Request for Federal Income Tax Withholding From Sick Pay - Form W-4S

Sep 19, 2026

Form W-4S requests federal income tax withholding from sick pay paid by a third-party payer. It explains when the form is needed, defines sick pay, and sets specific rules for withholding amounts, including whole-dollar limits and minimums tied to the payroll period. It also includes a worksheet to estimate 2026 taxes, calculate the correct number of sick pay payments, determine the withholding per payment, and guidance on avoiding underpayment penalties.

LanguageEnglish

CategoryForms

FormatPDF

Pages2

Reading Time1 min

AccessFree to download

General Instructions

Purpose of form

Definition of sick pay

Amount to be withheld

Caution and penalty guidance

Request for Federal Income Tax Withholding From Sick Pay

Employee and payer information

Withholding amount request and date

Worksheet for 2026 estimates

Specific Instructions for Worksheet

Home address(number and street or rural route) City or town,state,and ZIP code Employee's signature: -----------------------Separate here and give the top part of this form to the payer.Keep the lower part for your records.---------- # General Instructions Purpose of form.Give this form to the third-party payer of your sickpay,such as an insurance company,if you want federal income taxwithheld from the payments.You aren't required to have federal incometax withheld from sick pay paid by a third party.However,if you chooseto request such withholding,Internal Revenue Code sections 3402(o)and 6109 and their regulations require you to provide the informationrequested on this form.Don't use this form if your employer(or itsagent)makes the payments because employers are already required towithhold federal income tax from sick pay. Note:If you receve sick pay under a collective bargaining agreement,see your union representative or employer. Definition.Sick pay is a payment that you receive: ·Under a plan to which your employer is a party,and ·In place of wages for any period when you're temporarily absent fromwork because of your sickness or injury. Amount to be withheld.Enter on this form the amount that you wantwithheld from each payment.The amount that you enter: ·Must be in whole dollars(for example,$35,not $34.50); ·Must be at least $4 per day,$20 per week,or $88 per month based onyour payroll period;and ·Must not reduce the net amount of each sick pay payment that youreceive to less than $10. For payments larger or smaller than a regular full payment of sick pay,the amount withheld will be in the same proportion as your regularwithholding from sick pay.For example,if your regular full payment of$100 a week normally has $25(25%)withheld,then $20(25%)willbewithheld from a partial payment of $80. Caution:You may be subject to a penalty if your tax payments duringthe year aren't at least 90%of the tax shown on your tax return.Forexceptions and details,see Pub.505.Tax Withholding and Estimated # Request for Federal Income TaxWithholding From Sick Pay Give this form to the third-party payer of your sick pay. | nternal Revenue Service | Go to www.irs.gov/FormW4S for the latest information. | | | | | --- | --- | --- | --- | --- | | Your first name and middle initial | | Last name | Your social security number | | | | | | | | | | | | --- | --- | | Claim or identification number (if any).. | | | | | | I request federal income tax withholding from my sick pay payments.I want the following amount to be
withheld from each payment.(See Worksheet below.).·.·..·. | $ | Date: Worksheet(Enter amounts you estimate for 2026.Keep for your records.Do not send to the IRS.) | 1 Adjusted gross income (See instructions.).....··...··..··...·.
2 Deductions.You may take either your itemized deductions or your standard deduction.(See instructions.)
3 Taxable income.Subtract line 2 from line 1.(See instructions.)..·...··..... .
4 Tax.Use the 2026 Tax Rate Tables shown here to figure your 2026 tax.(See instructions.) .. ..
5 Credits (See instructions.)....···..···..··...··...·.
6 Subtract line 5 from line 4 .......................
7 Estimated federal income tax withheld or to be withheld from other sources (including amounts withheld
due to a prior Form W-4S)during 2026 or paid or to be paid with 2026 estimated tax payments ...
8 Subtract line 7 from line 6 . ...... .... ..
9 Enter the number of sick pay payments you expect to receive this year to which this Form W-4S will
apply ...............·..
10 Divide line 8 by line 9.Round to the nearest dollar.This is the amount that should be withheld from
each sick pay payment.Be sure it meets the requirements for the amount that should be withheld,as
explained under Amount to be withheld below.If it does,enter thi

FAQs

When should you use Form W-4S?

Use Form W-4S when you want a third-party payer of your sick pay to withhold federal income tax. You generally shouldn’t use it if your employer makes the payments, because employers are already required to withhold federal income tax from sick pay they pay.

What amount rules apply to the federal income tax withheld from sick pay?

The withheld amount must be in whole dollars, meet minimum thresholds based on the payroll period (at least $4 per day, $20 per week, or $88 per month), and must not reduce the net sick pay payment to less than $10.

How is the withholding amount for each sick pay payment determined?

The worksheet estimates federal income tax for 2026, subtracts other withheld or estimated amounts, then divides the result by the number of sick pay payments expected for the year. The result is rounded to the nearest dollar and entered on Form W-4S.

Sep 19, 2026

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