Form 4137 - Social Security And Medicare Tax On Unreported Tip Income
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24137
Social Security and Medicare Tax
OMB No. 1545-0074
on Unreported Tip Income
2014
Form
Information about Form 4137 and its instructions is at
Department of the Treasury
▶
Attachment
Internal Revenue Service (99)
24
Attach to Form 1040, Form 1040NR, Form 1040NR-EZ, Form 1040-SS, or Form 1040-PR.
▶
Sequence No.
Name of person who received tips. If married, complete a separate Form 4137 for each spouse with unreported tips.
Social security number
(a) Name of employer to whom
(b) Employer
(c) Total cash and charge
(d) Total cash and charge
1
you were required to, but did not
identification number
tips you received (including
tips you reported to your
report all your tips (see instructions)
(see instructions)
unreported tips) (see instructions)
employer
A
B
C
D
E
2 Total cash and charge tips you received in 2014. Add the
amounts from line 1, column (c) .
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3 Total cash and charge tips you reported to your employer(s) in 2014. Add the amounts from
line 1, column (d) .
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4 Subtract line 3 from line 2. This amount is income you must include in the total on Form
4
1040, line 7; Form 1040NR, line 8; or Form 1040NR-EZ, line 3 .
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5 Cash and charge tips you received but did not report to your employer because the total was
less than $20 in a calendar month (see instructions)
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6 Unreported tips subject to Medicare tax. Subtract line 5 from line 4
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7 Maximum amount of wages (including tips) subject to
117,000 00
social security tax .
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8 Total social security wages and social security tips (total of
boxes 3 and 7 shown on your Form(s) W-2) and railroad
retirement (RRTA) compensation (subject to 6.2% rate) (see
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instructions) .
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9 Subtract line 8 from line 7. If line 8 is more than line 7, enter -0-
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10 Unreported tips subject to social security tax. Enter the smaller of line 6 or line 9. If you
received tips as a federal, state, or local government employee (see instructions) .
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11 Multiply line 10 by .062 (social security tax rate) .
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12 Multiply line 6 by .0145 (Medicare tax rate).
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13 Add lines 11 and 12. Enter the result here and on Form 1040, line 58; Form 1040NR, line 56;
or Form 1040NR-EZ, line 16 (Form 1040-SS and 1040-PR filers, see instructions.) .
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General Instructions
Reminder
Form 1040NR-EZ, line 3. By filing this form,
your social security and Medicare tips will be
A 0.9% Additional Medicare Tax applies to
Future Developments
credited to your social security record (used
Medicare wages, Railroad Retirement Tax Act
to figure your benefits).
For the latest information about developments
compensation, and self-employment income
related to Form 4137 and its instructions,
If you believe you are an employee
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over a threshold amount based on your filing
!
and you received Form 1099-
such as legislation enacted after they were
status. Use Form 8959, Additional Medicare
published, go to
MISC, Miscellaneous Income,
Tax, to figure this tax. For more information
instead of Form W-2, Wage and
on Additional Medicare Tax, go to
CAUTION
What's New
and enter “Additional Medicare
Tax Statement, because your employer did
For 2014, the maximum wages and tips
Tax” in the search box.
not consider you an employee, do not use this
subject to social security tax increased to
form to report the social security and
Purpose of form. Use Form 4137 only to
$117,000. The social security tax rate an
Medicare tax on that income. Instead, use
figure the social security and Medicare tax
employee must pay on tips remains at 6.2%
Form 8919, Uncollected Social Security and
owed on tips you did not report to your
(.062).
Medicare Tax on Wages.
employer, including any allocated tips shown
on your Form(s) W-2 that you must report as
income. You must also report the income on
Form 1040, line 7; Form 1040NR, line 8; or
4137
For Paperwork Reduction Act Notice, see your tax return instructions.
Form
(2014)
Cat. No. 12626C
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