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

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TREASURY/IRS AND OMB USE ONLY DRAFT
Form

W-4S

Request for Federal Income Tax
Withholding From Sick Pay

Department of the Treasury
Internal Revenue Service

OMB No. 1545-0074

2026

Give this form to the third-party payer of your sick pay.
Go to www.irs.gov/FormW4S for the latest information.

Your first name and middle initial

Your social security number

Last name

Home address (number and street or rural route)
City or town, state, and ZIP code

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:

Separate here and give the top part of this form to the payer. Keep the lower part for your records.

Worksheet (Enter amounts you estimate for 2026. Keep for your records. Do not send to the IRS.)
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6
7

Adjusted gross income. (See instructions.) . . . . . . . . . . . . . . . . . . . .
Deductions. (You may take either your itemized deductions or your standard deduction. See instructions.)
Taxable income. Subtract line 2 from line 1. (See instructions.) . . . . . . . . . . . . . .
Tax. Use the 2026 Tax Rate Tables shown here to figure your 2026 tax. (See instructions.) . . . .
Credits. (See instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . .
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 this amount on Form W-4S above . .

General Instructions
Purpose of form. Give this form to the third-party payer of your sick
pay, such as an insurance company, if you want federal income tax
withheld from the payments. You aren’t required to have federal income
tax withheld from sick pay paid by a third party. However, if you choose
to request such withholding, Internal Revenue Code sections 3402(o)
and 6109 and their regulations require you to provide the information
requested on this form. Don’t use this form if your employer (or its
agent) makes the payments because employers are already required to
withhold federal income tax from sick pay.
Note: If you receive 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 from
work because of your sickness or injury.
Amount to be withheld. Enter on this form the amount that you want
withheld 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 on
your payroll period.
• Must not reduce the net amount of each sick pay payment that you
receive 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 regular
withholding from sick pay. For example, if your regular full payment of
$100 a week normally has $25 (25%) withheld, then $20 (25%) will be
withheld from a partial payment of $80.
Caution: You may be subject to a penalty if your tax payments during
the year aren’t at least 90% of the tax shown on your tax return. For
exceptions and details, see Pub. 505, Tax Withholding and Estimated
For Paperwork Reduction Act Notice, see page 2.

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2
3
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8
9

10

Tax. You may pay tax during the year through withholding or estimated
tax payments or both. To avoid a penalty, make sure that you have
enough tax withheld or make estimated tax payments using Form
1040-ES, Estimated Tax for Individuals. You may estimate your federal
income tax liability by using the worksheet above.
Sign this form. Form W-4S is not valid unless you sign it.
Statement of income tax withheld. After the end of the year, you’ll
receive a Form W-2, Wage and Tax Statement, reporting the taxable
sick pay paid and federal income tax withheld during the year. These
amounts are reported to the IRS.
Changing your withholding. Form W-4S remains in effect until you
change or revoke it. You may do this by giving a new Form W-4S or a
written notice to the payer of your sick pay. To revoke your previous
Form W-4S, complete a new Form W-4S and write “Revoked” in the
money amount box, sign it, and give it to the payer.

Specific Instructions for Worksheet
• See https://www.irs.gov/newsroom/one-big-beautiful-bill-provisions
for new provisions that may affect your 2026 tax withholding under One,
Big, Beautiful Bill (signed into law on July 4, 2025, as Public Law
119-21).
• See Revenue Procedure 2025-32 for important tax items (tax tables,
credits, deductions, etc.) and their 2026 amounts.
• See the 2026 Publication 505, Tax Withholding and Estimated Tax, for
more information on the deductions and credits you may take for 2026.
• See the 2026 Form W-4, Employee’s Withholding Certificate, for more
information on the deductions and credits you may take for 2026.
You may use the worksheet on page 1 to estimate the amount of federal
income tax that you want withheld from each sick pay payment. Use
your tax return for last year and the worksheet as a basis for estimating
your tax, tax credits, and withholding for this year.
(continued on back)
Cat. No. 10226E

Form W-4S (2026) Created 10/23/25

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

Employee’s signature:

$

TREASURY/IRS AND OMB USE ONLY DRAFT
Page 2

Form W-4S (2026)

You may not want to use Form W-4S if you already have your total
tax covered by estimated tax payments or other withholding.
If you expect to file a joint return, be sure to include the income,
deductions, credits, and payments of both yourself and your spouse in
figuring the amount you want withheld.
Caution: If any of the amounts on the worksheet change after you give
Form W-4S to the payer, you should use a new Form W-4S to request a
change in the amount withheld.

Line 2—Deductions

Filing Status
Standard Deduction
Married Individuals Filing Joint Returns
and Surviving Spouses
. . . . . . . . . . .
$32,200
Heads of Households . . . . . . . . . . . .
$24,150
Unmarried Individuals (other than Surviving
Spouses and Heads of Households) . . . . . . . .
$16,100
Married Individuals Filing Separate Returns . . . . . .
$16,100
Dependent. For tax years beginning in 2026, the standard deduction
amount for an individual who may be claimed as a dependent by

Line 5—Credits
Include on this line any tax credits that you’re entitled to claim, such as
the child tax credit and credit for other dependents, higher education
credits, credit for child and dependent care expenses, earned income
credit, or credit for the elderly or the disabled.

Line 7—Tax Withholding and Estimated Tax
Enter the federal income tax that you expect will be withheld this year
on income other than sick pay and any payments made or to be made
with 2026 estimated tax payments. Include any federal income tax
already withheld or to be withheld from wages and pensions.

2026 Tax Rate Tables (Revenue Procedure 2025-32)
Married Individuals Filing Joint Returns
and Surviving Spouses
If Taxable Income Is:

The Tax Is:

Married Individuals Filing Separate Returns
If Taxable Income Is:

The Tax Is:

Not over $24,800

10% of the taxable income

Not over $12,400

10% of the taxable income

Over $24,800 but not over $100,800

$2,480 plus 12%
of the excess over $24,800

Over $12,400 but not over $50,400

$1,240 plus 12%
of the excess over $12,400

Over $100,800 but not over $211,400

$11,600 plus 22%
of the excess over $100,800

Over $50,400 but not over $105,700

$5,800 plus 22%
of the excess over $50,400

Over $211,400 but not over $403,550

$35,932 plus 24%
of the excess over $211,400

Over $105,700 but not over $201,775

$17,996 plus 24%
of the excess over $105,700

Over $403,550 but not over $512,450

$82,048 plus 32%
of the excess over $403,550

Over $201,775 but not over $256,225

$41,024 plus 32%
of the excess over $201,775

Over $512,450 but not over $768,700

$116,896 plus 35%
of the excess over $512,450

Over $256,225 but not over $384,350

$58,448 plus 35%
of the excess over $256,225

Over $768,700

$206,583.50 plus 37%
of the excess over $768,700

Over $384,350

$103,291.75 plus 37%
of the excess over $384,350

Heads of Households
If Taxable Income Is:

The Tax Is:

Unmarried Individuals
(other than Surviving Spouses and Heads of Households)
If Taxable Income Is:

The Tax Is:

Not over $17,700

10% of the taxable income

Not over $12,400

10% of the taxable income

Over $17,700 but not over $67,450

$1,770 plus 12%
of the excess over $17,700

Over $12,400 but not over $50,400

$1,240 plus 12%
of the excess over $12,400

Over $67,450 but not over $105,700

$7,740 plus 22%
of the excess over $67,450

Over $50,400 but not over $105,700

$5,800 plus 22%
of the excess over $50,400

Over $105,700 but not over $201,750

$16,155 plus 24%
of the excess over $105,700

Over $105,700 but not over $201,775

$17,966 plus 24%
of the excess over $105,700

Over $201,750 but not over $256,200

$39,207 plus 32%
of the excess over $201,750

Over $201,775 but not over $256,225

$41,024 plus 32%
of the excess over $201,775

Over $256,200 but not over $640,600

$56,631 plus 35%
of the excess over $256,200

Over $256,225 but not over $640,600

$58,448 plus 35%
of the excess over $256,225

Over $640,600

$191,171 plus 37%
of the excess over $640,600

Over $640,600

$192,979.25 plus 37%
of the excess over $640,600

Paperwork Reduction Act Notice. We ask for the information on this
form to carry out the Internal Revenue laws of the United States.
You are not required to provide the information requested on a form
that is subject to the Paperwork Reduction Act unless the form displays
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returns and return information are confidential, as required by Code
section 6103.
The average time and expenses required to complete and file this
form will vary depending on individual circumstances. For estimated
averages, see the instructions for your income tax return.
If you have suggestions for making this form simpler, we would be
happy to hear from you. See the instructions for your income tax return.

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

Itemized deductions. Miscellaneous itemized deductions are no longer
allowed. (See Code section 67.) Regular itemized deductions may be
reduced for individuals with taxable income in the 37 percent rate
bracket. (See Code section 68.)
Standard deduction. For tax years beginning in 2026, the standard
deduction amounts are as follows:

another taxpayer cannot exceed the greater of (1) $1,350, or (2) the sum
of $450 and the individual’s earned income.
Aged or blind. For tax years beginning in 2026, the additional standard
deduction amount for the aged or the blind is $1,650. The additional
standard deduction amount is increased to $2,050 if the individual is
also unmarried and not a surviving spouse.
Certain individuals not eligible for standard deduction. For the
following individuals, the standard deduction is zero.
• A married individual filing a separate return if either spouse itemizes
deductions.
• A nonresident alien individual.
• An individual filing a return for a period of less than 12 months
because of a change in their annual accounting period.