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Your employer may be required to send a copy of this form to the department for review.  \n1. Select one:  Single  Married  Married, but withhold at the higher single rate.  \nNote: Select “Single” if you’re married but legally separated or your spouse is a non-U.S. citizen without  \npermanent resident status.  \n2. Allowances. Enter the number from Worksheet A, line A5, Worksheet B, line B9, or Worksheet C,  \nline C6 (see instructions) . Otherwise, if you aren’t exempt, enter 0   2.   \n3. Additional amount from Worksheet C, line C10, or other amount to withhold from each paycheck ... 3.  \n4. Exemption from withholding. I certify my wages are exempt from withholding and I meet the conditions for exemption as stated in Form OR-W-4 Instructions. Complete both lines:  \n• Enter your exemption code from the Exemption chart in Form OR-W-4 Instructions....................... 4a.  \n• Write “Exempt”............................................................................................................................... .... 4b.  \n.00  \n_______________________  \nSign here. Under penalty of false swearing, I declare the information provided is true, correct, and complete.  \n\n| Employee signature (This form isn’t valid unless signed.) | Date |\n| --- | --- |\n\nEmployer use only.  \n\n| Employer name | Federal employer identifcation number (FEIN) |  |  |\n| --- | --- | --- | --- |\n| Employer address | City | State | ZIP code |\n\n—Submit your completed form to your employer—","cbCaipfUcOYIX09C","https://ap.wps.com/l/cbCaipfUcOYIX09C","pdf",65323,"English","# Employee Information\n## Withholding Status and Allowances\n## Exemption From Withholding and Certification\n# Employee Signature and Date\n# Employer Use Only","[{\"question\":\"What information is required from the employee on Form OR-W-4?\",\"answer\":\"The employee provides name and address details, selects a withholding status option, enters allowances (or 0 if not exempt), and may enter an additional withholding amount. The employee also completes exemption certification fields and signs the form.\"},{\"question\":\"How does the employee indicate exemption from withholding?\",\"answer\":\"The employee must certify that wages are exempt from withholding, enter an exemption code from the OR-W-4 instructions exemption chart, and write “Exempt” in the designated line.\"},{\"question\":\"What does the employer need to complete for this form?\",\"answer\":\"The employer fills in the employer name, federal employer identification number (FEIN), employer address, city, state, and ZIP code in the employer-only section, and returns the completed form as required.\"}]","2026 Form OR-W-4 - Oregon Withholding Statement and Exemption Certificate | PDF",1789805629]