IRS Form W‑4S – Fillable PDF for Sick Pay Tax Withholding

Form W‑4S, officially titled Request for Federal Income Tax Withholding From Sick Pay, is the IRS document you give to a third‑party payer (such as an insurance company) so that federal income tax can be withheld from your sick‑pay benefits.

What Is Form W‑4S?

This one‑page form has two parts: a Withholding Certificate that the payer keeps, and a Worksheet for your records. The certificate tells the payer how much tax you want taken out of each payment, while the worksheet helps you calculate the correct amount based on your projected income, deductions, and credits.

How to Complete Form W‑4S Online with Formize

Instead of downloading the PDF and editing it in a desktop program, you can fill it out instantly on our site:

1. Click the **"Fill out this form"** button below.
2. Wait a few seconds while the Formize PDF Filler app loads the official IRS PDF.
3. Enter your personal information, Social Security number, and the exact dollar amount you want withheld.
4. Complete the worksheet section to verify your calculation.
5. Review the completed form, then click **Submit** to download a signed copy or print it for your payer.

When Should You Use Form W‑4S?

Use this form whenever you receive sick‑pay from a third‑party payer (e.g., an insurance carrier) and you want federal tax withheld. It is not required when the sick pay comes directly from your employer, because employers already withhold taxes.

Common Mistakes to Avoid

• Entering amounts in cents – the IRS requires whole‑dollar amounts only.
• Withholding less than the minimum: $4 per day, $20 per week, or $88 per month.
• Reducing your net payment below $10 – the payer cannot withhold more than the payment allows.
• Forgetting to sign and date the form – an unsigned form is invalid.

Where to Find Help

If you have questions about the calculations, consult the IRS instructions (linked on the form) or a tax professional. You can also review our detailed FAQ below.