USA MEDICAL IMAGING

Form W4

Form W-4

(Rev. December 2020)Department of the Treasury Internal Revenue Service

Employee's Withholding Certificate

  • Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.
  • Give Form W-4 to your employer.
  • Your withholding is subject to review by the IRS.

OMB No. 1545-0074


2021

Step 1:Enter Personal Information

Step 3: Claim Dependents

Step 4 (optional): Other Adjustments

Employers Only

Step 2(b)- Multiple Jobs Worksheet (Keep for your records.)

1. Two jobs. If you have two jobs or you're married filing jointly and you and your spouse each have one job, find the amount from the appropriate table on page 4. Using the "Higher Paying Job" row and the"Lower Paying Job" column, find the value at the intersection of the two household salaries and enter that value on line 1. Then, skip to line 3. $
2. Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and 2c below. Otherwise, skip to line 3.
a. Find the amount from the appropriate table on page 4 using the annual wages from the highest paying job in the "Higher Paying Job" row and the annual wages for your next highest paying job in the "Lower Paying Job" column. Find the value at the intersection of the two household salaries and enter that value on line 2a. $
b. Add the annual wages of the two highest paying jobs from line 2a together and use the total as the wages in the "Higher Paying Job" row and use the annual wages for your third job in the "Lower Paying Job" column to find the amount from the appropriate table on page 4 and enter this amount on line 2b. $
c. Add the amounts from lines 2a and 2b and enter the result on line 2c. $
3. Enter the number of pay periods per year for the highest paying job. For example, if that job pays weekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc. $
4. Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter this amount here and in Step 4(c) of Form W-4 for the highest paying job (along with any other additional amount you want withheld) $

Step 4(b)- Deductions Worksheet (Keep for your records.)

1. Enter an estimate of your 2021 itemized deductions (from Schedule A (Form 1040)). Such deductions may include qualifying home mortgage interest, charitable contributions, state and local taxes (up to $10,000), and medical expenses in excess of 7.5% of your income. $
2. Enter
  • $25,100 if you're married filing jointly or qualifying widow(er)
  • $18,800 if you're head of household
  • $12,550 if you're single or married filing separately
$
3. If line 1 is greater than line 2, subtract line 2 from line 1 and enter the result here. If line 2 is greater than line 1, enter "-0-". $
4. Enter an estimate of your student loan interest, deductible IRA contributions, and certain other adjustments (from Part II of Schedule 1 (Form 1040)). See Pub. 505 for more information. $
5. Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4. $

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