Form YearExtract the tax year from the form (e.g., 2023, 20...
First NameExtract employee first name and middle initial....
Last NameExtract employee last name....
SSNExtract Social Security Number (may be masked)....
AddressExtract employee home address (street, city, state...
Filing StatusIdentify filing status: Single or Married Filing S...
Multiple Jobs CheckboxIs Step 2(c) checkbox marked (multiple jobs or spo...
Qualifying ChildrenExtract number of qualifying children under 17 fro...
Child Tax Credit AmountExtract the calculated child tax credit amount ($2...
Other DependentsExtract number of other dependents from Step 3. Re...
Other Dependents AmountExtract the other dependents credit amount ($500 x...
Total CreditsExtract total claim amount from Step 3 (sum of cre...
Other IncomeExtract other income amount from Step 4(a) not fro...
DeductionsExtract deductions amount from Step 4(b) if claimi...
Extra WithholdingExtract extra withholding per pay period from Step...
Exempt StatusDid employee claim EXEMPT from withholding? Yes or...
Signature DateExtract the date employee signed the form. Return ...
Employer NameExtract employer name and address if completed....
Employer EINExtract employer EIN if shown. Return N/A if blank...
First Date of EmploymentExtract first date of employment if shown. Return ...