Your details
First name and middle initial, last name, Social Security number, home address, and city or town, state and ZIP code.
W-4S
Request for Federal Income Tax Withholding From Sick Pay
- Agency
- IRS
- Revision
- 2026
- Fillable fields
- 17
- Pages
- 2
- Official source
- IRS form page
- Checked
- October 21, 2026
Form W-4S: Request for Federal Income Tax Withholding From Sick Pay
Form W-4S is the Request for Federal Income Tax Withholding From Sick Pay. The IRS says to give it to the third-party payer of your sick pay, such as an insurance company, if you want federal income tax withheld from the payments.
The form says you aren't required to have federal income tax withheld from sick pay paid by a third party. It is not for sick pay your employer or its agent pays, because the form says employers are already required to withhold federal income tax from sick pay. The top part, with your name, address, Social Security number and the amount to withhold from each payment, goes to the payer. The worksheet below it stays with you.
This is the 2026 edition. You can fill out Form W-4S free in your browser on this page and download it without an account.
What's on Form W-4S
Claim or identification number
A claim or identification number from the payer, if any.
Amount to withhold and signature
The dollar amount you want withheld from each sick pay payment, then the employee's signature and date. The form says it is not valid unless you sign it.
Worksheet, lines 1 to 6
Estimated 2026 adjusted gross income, deductions, taxable income, tax from the 2026 Tax Rate Tables, credits, and tax after credits.
Worksheet, lines 7 to 10
Other withholding and estimated tax payments, the number of sick pay payments expected, and the amount to withhold from each payment.
Page 2 tables
2026 standard deduction amounts by filing status and the 2026 Tax Rate Tables (Rev. Proc. 2025-32).
How to fill out Form W-4S
- 1
Enter your details
Fill in your name, Social Security number, home address and any claim or identification number.
- 2
Estimate your 2026 tax
Use worksheet lines 1 to 6 with the standard deduction amounts and the 2026 Tax Rate Tables printed on page 2.
- 3
Line 7: other payments
Enter tax withheld or to be withheld from other sources, including a prior Form W-4S, and 2026 estimated tax payments.
- 4
Lines 8 to 10: per-payment amount
Subtract line 7 from line 6, divide by the number of payments on line 9, and round to the nearest dollar.
- 5
Check the amount rules
The form says the amount is in whole dollars, at least $4 per day, $20 per week, or $88 per month, and does not reduce a payment below $10.
- 6
Sign and give it to the payer
Sign and date, separate the top part and give it to the payer of your sick pay. Keep the lower part for your records.
Why fill Form W-4S on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the IRS, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes, changes and timing
Where to send it
Give the top part to the third-party payer of your sick pay. The worksheet says "Keep for your records. Do not send to the IRS."
Changing or revoking
The form stays in effect until you change or revoke it. To revoke, the form says to complete a new Form W-4S, write "Revoked" in the money amount box, sign it and give it to the payer.
Partial payments
The amount withheld from a larger or smaller payment is in the same proportion. The form's example: if $25 (25%) is withheld from $100, then $20 (25%) is withheld from a partial payment of $80.
Year-end statement
The form says that after the end of the year, you'll receive a Form W-2 reporting the taxable sick pay paid and federal income tax withheld.
Underpayment caution
The form says 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. It points to Pub. 505.
Related forms
W-4
Employee's Withholding Certificate
48 fields, 5 pages
W-2
Wage and Tax Statement
568 fields, 11 pages
1040-ES
Form 1040-ES, Estimated Tax for Individuals
118 fields, 16 pages
1040
U.S. Individual Income Tax Return
199 fields, 2 pages
W-4V
Voluntary Withholding Request
14 fields, 2 pages
W-4P
Withholding Certificate for Periodic Pension or Annuity Payments
44 fields, 4 pages
Who fills out Form W-4S?
The person who receives sick pay fills it out and gives the top part to the third-party payer. The worksheet says to keep it for your records and not send it to the IRS.
Official sources and the blank
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Questions about Form W-4S
Do I send Form W-4S to the IRS?
No. You give the top part to the third-party payer of your sick pay. The form says to keep the worksheet and not send it to the IRS.
Is withholding from third-party sick pay required?
The form says you aren't required to have federal income tax withheld from sick pay paid by a third party. Form W-4S is how you request it.
Can I use Form W-4S for sick pay from my employer?
No. The form says not to use it if your employer or its agent makes the payments, because employers are already required to withhold.
What is the smallest amount I can request?
The form says the amount must be at least $4 per day, $20 per week, or $88 per month based on your payroll period, in whole dollars.
How do I stop the withholding?
The form says to complete a new Form W-4S, write "Revoked" in the money amount box, sign it and give it to the payer.
What counts as sick pay?
The form defines it as a payment you receive under a plan to which your employer is a party, in place of wages for any period you're temporarily absent from work because of sickness or injury.