Form AZ A-4

Please complete Form AZ A-4 so that Haggai Healthcare can withhold the correct state income tax from your pay.

External .gov link with withholding percentage calculator and information and a link to download this year’s AZ A-4 Form: AZ State Tax Withholding

To save time, please print and complete, then bring with you to your in-person onboarding appointment. If you do not have a printer, you can fill out a paper copy at your onboarding appointment.