Virginia Form VA-5 Employer’s Return of Virginia Income Tax Withheld

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Virginia account number:* ⚠️

Employer name:*

Address:*

City, State and Zip code:*

Filing year:

Filing frequency:

Select month:

1. Virginia Income Tax Withheld:

2. Previous Period(s) Adjustments:

3. Adjustment Total:

4. Penalty:

5. Interest:

6. Total Amount Due:

Check here to pay your balance due (line 6) with this form.

Banking Information

Electronic payments or Electronic Funds Transfer (EFT) involves the transfer of funds from your bank account to the State’s bank account using the Automated Clearinghouse (ACH) network to electronically transfer payments. The ACH system is a nationwide network for the distribution and settlement of electronic debits and credits among financial institutions. Your transaction uses the ACH Debit.

Only checking accounts may be used to pay via ACH Debit. If your bank does not honor this ACH Debit payment, Virginia Tax may impose a penalty of $35 as authorized by Code of Virginia § 2.2-614.1. This penalty would be in addition to other penalties such as for late payment of a tax.

Virginia Tax does not, at present, support International ACH Transactions (IAT) for ACH Debit transactions. By signing below, you are certifying that your ACH Debit transaction does not directly involve a financial institution outside of the territorial jurisdiction of the United States at any point in the process.

Penalty and interest will be assessed for late filed returns or late payments, if applicable. You may calculate and include the penalty and interest as part of your ACH Debit payment. If penalty and interest is not included, you will be billed for the applicable penalty and/or interest.

WARNING: Some banks use a "filter", which prevents unauthorized debits against a customer's account. If your bank requests a filter number or Company ID for the debit transactions, use 1546001745. The agency name will display as Virginia Dept. of Taxation. Failure to provide the correct number to the bank will cause the payment to reverse. Please note that the filter number is not needed in all instances. If your bank denies your electronic payment, the denial is handled like a returned check and late payment charges may apply.

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Declaration and Signature: I declare that this return (including accompanying schedules and statements) has been examined by me and to the best of my knowledge and belief is true, correct, and complete. I agree