are—