adjunct packet · pdf fileadjunct packet checklist ... social security card ... hrc: call mr....

G:\GC\Forms\Adjunct Packet Checklist

Adjunct Packet Checklist When you accept an offer of employment with the Borough of Manhattan Community College, you must present ORIGINAL documents as outlined below.

□ Proof of Identity and Employment Eligibility Under federal law you must complete an Employment Verification (I-9) form in the presence of an HR officer. Be sure to bring appropriate proof of identity/eligibility to HR before your first day of work.

□ Social Security Card □ Personnel Information Form

□ CUNY Employment Application –Part 1 □ Amended Constitutional Oath Upon Appointment □ CUNY Employment Application –Part 2 □ Employee’s Withholding Allowance Certificate (W-4 and IT-2104) □ Addendum to Application for □ Transcript Employment

□ Two (2) Reference Letters If applicable, complete and return:

□ Direct Deposit of Net Pay Enrollment □ BMCC Computer System Accounts Please take time to familiarize yourself with the following: • Appointment and payroll processing • Available Benefits • Important information for Adjuncts • Claiming CUNY Service Credit • Listing of various policies/procedures on BMCC HR web. The timing of your initial pay check will be based on the process and our receipt of the above documents. If you have any questions about your appointment or payroll process, please call us at 212-220-8300. _____________________________ _________________________ Print Name Date _____________________________ Signature

Dear New Employee Welcome to BMCC. Attached are a variety of documents concerning your appointment to the college that you need to be aware of or must complete. Please read these materials carefully and provide all of the requested information as quickly as possible.

The offer of this employment is conditional upon satisfactory completion of all verifications, including but not limited to confirmation of academic and professional credential, necessary employment and background checks. Please be advised, that the primary vehicle of the departmental communication with departmental faculty is through the faculty member’s department mailbox. For this reason, you are required to check your mailbox each day you are on campus. This will ensure your timely receipt of important department and college notices.

We hope you will enjoy your experience at the college. Best wishes for a productive and successful career at BMCC. Sincerely,

Robert E. Diaz Vice President for Legal Affairs and Faculty & Staff Relations /New Employee

Borough of Manhattan Community College

Office of Human Resources

Personnel Information Form

Name (print) Social Security Number Title Department Date of Appointment

☐ Female ☐ Male Date of Birth__________________________

Ethnicity:

☐ African American ☐ Alaskan Native ☐ American Indian ☐ Asian

☐ Black ☐ Hispanic ☐ Italian American

☐ Pacific Islander ☐ Puerto Rican ☐ White ☐ Other

U.S. Citizen: ☐ Yes ☐ No If you are not a U.S. Citizen,

Of what country are you a citizen? What type of VISA are you holding: Expiration Date:

Are you a Veteran? ☐ Yes ☐ No If you are a veteran, please specify:

☐ Active Reserve ☐ Disabled ☐ Disabled Vietnam Era

☐ Inactive Reserve ☐ Retired ☐ Vietnam Era Home Address: (print) Telephone Number: E‐Mail Address Emergency Contact: Relationship: Address: Telephone Number: Business Number:

Education: Degree Major Date Earned Institution___________

To be completed by the Office of Human Resources

I‐9 Date: ______________ Work Authorization Expiration Date: _______________ Staff Initial_________ Date: ________

HR‐2000

Tax Certification for Foreign Nationals (Excluding Applicants with Permanent Resident Status)

The City University of New York has currently implemented the GLACIER online tax compliance system and all Foreign Nationals will be required to register through it, in order to ensure that the appropriate taxation is deducted from you wages. To complete your individual tax record, you will need to obtain instructions and a password from the Office of Human Resources. Please contact the individuals listed below at your earliest convenience, but no later than 10 days after your employment begins. Gloria Chao Phone Number: (212) 220-8300 E-Mail Address: [email protected] Please note that unless your record is completed in GLACIER, and copies of the supported documents are submitted, the Payroll Office had been instructed to withhold taxes at the maximum rate of withholding until your record in GLACIER has been completed. Furthermore, any taxes withheld will not be refunded by the Payroll office under circumstance.

I have been notified of my requirements to complete certain information in GLACIER. I understand that I must go to the Office of Human Resources to obtain access and instructions for GLACIER.

Employee Name (Print)

Employee Signature Date

E-mail Address (CUNY e-mail preferred) Employee Phone Number

Form I-9 Certifier Signature Date

BENEFITS AVAILABLE FOR ELIGIBLE ADJUNCTS

Health Insurance

Health insurance coverage is available to Adjuncts through the NYCHBP. Benefits will

be provided to an eligible adjunct that is not covered by other primary health care from

any other source, including but not limited to other employment, spouse/domestic

partner’s employment or the New York State Health Insurance Program (NYSHIP).

Available plans: Ask for Rate Sheet for Adjuncts.

Eligibility: To be eligible for this benefit, the adjunct must be paid with tax-

levy money (not Research Foundation or Grants) and must meet

the following requirements:

Teaching adjuncts---Working six (6) or more credit hours per week, consecutively for

the entire semester will be eligible for health coverage pending them worked one or two

courses per week for the past 2 semesters.

Non-teaching adjuncts---Working fifteen (15) or more credit hours per week,

consecutively for the entire semester will be eligible for health coverage pending they

worked at least fifteen (15) or more credit hours per week for the past 2 semesters.

Employees have 30 days from beginning of semester to enroll.

Employees teaching at more than one college need to contact the Benefits Officer at each

school to certify eligibility.

Pension

All adjuncts are eligible to join the New York City Teachers’ Retirement System

(TRS). Membership is optional. After enrolling, employee contribution is based on

salary.

Contribution Rate

--$45,000 or less: 3.00%

--More than $45,000 to $55,000 3.50%

--More than $55,000 to $75,000 4.50 %

--More than $75,000 to $100,000 5.75%

--More than $100,000 6.00%

Under IRS rulings and regulations, CUNY employees who are eligible to participate in

TRS are deemed to be “active employees” in a pension plan whether or not they actually

elected to participate in TRS. Therefore, the City of New York is obliged to check the

box on each employee’s form W-2 indicating to the IRS that he/she is a participant in a

defined pension plan.

Tax Deferred Annuity

Yearly maximum $18,000 (2015)

Tax deferred annuity plans are available for adjuncts.

Available plans: TIAA/CREF-SRA: N. Dargenson (800) 842-2733 ext. 4877 for an

appointment.

TRS-TDA: (TRS members only) (888) 869-2877

HRC: Call Mr. Alvin Piket at (800) 786-1598

Tuition Waiver

All adjuncts that have been teaching ten (10) consecutive semesters in the same

department at one CUNY College are eligible for a tuition waiver within CUNY

colleges only. One course of undergraduate or graduate allowed per semester.

NOTE: Only tax-levy services are counted toward benefits eligibility.

Summer and winter sessions are excluded for purpose of determining eligibility.

For more information and enrollment applications, please contact Ms. Amparo Lopez-

Moreno, Room S717E, (212) 220-8301 or email [email protected]

mailto:[email protected]

Important information for Adjuncts

Department Mail Boxes and Email Accounts

The primary Vehicle for the departmental communication with departmental faculty is

through eh faculty member’s department mailbox. For this reason, you are required to check

your mailbox each day you are on campus. This will ensure your timely receipt of important

department and college notices.

The college provides each adjunct with a college email account, In order to use the

college’s e‐mail and computer systems, you will need usernames and passwords.

Adjunct faculty must apply for a login ID, BMCC e‐mail address, and voice mailbox. Your

login ID is required to access the school’s computer systems and final grading. All official

college correspondences and Helpdesk requests that are generated in your name are sent to

your BMCC e‐mail address,

Please stop by the Helpdesk, located in room S‐141A (Inside the College Computer

Center, Room S‐141) to complete the Accounts and Passwords form to apply for these IDs and

voice mail box. Requests to create them will be generated, and soon after a technician will

contact you.

For security reasons, you must bring with you your faculty/staff ID.

Policy on Hiring and Paying Adjuncts as Adjunct Assistant Professor, Adjunct Associate

Professor or Adjunct Professor

A. All persons hired as adjuncts are processed by the Office of Human Resources as adjunct

lecturers. They will be processed at ta higher title only under the following

circumstances:

1. (a). An employee will be processed as an Adjunct Assistant Professor if on the

Personnel Data Form he/she indicates that he/she has a PH’D. We accept

this represent5ation in good faith. This decision is, however, subject to

verification through the presentation of official college transcripts. If the

employee fails to provide documentation by the end of the appointment

period, he/she will not be reappointed to the adjunct assistant professor

title until the necessary documentation is presented.

(b). An employee who has a CUNY approved equivalency related to the work

of the depart they are teaching in, will be placed in the Adjunct Assistant

Professor title upon presentation of the CUNY approved equivalency.

2. If the employee presents evidence that they have been working at another CUNY

campus as an Adjunct Associate Professor or Adjunct Professor, BMCC will honor

this prior rank once verified. Salary rate, however, will be based on the entry

rate of pay for the title plus any adjustment required by the labor contract based

on consecutive semesters of service at CUNY. This adjustment will be based on

the Office of Human Resources review of the employee’s CUNY service record. It

is the obligation of the employee to provide his prior serviced record to verify

rank and rate. BMCC will make adjustments to rank or rate retroactive to the

first day of the semester in which documentation verifying the adjustment is

authorized had been presented.

3. If the employee worked at a non‐CUNY college in a higher title, the employee

will be considered for the higher title only if the Department Chairperson

Submits a written recommendation to the Senior Vice President indicating what

title the chairperson believes the employee should be placed at and why. The

employee will initially be processed as an Adjunct Assistant Processor. Upon

receipt of a memorandum form the Senior Vice President approving the

recommendation, the Office of Human Resources will process the adjustment

recommended by the Senior Vice President retroactive to the first day of the

semester.

G:\GC\Forms\Important information for Adjuncts

New Hire Account Request Form

Your OFFICIAL NAME must be used on this form. Please PRINT or TYPE all information.

Personal Information

Full Name:

Last First M.I.

DOB: Last 4 SSN:

Job Information

Job Title: Department:

Department’s Ext.: Employee ID:

New/ Old Ext. Line: Room # :

Hired By BMCC....………….. [ ] Research Found…………. [ ]

Position/Function Full Time………….. [ ] Part Time…………. [ ]

Faculty…………….. [ ] Staff……………….. [ ] Student-Staff………… [ ]

New Account (s) Computer…………………… [ ] Email…………….... [ ] Phone/Voicemail………… [ ] Copy/Print………… [ ]

Room Acs/Keys

Comments:

Approval

Please provide ONE signature of approval before returning This Form to the Help Desk, Room S-141

Vice-president:

Last First Date Signature

Director/Manager:


Chairperson:


Any missing or unclear information will result in a delay in the process.

OFFICE USE ONLY

Date Received: AD/Email Copy/Print Access/Keys

Received By:

Date Completed: Telephony Web Directory Others

Completed By:

Form W-4 Department of the Treasury Internal Revenue Service

Employee's Withholding Allowance Certificate

subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.

OMB No. 1545-0074

2015 1 Your first name and middle initial Last name 2 Your social security number

Home address (number and street or rural route) 3 Single Married Married, but withhold at higher Single rate.

Note. If married, but legally separated, or spouse is a nonresident alien, check the “Single” box.

City or town, state, and ZIP code 4 If your last name differs from that shown on your social security card, check here. You must call 1-800-772-1213 for a replacement card. ▶

5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2)

6 Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . .

5

6 $

7 I claim exemption from withholding for 2015, and I certify that I meet both of the following conditions for exemption.

• Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and

• This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.

If you meet both conditions, write “Exempt” here . . . . . . . . . . . . . . . ▶ 7

(This form is not valid unless you sign it.) ▶ Date ▶

8 Employer’s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.) 9 Office code (optional) 10 Employer identification number (EIN)

}

{

Form W-4 (2015)

Purpose. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes.

Exemption from withholding. If you are exempt, complete only lines 1, 2, 3, 4, and 7 and sign the form to validate it. Your exemption for 2015 expires February 16, 2016. See Pub. 505, Tax Withholding and Estimated Tax.

Note. If another person can claim you as a dependent on his or her tax return, you cannot claim exemption from withholding if your income exceeds $1,050 and includes more than $350 of unearned income (for example, interest and dividends).

Exceptions. An employee may be able to claim exemption from withholding even if the employee is a dependent, if the employee:

• Is age 65 or older,

• Is blind, or

• Will claim adjustments to income; tax credits; or itemized deductions, on his or her tax return.

The exceptions do not apply to supplemental wages greater than $1,000,000.

Basic instructions. If you are not exempt, complete the Personal Allowances Worksheet below. The worksheets on page 2 further adjust your withholding allowances based on itemized deductions, certain credits, adjustments to income, or two-earners/multiple jobs situations.

Complete all worksheets that apply. However, you may claim fewer (or zero) allowances. For regular wages, withholding must be based on allowances you claimed and may not be a flat amount or percentage of wages.

Head of household. Generally, you can claim head of household filing status on your tax return only if you are unmarried and pay more than 50% of the costs of keeping up a home for yourself and your dependent(s) or other qualifying individuals. See Pub. 501, Exemptions, Standard Deduction, and Filing Information, for information.

Tax credits. You can take projected tax credits into account in figuring your allowable number of withholding allowances. Credits for child or dependent care expenses and the child tax credit may be claimed using the Personal Allowances Worksheet below. See Pub. 505 for information on converting your other credits into withholding allowances.

Nonwage income. If you have a large amount of nonwage income, such as interest or dividends, consider making estimated tax payments using Form 1040-ES, Estimated Tax for Individuals. Otherwise, you may owe additional tax. If you have pension or annuity income, see Pub. 505 to find out if you should adjust your withholding on Form W-4 or W-4P.

Two earners or multiple jobs. If you have a working spouse or more than one job, figure the total number of allowances you are entitled to claim on all jobs using worksheets from only one Form W-4. Your withholding usually will be most accurate when all allowances are claimed on the Form W-4 for the highest paying job and zero allowances are claimed on the others. See Pub. 505 for details.

Nonresident alien. If you are a nonresident alien, see Notice 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, before completing this form.

Check your withholding. After your Form W-4 takes effect, use Pub. 505 to see how the amount you are having withheld compares to your projected total tax for 2015. See Pub. 505, especially if your earnings exceed $130,000 (Single) or $180,000 (Married).

Future developments. Information about any future developments affecting Form W-4 (such as legislation enacted after we release it) will be posted at www.irs.gov/w4.

Personal Allowances Worksheet (Keep for your records.) A Enter “1” for yourself if no one else can claim you as a dependent . . . . . . . . . . . . . . . . . . A

B Enter “1” if: { • You are single and have only one job; or

• You are married, have only one job, and your spouse does not work; or

• Your wages from a second job or your spouse’s wages (or the total of both) are $1,500 or less.

. . . B

C Enter “1” for your spouse. But, you may choose to enter “-0-” if you are married and have either a working spouse or more than one job. (Entering “-0-” may help you avoid having too little tax withheld.) . . . . . . . . . . . . . . C

D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . . . . . D

E Enter “1” if you will file as head of household on your tax return (see conditions under Head of household above) . . E

F Enter “1” if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit . . . F

(Note. Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)

G Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information. • If your total income will be less than $65,000 ($100,000 if married), enter “2” for each eligible child; then less “1” if you have two to four eligible children or less “2” if you have five or more eligible children.

• If your total income will be between $65,000 and $84,000 ($100,000 and $119,000 if married), enter “1” for each eligible child . . . G H Add lines A through G and enter total here. (Note. This may be different from the number of exemptions you claim on your tax return.) ▶ H

For accuracy, complete all worksheets that apply.

• If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions and Adjustments Worksheet on page 2.

• If you are single and have more than one job or are married and you and your spouse both work and the combined earnings from all jobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 to avoid having too little tax withheld.

• If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below.

Separate here and give Form W-4 to your employer. Keep the top part for your records.

▶ Whether you are entitled to claim a certain number of allowances or exemption from withholding is

Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete.

Employee’s signature

For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 10220Q Form W-4 (2015)

Form W-4 (2015) Page 2

Deductions and Adjustments WorksheetNote. Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income. 1 Enter an estimate of your 2015 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state

and local taxes, medical expenses in excess of 10% (7.5% if either you or your spouse was born before January 2, 1951) of your income, and miscellaneous deductions. For 2015, you may have to reduce your itemized deductions if your income is over $309,900 and you are married filing jointly or are a qualifying widow(er); $284,050 if you are head of household; $258,250 if you are single and not head of household or a qualifying widow(er); or $154,950 if you are married filing separately. See Pub. 505 for details . . . . 1 $

2 Enter: { $9,250 if head of household } . . . . . . . . . . . 2 $

$12,600 if married filing jointly or qualifying widow(er)

$6,300 if single or married filing separately

3 Subtract line 2 from line 1. If zero or less, enter “-0-” . . . . . . . . . . . . . . . . 3 $ 4 Enter an estimate of your 2015 adjustments to income and any additional standard deduction (see Pub. 505) 4 $ 5 Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to

Withholding Allowances for 2015 Form W-4 worksheet in Pub. 505.) . . . . . . . . . . . . 5 $

6 Enter an estimate of your 2015 nonwage income (such as dividends or interest) . . . . . . . . 6 $ 7 Subtract line 6 from line 5. If zero or less, enter “-0-” . . . . . . . . . . . . . . . . 7 $ 8 Divide the amount on line 7 by $4,000 and enter the result here. Drop any fraction . . . . . . . 8

9 Enter the number from the Personal Allowances Worksheet, line H, page 1 . . . . . . . . . 9

10 Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/Multiple Jobs Worksheet, also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1 10

Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.)Note. Use this worksheet only if the instructions under line H on page 1 direct you here.

1 Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet) 1 2 Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if

you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more than “3” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter “-0-”) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet . . . . . . . . . 3

Note. If line 1 is less than line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4 through 9 below to figure the additional withholding amount necessary to avoid a year-end tax bill.

4 Enter the number from line 2 of this worksheet . . . . . . . . . . 4

5 Enter the number from line 1 of this worksheet . . . . . . . . . . 5

6 Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . . . . 7 $ 8 Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed . . 8 $ 9 Divide line 8 by the number of pay periods remaining in 2015. For example, divide by 25 if you are paid every two

weeks and you complete this form on a date in January when there are 25 pay periods remaining in 2015. Enter the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld from each paycheck 9 $

Table 1 Table 2 Married Filing Jointly All Others Married Filing Jointly All Others

If wages from LOWEST paying job are—

Enter on line 2 above

If wages from LOWEST paying job are—


If wages from HIGHEST paying job are—


If wages from HIGHEST paying job are—


$0 - $6,000 6,001 - 13,000

13,001 - 24,000 24,001 - 26,000 26,001 - 34,000 34,001 - 44,000 44,001 - 50,000 50,001 - 65,000 65,001 - 75,000 75,001 - 80,000 80,001 - 100,000

100,001 - 115,000 115,001 - 130,000 130,001 - 140,000 140,001 - 150,000 150,001 and over

0 1 2 3 4 5 6 7 8 9

10 11 12 13 14 15

$0 - $8,000 8,001 - 17,000 17,001 - 26,000

26,001 - 34,000 34,001 - 44,000 44,001 - 75,000 75,001 - 85,000 85,001 - 110,000

110,001 - 125,000 125,001 - 140,000 140,001 and over

0 1 2 3 4 5 6 7 8 9

10

$0 - $75,000 75,001 - 135,000

135,001 - 205,000 205,001 - 360,000 360,001 - 405,000

405,001 and over

$600 1,000 1,120 1,320 1,400

1,580

$0 - $38,000 38,001 - 83,000

83,001 - 180,000 180,001 - 395,000 395,001 and over

$600 1,000 1,120 1,320 1,580

Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Internal Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your employer uses it to determine your federal income tax withholding. Failure to provide a properly completed form will result in your being treated as a single person who claims no withholding allowances; providing fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws; and to the Department of Health and Human Services for use in the National Directory of New Hires. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax 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.

First name and middle initial Last name Your social security number

Permanent home address (number and street or rural route) Apartment number

City,village,orpostoffice State ZIPcode

Are you a resident of New York City? ........... Yes NoAre you a resident of Yonkers? ..................... Yes NoComplete the worksheet on page 3 before making any entries.1 TotalnumberofallowancesyouareclaimingforNewYorkStateandYonkers,ifapplicable(from line 17) ........... 12 Total number of allowances for New York City (from line 28) .................................................................................. 2

Use lines 3, 4, and 5 below to have additional withholding per pay period under special agreement with your employer.

3 NewYorkStateamount ........................................................................................................................................ 34 New York City amount ........................................................................................................................................... 45 Yonkers amount .................................................................................................................................................... 5

NewYorkStateDepartmentofTaxationandFinance

Employee’sWithholdingAllowanceCertificate NewYorkState•NewYorkCity•Yonkers

SingleorHeadofhousehold Married

Married, but withhold at higher single rate

Note:Ifmarriedbutlegallyseparated,markanX in the Single or Head of household box.

IcertifythatIamentitledtothenumberofwithholdingallowancesclaimedonthiscertificate.Employee’ssignature Date

Employer’s name and address (Employer: complete this section only if you are sending a copy of this form to the NYS Tax Department.) Employeridentificationnumber

Penalty – A penalty of $500 may be imposed for any false statement you make that decreases the amount of money you have withheld from your wages. You may also be subject to criminal penalties.

Employee: detach this page and give it to your employer; keep a copy for your records.

Changes effective for 2015FormIT-2104hasbeenrevisedfortaxyear2015.Theworksheetonpage3,thechartsbeginningonpage4,andtheadditionaldollaramountsintheinstructionsonpage2,usedtocomputewithholdingallowancesortoenteranadditionaldollaramountonline(s)3,4,or5,havebeenrevised.IfyoupreviouslyfiledaFormIT-2104andusedtheworksheet,charts,oradditionaldollaramounts,youshouldcompleteanew2015FormIT-2104andgiveittoyouremployer.

WhoshouldfilethisformThiscertificate,FormIT-2104,iscompletedbyanemployeeandgiventotheemployertoinstructtheemployerhowmuchNewYorkState(andNewYorkCityandYonkers)taxtowithholdfromtheemployee’spay.Themoreallowancesclaimed,thelowertheamountoftaxwithheld.

IfyoudonotfileFormIT-2104,youremployermayusethesamenumberofallowancesyouclaimedonfederalFormW-4.Duetodifferencesintaxlaw,thismayresultinthewrongamountoftaxwithheldforNewYorkState,NewYorkCity,andYonkers.CompleteFormIT-2104eachyear

andfileitwithyouremployerifthenumberofallowancesyoumayclaimisdifferentfromfederalFormW-4orhaschanged.CommonreasonsforcompletinganewFormIT-2104eachyearincludethefollowing:• Youstartedanewjob.• Youarenolongeradependent.• Yourindividualcircumstancesmayhavechanged(forexample,you

were married or have an additional child).• YoumovedintooroutofNYCorYonkers.• Youitemizeyourdeductionsonyourpersonalincometaxreturn.• YouclaimallowancesforNewYorkStatecredits.• Youowedtaxorreceivedalargerefundwhenyoufiledyourpersonalincometaxreturnforthepastyear.

• Yourwageshaveincreasedandyouexpecttoearn$106,200ormoreduringthetaxyear.

• Thetotalincomeofyouandyourspousehasincreasedto$106,200ormoreforthetaxyear.

• Youhavesignificantlymoreorlessincomefromothersourcesorfromanother job.

• Younolongerqualifyforexemptionfromwithholding.

Instructions

Employer: Keepthiscertificatewithyourrecords.Mark an XinboxAand/orboxBtoindicatewhyyouaresendingacopyofthisformtoNewYorkState (see instructions):

A Employeeclaimedmorethan14exemptionallowancesforNYS ............ A

B Employeeisanewhireorarehire ... B Firstdate employee performed services for pay (mm-dd-yyyy) (see instr.):

Aredependenthealthinsurancebenefitsavailableforthisemployee? ............. Yes No

IfYes,enterthedatetheemployeequalifies(mm-dd-yyyy):

IT-2104

of 7 IT-2104 (2015)

• YouhavebeenadvisedbytheInternalRevenueServicethatyouare entitled to fewer allowances than claimed on your original federal FormW-4,andthedisallowedallowanceswereclaimedonyouroriginalFormIT-2104.

Exemption from withholdingYoucannotuseFormIT-2104toclaimexemptionfromwithholding.Toclaimexemptionfromincometaxwithholding,youmustfileFormIT-2104-E,Certificate of Exemption from Withholding, with your employer.Youmustfileanewcertificateeachyearthatyouqualifyforexemption.ThisexemptionfromwithholdingisallowableonlyifyouhadnoNewYorkincometaxliabilityintheprioryear,youexpectnoneinthecurrent year, andyouareover65yearsofage,under18,orafull-timestudentunder25.Youmayalsoclaimexemptionfromwithholdingifyou are a military spouse and meet the conditions set forth under the ServicemembersCivilReliefActasamendedbytheMilitarySpousesResidencyReliefAct.Ifyouareadependentwhoisunder18orafull-timestudent,youmayowetaxifyourincomeismorethan$3,100.

Withholding allowancesYou may not claim a withholding allowance for yourself or, if married, your spouse. Claim the number of withholding allowances you compute inPart1andPart3onpage3ofthisform.Ifyouwantmoretaxwithheld, you may claim fewer allowances. If you claim more than 14 allowances, your employer must send a copy of your Form IT-2104 totheNewYorkStateTaxDepartment.Youmaythenbeaskedtoverifyyourallowances.Ifyouarriveatnegativeallowances(lessthanzero)onlines1or2andyouremployercannotaccommodatenegativeallowances, enter 0 and see Additional dollar amount(s) below.

Income from sources other than wages –Ifyouhavemorethan$1,000ofincomefromsourcesotherthanwages(suchasinterest,dividends, or alimony received), reduce the number of allowances claimedonline1andline2(ifapplicable)oftheIT-2104certificatebyoneforeach$1,000ofnonwageincome.Ifyouarriveatnegativeallowances(lessthanzero),seeWithholding allowances above. You may also considerfilingestimatedtax,especiallyifyouhavesignificantamountsofnonwageincome.EstimatedtaxrequiresthatpaymentsbemadebytheemployeedirectlytotheTaxDepartmentonaquarterlybasis.Formoreinformation,seetheinstructionsforFormIT-2105,Estimated Tax Payment Voucher for Individuals, or see Need help?onpage6.

Other credits (Worksheetline13) – Ifyouwillbeeligibletoclaimany credits other than the credits listed in the worksheet, such as an investmenttaxcredit,youmayclaimadditionalallowances.

FindyourfilingstatusandyourNewYorkadjustedgrossincome(NYAGI)inthechartbelow,anddividetheamountoftheexpectedcreditbythenumber indicated. Enter the result (rounded to the nearest whole number) online13.

Example: You are married and expect your New York adjusted gross income to be less than $318,750. In addition, you expect to receive a flow-through of an investment tax credit from the S corporation of which you are a shareholder. The investment tax credit will be $160. Divide the expected credit by 66. 160/66 = 2.4242. The additional withholding allowance(s) would be 2. Enter 2 on line 13.

Married couples with both spouses working –Ifyouandyourspousebothwork,youshouldeachfileaseparateIT-2104certificatewithyourrespectiveemployers.Yourwithholdingwillbettermatchyourtotaltaxifthehigherwage-earningspouseclaimsallofthecouple’sallowancesandthelowerwage-earningspouseclaimszeroallowances.Do not claim moretotalallowancesthanyouareentitledto.Ifyourcombinedwagesare:• lessthan$106,200,youshouldeachmarkanXintheboxMarried,

but withhold at higher single rateonthecertificatefront,anddividethe

totalnumberofallowancesthatyoucomputeonline17andline28(ifapplicable) between you and your working spouse.

• $106,200ormore,usethechart(s)inPart4andentertheadditionalwithholding dollar amount on line 3.

Taxpayers with more than one job –Ifyouhavemorethanonejob,fileaseparateIT-2104certificatewitheachofyouremployers.Besure to claim only the total number of allowances that you are entitled to.Yourwithholdingwillbettermatchyourtotaltaxifyouclaimallofyourallowancesatyourhigher-payingjobandzeroallowancesatthelower-payingjob.Inaddition,tomakesurethatyouhaveenoughtaxwithheld,ifyouareasingletaxpayerorheadofhouseholdwithtwo or more jobs, and your combined wages from all jobs are under $106,200,reducethenumberofallowancesbysevenonline1andline2(ifapplicable)onthecertificateyoufilewithyourhigher-payingjobemployer.Ifyouarriveatnegativeallowances(lessthanzero),see Withholding allowances above.

Ifyouareasingleoraheadofhouseholdtaxpayer,andyourcombinedwagesfromallofyourjobsarebetween$106,200and$2,231,827,usethe chart(s) in Part 5 and enter the additional withholding dollar amount from the chart on line 3.

Ifyouareamarriedtaxpayer,andyourcombinedwagesfromallofyourjobsare$106,200ormore,usethechart(s)inPart4andentertheadditionalwithholdingdollaramountfromthechartonline3(Substitutethe words Higher-paying job for Higher earner’s wages within the chart).

Dependents – Ifyouareadependentofanothertaxpayerandexpectyourincometoexceed$3,100,youshouldreduceyourwithholdingallowancesbyoneforeach$1,000ofincomeover$2,500.Thiswillensurethatyouremployerwithholdsenoughtax.

Following the above instructions will help to ensure that you will not owe additionaltaxwhenyoufileyourreturn.

Heads of households with only one job – Ifyouwillusethehead-of-householdfilingstatusonyourstateincometaxreturn,markthe Single or Head of householdboxonthefrontofthecertificate.Ifyouhave only one job, you may also wish to claim two additional withholding allowancesonline14.

Additional dollar amount(s)You may ask your employer to withhold an additional dollar amount each payperiodbycompletinglines3,4,and5onFormIT-2104.Inmostinstances, if you compute a negative number of allowances and your employer cannot accommodate a negative number, for each negative allowanceclaimedyoushouldhaveanadditional$1.85oftaxwithheldperweekforNewYorkStatewithholdingonline3,andanadditional$0.80oftaxwithheldperweekforNewYorkCitywithholdingonline4.Yonkersresidentsshoulduse16.75%(.1675)oftheNewYorkStateamountforadditional withholding for Yonkers on line 5.

Note:Ifyouarerequestingyouremployertowithholdanadditionaldollaramountonlines3,4,or5ofthisallowancecertificate,theadditionaldollar amount, as determined by these instructions or by using the chart(s)inPart4orPart5,isaccurateforaweeklypayroll.Therefore,if you are not paid on a weekly basis, you will need to adjust the dollar amount(s)thatyoucompute.Forexample,ifyouarepaidbiweekly,youmust double the dollar amount(s) computed.

Avoid underwithholdingFormIT-2104,togetherwithyouremployer’swithholdingtables,isdesignedtoensurethatthecorrectamountoftaxiswithheldfromyourpay.Ifyoufailtohaveenoughtaxwithheldduringtheentireyear,youmayowealargetaxliabilitywhenyoufileyourreturn.TheTaxDepartmentmustassess interest and may impose penalties in certain situations in addition tothetaxliability.Evenifyoudonotfileareturn,wemaydeterminethatyouowepersonalincometax,andwemayassessinterestandpenaltiesontheamountoftaxthatyoushouldhavepaidduringtheyear.

Single and NYAGI is:

Head of household and NYAGI is:

Married and NYAGI is:

Divide amount of expected credit by:

Less than Less than Less than 66 $212,500 $265,600 $318,750 Between Between Between $212,500and $265,600and $318,750and 68 $1,062,650 $1,594,050 $2,125,450 Over Over Over 88 $1,062,650 $1,594,050 $2,125,450

(continued)

IT-2104 (2015) Page 3 of 7

WorksheetSee the instructions before completing this worksheet.

Part 1 – Complete this part to compute your withholding allowances for New York State and Yonkers (line1).

Part 3 – Complete this part to compute your withholding allowances for New York City (line2).

Part 2 – Complete this part only if you expect to itemize deductions on your state return.

18 Enteryourestimatedfederalitemizeddeductionsforthetaxyear ........................................................................................... 18 19 Enteryourestimatedstate,local,andforeignincometaxesorstateandlocalgeneralsalestaxesincludedonline18 ........ 19 20 Subtractline19fromline18 .................................................................................................................................................... 20 21 Enteryourestimatedcollegetuitionitemizeddeduction .......................................................................................................... 21 22 Addlines20and21 ................................................................................................................................................................. 22 23 Basedonyourfederalfilingstatus,entertheapplicableamountfromthetablebelow ........................................................... 23

Single(cannotbeclaimedasadependent) .... $ 7,900 Qualifyingwidow(er) ........................................ $15,850 Single(canbeclaimedasadependent) ....... $ 3,100 Marriedfilingjointly .......................................... $15,850 Headofhousehold......................................... $11,100 Marriedfilingseparatereturns ......................... $ 7,900

24 Subtractline23fromline22(if line 23 is larger than line 22, enter 0 here and on line 16 above) ....................................................... 24 25 Divideline24by$1,000.Dropanyfractionandentertheresulthereandonline16above ................................................... 25

26 Entertheamountfromline6above ......................................................................................................................................... 26 27 Addlines14through16aboveandentertotalhere ................................................................................................................ 27 28 Addlines26and27.Entertheresulthereandonline2 ......................................................................................................... 28

6 Enter the number of dependents that you will claim on your state return (do not include yourself or, if married, your spouse) ..... 6 For lines 7, 8, and 9, enter 1 for each credit you expect to claim on your state return. 7 College tuition credit .................................................................................................................................................................. 7 8 NewYorkStatehouseholdcredit ............................................................................................................................................... 8 9 Realpropertytaxcredit .............................................................................................................................................................. 9 For lines 10, 11, and 12, enter 3 for each credit you expect to claim on your state return. 10 Child and dependent care credit ................................................................................................................................................ 10 11 Earned income credit ................................................................................................................................................................. 11 12 EmpireStatechildcredit ............................................................................................................................................................ 12 13 Other credits (see instructions) ...................................................................................................................................................... 13 14 Headofhouseholdstatusand only one job (enter 2 if the situation applies) ................................................................................... 14 15 Enteranestimateofyourfederaladjustmentstoincome,suchasalimonyyouwillpayforthetaxyear anddeductibleIRAcontributionsyouwillmakeforthetaxyear.Totalestimate$ . Dividethisestimateby$1,000.Dropanyfractionandenterthenumber .............................................................................. 15 16 Ifyouexpecttoitemizedeductionsonyourstatetaxreturn,completePart2belowandenterthenumberfromline25. All others enter 0 ................................................................................................................................................................... 16 17 Addlines6through16.Entertheresulthereandonline1.Ifyouhavemorethanonejob,orifyouandyourspouseboth work, see instructions for Taxpayers with more than one job or Married couples with both spouses working. ..................... 17

Standard deduction table

EmployersBox A – Ifyouarerequiredtosubmitacopyofanemployee’sFormIT-2104totheTaxDepartmentbecausetheemployeeclaimedmorethan14allowances,markanX inboxAandsendacopyofFormIT-2104to:NYS Tax Department, Income Tax Audit Administrator,WithholdingCertificateCoordinator,WAHarrimanCampus, Albany NY 12227-0865.Iftheemployeeisalsoanewhireorrehire, see Box B instructions.

Duedatesforsendingcertificatesreceivedfromemployeesclaimingmorethan14allowancesare:Quarter Due date Quarter Due dateJanuary–March April30 July–September October31April–June July31 October–December January31

Box B – IfyouaresubmittingacopyofthisformtocomplywithNewYorkState’sNewHireReportingProgram,markanX inboxB.Enterthefirstdayanyservicesareperformedforwhichtheemployeewillbepaidwages, commissions, tips and any other type of compensation. For servicesbasedsolelyoncommissions,thisisthefirstdayanemployeeworking for commissions is eligible to earn commissions. Also, mark an X in the Yes or Noboxindicatingifdependenthealthinsurancebenefitsareavailabletothisemployee.IfYes,enterthedatetheemployeequalifiesforcoverage.Mailthecompletedform,within20daysofhiring,to:NYS TaxDepartment,NewHireNotification,POBox15119,AlbanyNY12212-5119. Toreportnewly-hiredorrehiredemployeesonlineinsteadofsubmitting this form, go to www.nynewhire.com.

of 7 IT-2104 (2015)

Part 4 – These charts are only for married couples with both spouses working or married couples with one spouse working more than onejob,andwhosecombinedwagesarebetween$106,200and$2,231,827.

Enter the additional withholding dollar amount on line 3.

Theadditionaldollaramount,asshownbelow,isaccurateforaweeklypayroll.Ifyouarenotpaidonaweeklybasis,youwillneedtoadjustthesedollaramount(s).Forexample,ifyouarepaidbiweekly,youmustdoublethedollaramount(s)computed.

$106,200 $127,500 $148,700 $169,950 $191,200 $233,700 $276,250 $318,750 $371,900 $425,050 $478,200 $127,499 $148,699 $169,949 $191,199 $233,699 $276,249 $318,749 $371,899 $425,049 $478,199 $531,299

$53,100 $74,299 $11 $16

$74,300 $95,549 $11 $17 $22 $27

$95,550 $116,799 $8 $15 $20 $27 $34

$116,800 $127,499 $2 $10 $16 $23 $32 $31

$127,500 $138,099 $4 $13 $20 $30 $29

$138,100 $148,699 $2 $10 $17 $27 $29 $26

$148,700 $159,349 $4 $14 $25 $29 $24

$159,350 $170,149 $2 $11 $21 $27 $24 $22

$170,150 $191,199 $4 $16 $22 $23 $22 $18

$191,200 $233,699 $6 $12 $18 $20 $18 $19

$233,700 $276,249 $6 $12 $23 $25 $19 $18

$276,250 $318,749 $6 $18 $30 $26 $19

$318,750 $371,899 $10 $20 $27 $22

$371,900 $425,049 $8 $16 $23

$425,050 $478,199 $8 $16

$478,200 $531,299 $8

Combined wages between $106,200 and $531,299Higher earner’s wages

$531,300 $584,450 $637,600 $690,700 $743,850 $797,000 $850,150 $903,300 $956,450 $1,009,550 $1,062,650 $1,115,850 $584,449 $637,599 $690,699 $743,849 $796,999 $850,149 $903,299 $956,449 $1,009,549 $1,062,649 $1,115,849 $1,168,949

$233,700 $276,249 $18

$276,250 $318,749 $20 $16

$318,750 $371,899 $15 $17 $19 $14

$371,900 $425,049 $18 $11 $13 $15 $7 $7

$425,050 $478,199 $23 $18 $11 $13 $15 $7 $7 $7

$478,200 $531,299 $16 $23 $18 $11 $13 $15 $7 $7 $7 $7

$531,300 $584,449 $8 $16 $23 $18 $11 $13 $15 $7 $7 $7 $8 $11

$584,450 $637,599 $8 $16 $23 $18 $11 $13 $15 $7 $7 $8 $11

$637,600 $690,699 $8 $16 $23 $18 $11 $13 $15 $7 $8 $11

$690,700 $743,849 $8 $16 $23 $18 $11 $13 $15 $8 $11

$743,850 $796,999 $8 $16 $23 $18 $11 $13 $16 $11

$797,000 $850,149 $8 $16 $23 $18 $11 $14 $19

$850,150 $903,299 $8 $16 $23 $18 $12 $17

$903,300 $956,449 $8 $16 $23 $20 $15

$956,450 $1,009,549 $8 $16 $24 $23

$1,009,550 $1,062,649 $8 $17 $27

$1,062,650 $1,115,849 $9 $19

$1,115,850 $1,168,949 $9

Combined wages between $531,300 and $1,168,949

Higher earner’s wages

IT-2104 (2015) Page 5 of 7

$1,168,950 $1,222,100 $1,275,300 $1,328,400 $1,381,500 $1,434,700 $1,487,800 $1,540,900 $1,594,050 $1,647,250 $1,222,099 $1,275,299 $1,328,399 $1,381,499 $1,434,699 $1,487,799 $1,540,899 $1,594,049 $1,647,249 $1,700,399

$584,450 $637,599 $14 $17

$637,600 $690,699 $14 $17 $20 $23

$690,700 $743,849 $14 $17 $20 $23 $26 $30

$743,850 $796,999 $14 $17 $20 $23 $26 $30 $33 $36

$797,000 $850,149 $14 $17 $20 $23 $26 $30 $33 $36 $39 $42

$850,150 $903,299 $22 $17 $20 $23 $26 $30 $33 $36 $39 $42

$903,300 $956,449 $20 $25 $20 $23 $26 $30 $33 $36 $39 $42

$956,450 $1,009,549 $18 $23 $29 $23 $26 $30 $33 $36 $39 $42

$1,009,550 $1,062,649 $26 $21 $27 $32 $26 $30 $33 $36 $39 $42

$1,062,650 $1,115,849 $29 $27 $23 $28 $33 $28 $31 $34 $37 $40

$1,115,850 $1,168,949 $19 $29 $27 $23 $28 $33 $28 $31 $34 $37

$1,168,950 $1,222,099 $9 $19 $29 $27 $23 $28 $33 $28 $31 $34

$1,222,100 $1,275,299 $9 $19 $29 $27 $23 $28 $33 $28 $31

$1,275,300 $1,328,399 $9 $19 $29 $27 $23 $28 $33 $28

$1,328,400 $1,381,499 $9 $19 $29 $27 $23 $28 $33

$1,381,500 $1,434,699 $9 $19 $29 $27 $23 $28

$1,434,700 $1,487,799 $9 $19 $29 $27 $23

$1,487,800 $1,540,899 $9 $19 $29 $27

$1,540,900 $1,594,049 $9 $19 $29

$1,594,050 $1,647,249 $9 $19

$1,647,250 $1,700,399 $9

Combined wages between $1,168,950 and $1,700,399


$1,700,400 $1,753,500 $1,806,650 $1,859,800 $1,912,900 $1,966,050 $2,019,200 $2,072,350 $2,125,450 $2,178,650 $1,753,499 $1,806,649 $1,859,799 $1,912,899 $1,966,049 $2,019,199 $2,072,349 $2,125,449 $2,178,649 $2,231,827

$850,150 $903,299 $45 $48

$903,300 $956,449 $45 $48 $51 $54

$956,450 $1,009,549 $45 $48 $51 $54 $57 $60

$1,009,550 $1,062,649 $45 $48 $51 $54 $57 $60 $63 $66

$1,062,650 $1,115,849 $43 $46 $49 $53 $56 $59 $62 $65 $480 $904

$1,115,850 $1,168,949 $40 $43 $46 $49 $53 $56 $59 $62 $477 $904

$1,168,950 $1,222,099 $37 $40 $43 $46 $49 $53 $56 $59 $474 $901

$1,222,100 $1,275,299 $34 $37 $40 $43 $46 $49 $53 $56 $471 $898

$1,275,300 $1,328,399 $31 $34 $37 $40 $43 $46 $49 $53 $468 $895

$1,328,400 $1,381,499 $28 $31 $34 $37 $40 $43 $46 $49 $465 $892

$1,381,500 $1,434,699 $33 $28 $31 $34 $37 $40 $43 $46 $462 $889

$1,434,700 $1,487,799 $28 $33 $28 $31 $34 $37 $40 $43 $459 $886

$1,487,800 $1,540,899 $23 $28 $33 $28 $31 $34 $37 $40 $456 $883

$1,540,900 $1,594,049 $27 $23 $28 $33 $28 $31 $34 $37 $453 $880

$1,594,050 $1,647,249 $29 $27 $23 $28 $33 $28 $31 $34 $450 $877

$1,647,250 $1,700,399 $19 $29 $27 $23 $28 $33 $28 $31 $447 $874

$1,700,400 $1,753,499 $9 $19 $29 $27 $23 $28 $33 $28 $443 $871

$1,753,500 $1,806,649 $9 $19 $29 $27 $23 $28 $33 $440 $867

$1,806,650 $1,859,799 $9 $19 $29 $27 $23 $28 $446 $864

$1,859,800 $1,912,899 $9 $19 $29 $27 $23 $440 $869

$1,912,900 $1,966,049 $9 $19 $29 $27 $435 $864

$1,966,050 $2,019,199 $9 $19 $29 $440 $859

$2,019,200 $2,072,349 $9 $19 $441 $864

$2,072,350 $2,125,449 $9 $431 $865

$2,125,450 $2,178,649 $216 $443

$2,178,650 $2,231,827 $14



Note:Thesechartsdonotaccountforadditionalwithholdinginthefollowinginstances: • amarriedcouplewithbothspousesworking,whereonespouse’swagesaremorethan$1,115,914butlessthan$2,231,827,andtheother

spouse’swagesarealsomorethan$1,115,914butlessthan$2,231,827; • marriedtaxpayerswithonlyonespouseworking,andthatspouseworksmorethanonejob,withwagesfromeachjobunder$2,231,827,but

combinedwagesfromalljobsisover$2,231,827.Ifyouareinoneofthesesituationsandyouwouldliketorequestanadditionaldollaramountofwithholdingfromyourwages,pleasecontacttheTax

Departmentforassistance(seeNeed help?onpage6).

Need help?

Telephone assistanceAutomatedincometaxrefundstatus: (518)457-5149Personal Income TaxInformationCenter: (518)457-5181Toorderformsandpublications: (518)457-5431Text Telephone (TTY) Hotline (for persons with hearing and speech disabilities using a TTY): (518)485-5082

Visit our Web site at www.tax.ny.gov• getinformationandmanageyourtaxesonline• checkfornewonlineservicesandfeatures

Page 6 of 7 IT-2104 (2015)

$106,200 $127,500 $148,700 $169,950 $191,200 $233,700 $276,250 $318,750 $371,900 $425,050 $478,200 $127,499 $148,699 $169,949 $191,199 $233,699 $276,249 $318,749 $371,899 $425,049 $478,199 $531,299

$53,100 $74,299 $13 $18

$74,300 $95,549 $12 $19 $26 $25

$95,550 $116,799 $8 $16 $23 $26 $27

$116,800 $127,499 $2 $11 $18 $21 $25 $28

$127,500 $138,099 $4 $15 $18 $22 $28

$138,100 $148,699 $2 $11 $14 $19 $28 $26

$148,700 $159,349 $4 $11 $15 $27 $24

$159,350 $170,149 $2 $8 $13 $26 $25 $21

$170,150 $191,199 $3 $11 $25 $27 $22 $24

$191,200 $233,699 $8 $20 $29 $26 $24 $18

$233,700 $276,249 $8 $15 $23 $18 $18 $12

$276,250 $318,749 $7 $15 $22 $15 $16

$318,750 $371,899 $8 $16 $22 $14

$371,900 $425,049 $8 $16 $22

$425,050 $478,199 $8 $16

$478,200 $531,299 $8

Combined wages between $106,200 and $531,299Higher wage

$531,300 $584,450 $637,600 $690,700 $743,850 $797,000 $850,150 $903,300 $956,450 $1,009,550 $1,062,650 $1,115,850 $584,449 $637,599 $690,699 $743,849 $796,999 $850,149 $903,299 $956,449 $1,009,549 $1,062,649 $1,115,849 $1,168,949

$233,700 $276,249 $9

$276,250 $318,749 $9 $8

$318,750 $371,899 $16 $8 $8 $8

$371,900 $425,049 $14 $16 $8 $8 $8 $8

$425,050 $478,199 $22 $14 $16 $8 $8 $8 $8 $8

$478,200 $531,299 $16 $22 $14 $16 $8 $8 $8 $8 $8 $8

$531,300 $584,449 $8 $16 $22 $14 $16 $8 $8 $8 $8 $8 $222 $446

$584,450 $637,599 $8 $16 $22 $14 $16 $8 $8 $8 $8 $222 $446

$637,600 $690,699 $8 $16 $22 $14 $16 $8 $8 $8 $222 $446

$690,700 $743,849 $8 $16 $22 $14 $16 $8 $8 $222 $446

$743,850 $796,999 $8 $16 $22 $14 $16 $8 $222 $446

$797,000 $850,149 $8 $16 $22 $14 $16 $222 $446

$850,150 $903,299 $8 $16 $22 $14 $230 $446

$903,300 $956,449 $8 $16 $22 $228 $454

$956,450 $1,009,549 $8 $16 $235 $452

$1,009,550 $1,062,649 $8 $229 $460

$1,062,650 $1,115,849 $114 $240

$1,115,850 $1,168,949 $14

Combined wages between $531,300 and $1,168,949

Higher wage

Part 5 – Thesechartsareonlyforsingletaxpayersandheadofhouseholdtaxpayerswithmorethanonejob,andwhosecombinedwagesarebetween$106,200and$2,231,827.

Enter the additional withholding dollar amount on line 3.

Theadditionaldollaramount,asshownbelow,isaccurateforaweeklypayroll.Ifyouarenotpaidonaweeklybasis,youwillneedtoadjustthesedollaramount(s).Forexample,ifyouarepaidbiweekly,youmustdoublethedollaramount(s)computed.

PrivacynotificationTheCommissionerofTaxationandFinancemaycollectandmaintainpersonalinformationpursuanttotheNewYorkStateTaxLaw,includingbutnotlimitedto,sections5-a,171,171-a,287,308,429,475,505,697,1096,1142,and1415ofthatLaw;andmayrequiredisclosureofsocialsecuritynumberspursuantto42USC405(c)(2)(C)(i).Thisinformationwillbeusedtodetermineandadministertaxliabilitiesand,whenauthorizedbylaw,forcertaintaxoffsetandexchangeoftaxinformationprogramsas well as for any other lawful purpose.Informationconcerningquarterlywagespaidtoemployeesisprovidedtocertainstate agencies for purposes of fraud prevention, support enforcement, evaluation of the effectiveness of certain employment and training programs and other purposes authorizedbylaw.Failuretoprovidetherequiredinformationmaysubjectyoutocivilorcriminalpenalties,orboth,undertheTaxLaw.ThisinformationismaintainedbytheManagerofDocumentManagement,NYSTaxDepartment,WAHarrimanCampus,AlbanyNY12227;telephone(518)457-5181.

(Part 5 continued on page 7)

IT-2104 (2015) Page 7 of 7

$1,168,950 $1,222,100 $1,275,300 $1,328,400 $1,381,500 $1,434,700 $1,487,800 $1,540,900 $1,594,050 $1,647,250 $1,222,099 $1,275,299 $1,328,399 $1,381,499 $1,434,699 $1,487,799 $1,540,899 $1,594,049 $1,647,249 $1,700,399

$584,450 $637,599 $469 $493

$637,600 $690,699 $469 $493 $516 $539

$690,700 $743,849 $469 $493 $516 $539 $562 $585

$743,850 $796,999 $469 $493 $516 $539 $562 $585 $609 $632

$797,000 $850,149 $469 $493 $516 $539 $562 $585 $609 $632 $655 $678

$850,150 $903,299 $469 $493 $516 $539 $562 $585 $609 $632 $655 $678

$903,300 $956,449 $469 $493 $516 $539 $562 $585 $609 $632 $655 $678

$956,450 $1,009,549 $478 $493 $516 $539 $562 $585 $609 $632 $655 $678

$1,009,550 $1,062,649 $476 $501 $516 $539 $562 $585 $609 $632 $655 $678

$1,062,650 $1,115,849 $269 $285 $310 $325 $349 $372 $395 $418 $441 $465

$1,115,850 $1,168,949 $39 $68 $84 $109 $124 $147 $171 $194 $217 $240

$1,168,950 $1,222,099 $14 $39 $68 $84 $109 $124 $148 $171 $194 $217

$1,222,100 $1,275,299 $14 $39 $68 $84 $109 $124 $148 $171 $194

$1,275,300 $1,328,399 $14 $39 $68 $84 $109 $124 $148 $171

$1,328,400 $1,381,499 $14 $39 $68 $84 $109 $124 $147

$1,381,500 $1,434,699 $14 $39 $68 $84 $109 $124

$1,434,700 $1,487,799 $14 $39 $68 $84 $109

$1,487,800 $1,540,899 $14 $39 $68 $84

$1,540,900 $1,594,049 $14 $39 $68

$1,594,050 $1,647,249 $14 $39

$1,647,250 $1,700,399 $14


Higher wage

$1,700,400 $1,753,500 $1,806,650 $1,859,800 $1,912,900 $1,966,050 $2,019,200 $2,072,350 $2,125,450 $2,178,650 $1,753,499 $1,806,649 $1,859,799 $1,912,899 $1,966,049 $2,019,199 $2,072,349 $2,125,449 $2,178,649 $2,231,827

$850,150 $903,299 $701 $725

$903,300 $956,449 $701 $725 $748 $771

$956,450 $1,009,549 $701 $725 $748 $771 $794 $817

$1,009,550 $1,062,649 $701 $725 $748 $771 $794 $817 $841 $864

$1,062,650 $1,115,849 $488 $511 $534 $557 $581 $604 $627 $650 $673 $270

$1,115,850 $1,168,949 $263 $287 $310 $333 $356 $379 $403 $426 $449 $471

$1,168,950 $1,222,099 $240 $263 $287 $310 $333 $356 $379 $403 $426 $449

$1,222,100 $1,275,299 $217 $240 $263 $287 $310 $333 $356 $379 $403 $426

$1,275,300 $1,328,399 $194 $217 $240 $264 $287 $310 $333 $356 $379 $403

$1,328,400 $1,381,499 $171 $194 $217 $240 $263 $287 $310 $333 $356 $379

$1,381,500 $1,434,699 $148 $171 $194 $217 $240 $263 $287 $310 $333 $356

$1,434,700 $1,487,799 $124 $147 $171 $194 $217 $240 $263 $287 $310 $333

$1,487,800 $1,540,899 $109 $124 $147 $171 $194 $217 $240 $263 $287 $310

$1,540,900 $1,594,049 $84 $109 $124 $147 $171 $194 $217 $240 $263 $287

$1,594,050 $1,647,249 $68 $84 $109 $124 $147 $171 $194 $217 $240 $263

$1,647,250 $1,700,399 $39 $68 $84 $109 $124 $147 $171 $194 $217 $240

$1,700,400 $1,753,499 $14 $39 $68 $84 $109 $124 $147 $171 $194 $217

$1,753,500 $1,806,649 $14 $39 $68 $84 $109 $124 $147 $171 $194

$1,806,650 $1,859,799 $14 $39 $68 $84 $109 $124 $147 $171

$1,859,800 $1,912,899 $14 $39 $68 $84 $109 $124 $147

$1,912,900 $1,966,049 $14 $39 $68 $84 $109 $124

$1,966,050 $2,019,199 $14 $39 $68 $84 $109

$2,019,200 $2,072,349 $14 $39 $68 $84

$2,072,350 $2,125,449 $14 $39 $68

$2,125,450 $2,178,649 $14 $39

$2,178,650 $2,231,827 $14


Higher wage

adjunct packet · pdf fileadjunct packet checklist ... social security card ... hrc: call mr....

Documents