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Date And State
Check Date
State
Arizona
Alaska
Alabama
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
New York
New Hampshire
New Mexico
New Jersey
Nevada
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington DC
West Virginia
Wisconsin
Wyoming
General Information
Pay Type
Salaried
Hourly
Hourly Rate
Hours Per Period
Gross Pay
Gross Pay Method
Annually
Pay Per Period
Gross Pay YTD
Pay Frequency
Daily
Weekly
Bi-weekly
Semi-monthly
Monthly
Semi-Annually
Annual
Exempt from
Federal
Yes
No
Social Security Tax
Yes
No
Medicare
Yes
No
Federal Information
Use 2020 W4
Yes
No
Federal Filing Status
Single or Married Filing Separately
Married Filing Jointly or Qualifying Widow(er)
Head of Household
Nonresident Alien
Step 2: Two Jobs
Yes
No
Step 3: Dependents Amount
Step 4a: Other Income
Step 4b: Deductions
Federal Filing Status
Single
Married
Married Use Single Rate
# of Federal Allowances
Additional Federal Withholding
Round Federal Withholding
Yes
No
State Information
No State Information Required
State elected Percentage Rate
Zero
0.5
1.0
1.5
2.0
2.5
3.0
3.5
New York SDI
Yes
No
Total Allowances
Additional Withholding - NYC
Additional Withholding - Yonkers
Total Allowances - NYC
Filing Status
Single
Married
Married but use single rate
New York Paid Family Leave Insurance
Yes
No
California SDI
Yes
No
Total Allowances
Additional State Withholding
Basic Allowances
Additional Allowances
Annual Withholding Allowances
Colorado Paid Family and Medical Leave - Employee
Yes
No
Alaska SUI
Yes
No
Texarkana Resident
Yes
No
Pennsylvania SUI
Yes
No
Total Allowances
First-time Claimed Additional Dependent Exemptions
Adoption Exemptions
Dependent Exemptions
Personal Exemptions
Filing Status for Deduction
No Deduction
Single or Married Filing Separately
Married Filing Jointly
Head of household
Total Allowance
Zero
One
Two
Total Dependent
Exempt State
Yes
No
Additional State Withholding
Withholding code
NO_FORM
A
B
C
D
F
Total Allowance Amount
Age and Blindness Exemptions
Personal Exemptions
Rate code
Single - Code A
Married/Civil Union Couple Joint - Code B
Married/Civil Union Couple Separate - Code C
Head of Household - Code D
Surviving Spouse/Surviving Civil Union Partner - Code E
Personal Blindness
Yes
No
Spouse Blindness
Yes
No
Head Of Household
Yes
No
Maryland State Tax Exemption for PA Residents
Yes
No
Locale Information
No Locale Information Required
Address Line 1
Address Line 2
City
ZIP
ZIP+4
Resident
Resident
Nonresident
Exempt
Yes
No
Voluntary Deductions
Deductions
401k
HSA
Custom
Print a report
Print Report?
Yes - All reports
No
Print Info
ID (employee #, file #)
Employee Name
Address Line 1
Address Line 2
Address Line 3
Check #
Print # on check
Yes
No
Check Date
Remarks
Print company on check
Yes
No
Company sName
Address Line 1
Address Line 2
Address Line 3