U.S. Virgin Islands Wage and Tax Statement. This form is used by employers with employees who have had income tax, Social Security, or Medicare taxes from the U.S. Virgin Islands withheld, as well as for employees that the employer would have withheld VI income tax if the employee had not claimed more than one withholding allowance, or for those employees whom the employer has paid any amount for services if they are in a trade or business. This would also include the cash value of any payment the employer made that was not in the form of cash.