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Form W4S: Request for Federal Income Tax Withholding From Sick Pay
IRS Form W-4S is a Request for Federal Income Tax Withholding From Sick Pay, used to tell the third-party payer how much tax to withhold from sick pay payments. The form must be signed to be valid and covers estimates for 2026.
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IRS Form W4S - Request for Federal Income Tax Withholding From Sick Pay
IRS Form W-4S is a Request for Federal Income Tax Withholding From Sick Pay, used to tell the third-party payer how much tax to withhold from sick pay payments. The form must be signed to be valid and covers estimates for 2026.
Risk Radar
Scan points- 1The Form W-4S is not valid unless the employee signs it.
- 2Failing to sign the Form W-4S before giving it to the payer.
- 3Not sending the top part of the form to the third-party payer.
- 4Using an outdated version of Form W-4S (ensure revision date reads 20/26).
- 5Forgetting to complete the worksheet calculations for Line 1 through Line 8.
Plain English
This form tells an entity that pays you sick pay (like an insurance company) exactly how much federal income tax to take out of each payment before it reaches your bank account. By filling this out, you are directing the withholding amount so your final tax bill is accurate for 2026.
Submission Date
- Filing date: 2025-12-19 16:10:52
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
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Glossary Terms
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What this form is for
- Use this form when you want federal income tax withheld from sick pay payments made by a third-party payer.
- Do not use this form if your employer (or its agent) makes the payments, as employers are already required to withhold taxes in that case.
- Check Form 1040-ES instead when estimating tax liability for withholding purposes.
Form selector
Use this form or another form?
Receiving sick pay from an insurance company
The form must be given directly to the third-party payer.
✓ Ensure you provide both the top and lower parts of the form.
Sick pay is paid under a collective bargaining agreement
You should consult your union representative or employer for guidance.
✓ Verify if they require a specific instruction on the form.
Form W-4S (or check with your union/employer)
Deadline or filing window
There is no specific filing deadline mentioned; rather, the form remains in effect until changed or revoked. The worksheet allows estimation of tax liability using 2026 figures, and changes should be made if estimates change after submission.
Checklist
What you need before filling it out
Amount to be withheld
A whole dollar amount (must meet minimums) · Form W-4S, top section
Number of expected payments (Line 8)
The estimated count for 2026. · Form W-4S, Line 8
Withholding per payment (Line 10)
Result of dividing Line 8 by Line 9 and rounding to the nearest dollar. · Form W-4S, Line 10
Sick Pay Definition
A payment received under a plan where the employer is a party, in place of wages for temporary sickness/injury absence. · Form W-4S, Definition section
Before you submit
- 1Ensure you have provided your full name and middle initial.
- 2Verify that your social security number is accurately entered.
- 3Confirm the home address (number and street/rural route) is complete.
- 4Enter a whole dollar amount in the 'Amount to be withheld' box.
- 5Check that this amount meets the minimums: $4 per day, $20 per week, or $88 per month.
- 6Verify you have completed the worksheet calculations (Lines 8 and 9).
- 7Sign the form and date it before submitting.
How to file this form
- 1Complete the top portion of Form W-4S by filling in your personal information and checking the request statement.
- 2Fill out the Worksheet to estimate the number of sick pay payments expected (Line 8) and calculate the amount to be withheld per payment (Line 10).
- 3Enter the final, whole dollar 'Amount to be withheld' on the top portion of Form W-4S.
- 4Sign and date the form; separate the top part for your payer and keep the lower part for your records. Proof: Signed/Dated Form W-4S.
Known limitations
- 1The form does not apply if your employer (or its agent) makes the payments because employers are already required to withhold federal income tax from sick pay.
- 2Sick pay is defined as a payment received under an employer's plan in place of wages for temporary absence due to sickness or injury.
- 3If you receive sick pay under a collective bargaining agreement, consultation with your union representative or employer is necessary.
- 4The form must be signed to be valid; otherwise, it has no effect.
Field map
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Personal Info
2 items
Your legal name and current mailing address.
Your taxpayer identification number — must match IRS records.
Filing Status
1 items
Single, Married Filing Jointly, or Head of Household (for withholding purposes).
Dependents
1 items
Number of qualifying children and other dependents.
Adjustments
1 items
Additional income not from jobs or adjustments to withholding.
Withholding
1 items
Additional amount you want withheld from each paycheck.
Certification
1 items
Your tax entity type: Individual, Corporation, Partnership, etc.
Signatures
1 items
Sign and date to certify under penalty of perjury.
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Fillable formOpen in Editor->The current edition is 20/26, and the form was created on 12/18/25; readers should visit www.irs.gov/FormW4S for the latest information.
What changed or needs a fresh check
- Edition date — confirm 20/26
- OMB Number — confirm 1545-0074
- Creation Date — confirm 12/18/25
- Signature — confirm it is present (required for validity)
Quick Facts
Downloads
After you file
- 1Keep the lower part of Form W-4S for personal records.
- 2After year-end, review Form W-2, Wage and Tax Statement, which reports taxable sick pay and federal income tax withheld.
- 3If changing withholding, submit a new Form W-4S or provide written notice to the payer.
- 4To revoke previous withholding, complete a new Form W-4S, write "Revoked" in the money amount box, sign it, and give it to the payer.
Sources
- SRCThe official title is Request for Federal Income Tax Withholding From Sick Pay (Form W-4S 20 26).
- SRCThis form must be given to the third-party payer of sick pay. [Instructions p.1]
- SRCIt governs estimates for 2026 and has an OMB No. of 1545-0074. [Instructions p.1]
- SRCThe amount entered on Form W-4S must be in whole dollars (e.g., $35). [Form p.1] Amount to be withheld.
- SRCIf you do not submit this form, it is noted that IRS Code sections 3402(o) and 6109 require the information if withholding is requested. [Instructions p.1]
- SRCThe calculation for the amount per payment uses Line 8 divided by Line 9, rounded to the nearest dollar. [Form p.1] Worksheet.
- SRCA specific tax bracket example shows that income over $256,225 but not over $640,600 results in withholding of $58,448 plus 35% of the excess. [Form p.2] Paperwork Reduction Act Notice.
Common confusion points
Who should use this form?
A filer must give Form W-4S to a third-party payer (like an insurance company) if they want federal income tax withheld from sick pay, unless their employer already handles withholding.
→ Check the 'Purpose of form' section on page 1.
When is Form W-4S needed?
The form is required when requesting federal income tax withholding from sick pay under Internal Revenue Code sections 3402(o) and 6109, as stated in the instructions.
→ Confirm this requirement under 'Purpose of form' on page 1.
What if my employer pays the sick pay?
Do not use Form W-4S if your employer (or its agent) makes the payments because employers are already required to withhold federal income tax from sick pay.
→ Look at the note under 'Purpose of form' on page 1.
How do I calculate the amount to be withheld per payment?
Divide the total number of expected sick pay payments (Line 8) by the number of payments you expect this year (Line 9), then round to the nearest dollar. This amount goes on Form W-4S above Line 10.
→ Review the instructions for Lines 8, 9, and 10 on page 1.
What are the minimum/maximum rules for the withholding amount?
The amount entered must be in whole dollars, at least $4 per day, $20 per week, or $88 per month based on your payroll period, and it cannot reduce the net payment to less than $10.
→ Verify these constraints under 'Amount to be withheld' on page 1.
What happens if my sick pay amount changes?
If any amounts used in calculating withholding change after you give Form W-4S to the payer, a new Form W-4S should be used to request a change.
→ Check the caution note under 'Caution: If any of the amounts on the worksheet change' on page 2.
How do I revoke my current withholding?
To revoke a previous Form W-4S, complete a new Form W-4S and write “Revoked” in the money amount box, then sign it and give it to the payer.
→ Follow the instructions under 'Changing your withholding' on page 1.
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Questions about IRS Form W4S
What is IRS Form W4S used for?
This form tells an entity that pays you sick pay (like an insurance company) exactly how much federal income tax to take out of each payment before it reaches your bank account. By filling this out, you are directing the withholding amount so your final tax bill is accurate for 2026.
Who must file IRS Form W4S?
An individual who receives sick pay from a third-party payer must file IRS Form W-4S.
What information does IRS Form W4S require?
The form collects personal identification (name, SSN), and requires an estimate of the amount to be withheld per payment. The worksheet allows estimation based on projected income, deductions, credits, and other withholdings for 2026.
When is IRS Form W4S due?
Form W-4S remains in effect until you change or revoke it by submitting a new Form W-4S or written notice to the payer.
Where do I file IRS Form W4S?
The form must be given directly to the third-party payer of your sick pay. The top part should be sent to the payer, while the lower part is kept for the filer's records.
How do I complete IRS Form W4S?
First, fill out your personal details and then complete the worksheet to calculate the desired withholding amount per payment. Next, enter this calculated amount on the main form above the signature line. Finally, the form must be signed by the employee for it to be valid.
What happens if IRS Form W4S is filed incorrectly?
To avoid a penalty, the filer must ensure that enough tax is withheld or make estimated tax payments using Form 1040-ES.
Who should use this form?
A filer must give Form W-4S to a third-party payer (like an insurance company) if they want federal income tax withheld from sick pay, unless their employer already handles withholding. Check the 'Purpose of form' section on page 1.
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