UW Form W-4 Employee`s Withholding Allowance Certificate

University of Wisconsin Service Center
Human Resource System
Form W-4 | Employee’s Withholding Allowance Certificate
See reverse side for instructions. Please type data below. This is a tax form; do not use this form for an Address Change only. On every
W-4 form you submit, you must indicate your marital status and exemption status or it will be assigned to Single with zero exemptions.
Please enter name as it shows on your Social Security Card.
Personal Information
Last Name
First Name
MI
Date of Birth (mm/dd/yyyy)
Gender
Male
Female
Email Address
U.S. Social Security Number
Empl ID (if known)
Home Phone Number
Other
Citizenship – Check the box that best describes you
Born in USA
Naturalized Citizen
Neither
If Neither, complete the rest of this form AND the
International Visitors section at bottom.
Select one:
University Staff
Faculty, Acad Staff
Marital Status – For Tax Withholding (check only one)
Single (or married but legally separated)
Married
Married but withhold at higher Single rate
Student
Note: All Nonresident Aliens are required to check either ‘Single’ or ‘Married but withhold at higher Single
rate’ (see additional instructions on reverse side)
Street
Apt. No. City
State
Zip
U.S.
Address
Apt. No. City
Street
Foreign
Address
Province
Country
Postal Code
Home Information Release – My home address, telephone number or email address may be made available for the staff directory and
released to the public upon request.
Yes
No
Withholding Information
Exempt (Exempt status expires annually on February 15). International Nonresident Alien employees cannot claim exempt.
(This is not international tax treaty. See Glacier instructions on back.)
I claim exemption from withholding this year. I certify that I meet BOTH of the following:

Last year I had a right to a refund of ALL income tax withheld because I had no tax liability; AND

This year I expect a refund of ALL income tax withheld because I expect to have no tax liability
AND that I do not meet the conditions listed on the reverse side.
EXEMPT for Federal Tax:
Yes
No
EXEMPT for Wisconsin State Tax:
Yes
No
If you have checked yes in one of these boxes, do NOT enter any amounts in the Federal and/or Wisconsin State Tax blocks.
Number of Allowances for
Federal Tax (leave blank
if claiming exempt):
Federal Tax
Additional Federal Tax to be
Withheld:
$
Wisconsin State Tax
Number of Allowances for WI
Additional WI State Tax to
State Tax (leave blank
be Withheld:
if claiming exempt):
$
Leave above fields blank for all other states outside of Wisconsin.
Wisconsin Nonresident Reciprocity Declaration
I declare that while working in Wisconsin, I am a legal resident of the state indicated below, and that I am not subject to Wisconsin
income tax withholding in accordance with a reciprocal tax agreement. Check appropriate box:
Indiana
Illinois
Michigan
Kentucky
If you have checked one of these boxes, do NOT enter any amounts in the Wisconsin State Tax blocks.
If your UW work is primarily performed outside of Wisconsin (WI), you reside outside of WI and it is not a reciprocal state as defined
above, but a portion of your work is performed in WI during any calendar year; refer to instructions on the back for Non-WI residents.
U.S. state or foreign country of
U.S. state or foreign country
If CA residence, please indicate # of
Additional CA State Tax to
tax residence:
where work is performed:
allowances for CA state tax (leave
be Withheld:
blank if claiming exempt):
$
U.S. Citizens working outside of the U.S. may qualify for exemption from state and federal income tax by filing IRS Form 673.
All International Visitors Complete the Following – See reverse side for instructions
Are you a permanent U.S. resident (green card holder)?
Original Date of Entry to the U.S. Country of Citizenship
on current immigration status:
Yes
No - if No, specify Visa Type
Country of Tax Residence (not U.S.)
(current immigration status): _______
(mm/dd/yyyy)
Signature
Under the penalties of perjury, I declare that I have examined this entire certificate and to the best of my knowledge and belief, it is true,
correct, and complete. (This form is not valid unless you sign it.)
Employee Signature
Date
(mm/dd/yyyy)
For Office Use Only
P102.20150825
Empl ID:
UDDS/Department ID:
W-4 Instructions
All International Visitors:
All International visitors must provide an email address in order to obtain access to the Glacier Nonresident Alien Tax Compliance System,
which is required.
Within one week after your position, visa code and email address have been entered into the Human Resource System, you should receive
instructional emails from [email protected] and [email protected] These emails will also contain the web link, login
and password you will need to access Glacier.
After you enter your immigration information and history into Glacier’s self-service application, Glacier will reveal whether you are a resident
or nonresident alien for tax purposes. Glacier will also issue tax treaty forms, if you are eligible. Following your Glacier entry, you will be
instructed to print, sign and deliver the required forms and immigration document photocopies to the person listed on the second page of
your Glacier Tax Summary Report.
Instructions for International Nonresident Aliens:
Marital Status: Check “Single”, or if you are married, check “Married but withhold at higher Single rate”.
Exempt: Check "No". International Nonresident Alien employees cannot claim exempt for either Federal or State Tax. (This is not
international tax treaty.)
Number of Allowances for Federal and Wisconsin State Tax: Enter "1" Allowance unless:
You are from Canada or Mexico. If so, you will be taxed as Single, but may claim additional allowances for your dependents for both
Federal and State purposes. Your dependents DO NOT need to live with you in the USA.
You are from the Republic of Korea. If so, you will be taxed as Single, but may claim additional allowances for your dependents for
both Federal and State purposes ONLY if your dependents live with you in the USA.
Students from India: Per IRS regulations, the only Nonresident Aliens eligible to claim the Standard Deduction are Students from India.
Write “India Student” in the ‘Additional Federal Tax to be withheld’ box to claim this benefit.
For more details on federal tax withholding, see IRS Pub. 15 (Circular E), Employer’s Tax Guide, IRS Pub. 901 U.S. Tax Treaties, and IRS
Pub. 515 Withholding of Tax on Nonresident Aliens and Foreign Entities.
Instructions for All Other Persons:
Exempt: You are not eligible to claim exempt if:
You can be claimed as a dependent on someone else’s tax return, and
1. Your income exceeds $1050 and includes more than $350 of unearned income (interest on savings, dividends, etc.) for Federal
or Wisconsin, or
2. Your gross income (total unearned income and earned income) was more than $10,150 if single, $13,050 if head of household,
$20,300 if married filing jointly, or $3,950 if married filing separately.
Allowances: Enter the allowances you can claim. (http://apps.irs.gov/app/withholdingcalculator/ will help you figure the number of
withholding allowances you can claim). In general you can claim one allowance for:
•
•
•
yourself, if no one else is claiming you as a dependent,
your spouse, if your spouse does not work,
each dependent not claimed by someone else
If claiming "EXEMPT" from federal and/or state withholding you must leave the Allowance Box blank.
To DECREASE withholding, increase the number of allowances.
To INCREASE withholding, decrease the number of allowances.
Additional Tax: If you want additional tax withheld: (1) estimate the yearly amount you have had under withheld; (2) divide the yearly
amount by the number of pay periods remaining in the calendar year and enter the result in the Additional Tax blocks. For Wisconsin
State tax, a Form WT-4A must be completed, if you are withholding only a fixed dollar amount. Additional tax withholding amounts are
taken from every check. If you wish to discontinue previously requested additional or fixed tax withholding, you must submit a new W4
and/or WT-4A.
Non-Wisconsin-Residents: If you reside outside of Wisconsin in a state that has no reciprocity agreement with Wisconsin, you are not a
Wisconsin resident, you perform work primarily outside of Wisconsin, but you earned wages while present in Wisconsin that are over
$1500 in a calendar year; complete this form and submit the completed form to the UW Service Center/Payroll for correct W-2
processing: Declaration of Wages for Non-Wisconsin-Residents.
Reference Pages
All IRS forms mentioned on this page can be found at http://www.irs.gov. For additional tax information, visit
https://uwservice.wisc.edu/tax/.