Uncollected Social Security And Medicare Tax On Wages Form 8919 (2011)

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Uncollected Social Security and
OMB No. 1545-0074
8919
Form
Medicare Tax on Wages
2011
See instructions.
Attachment
Department of the Treasury
72
Attach to your tax return.
Sequence No.
Internal Revenue Service
Name of person who must file this form. If married, complete a separate Form 8919 for each spouse who must file this form.
Social security number
Social security number
Who must file.
You must file Form 8919 if all of the following apply.
You performed services for a firm.
The firm did not withhold your share of social security and Medicare taxes from your pay.
Your pay from the firm was not for services as an independent contractor.
One or more of the reasons listed below under Reason codes apply to you.
Reason codes:
For each firm listed below, enter in column (c) the applicable reason code(s) for filing this form. If none of the reason
codes apply to you, but you believe you should have been treated as an employee, enter reason
code G, and file Form SS-8 on or before the date you file your tax return.
A
I filed Form SS-8 and received a determination letter stating that I am an employee of this firm.
B
I was designated as a "section 530 employee" by my employer or by the IRS prior to January 1, 1997.
C
I received other correspondence from the IRS that states I am an employee.
D
I was previously treated as an employee by this firm and am performing services in a substantially similar capacity
and under substantially similar direction and control. (You must also enter reason code G.)
E
My co-workers, performing substantially similar services under substantially similar direction and control, are treated
as employees. (You must also enter reason code G.)
F
My co-workers, performing substantially similar services under substantially similar direction and control, filed Form
SS-8 for this firm and received a determination that they were employees. (You must also enter reason code G.)
G
I filed Form SS-8 with the IRS and have not received a reply.
H
I received a Form W-2 and a Form 1099-MISC from this firm for 2011. The amount on Form 1099-MISC should have
been included as wages on Form W-2.
(b)
(b)
Firm's
(c)
(c)
Enter
(d)
(d)
Date IRS
(e)
(e)
Check
(f) (f)
Total wages received
determination or
federal
reason
if Form
with no social security or
correspondence
identification
code(s)
1099-MISC
Medicare tax
(a)
(a)
Name of firm
was received
number
from
was
withholding and not
(YYYY/MM/DD)
above
received
reported on Form W-2
(see instructions)
(see instructions)
1
2
3
4
5
6
Total wages. Combine lines 1 through 5 in column (f). Enter here and include on Form 1040,
6
line 7; Form 1040NR, line 8; or Form 1040NR-EZ, line 3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
106,800.00
7
Maximum amount of wages subject to social security tax
7
. . . . . . . . . . . . . . . .
8
Total social security wages and tips (total of boxes 3 and 7 on
Form(s) W-2) or railroad retirement (tier 1) compensation, and
unreported tips subject to social security tax from Form 4137,
line 10
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9
Subtract line 8 from line 7. If line 8 is more than line 7, enter -0- here and on line 10
9
. . . . . . . . . . . . . . . . .
10
Wages subject to social security tax. Enter the smaller of line 6 or line 9
10
. . . . . . . . . . . . . . . . . . . . . . .
11
Multiply line 10 by .042 (social security tax rate for 2011)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
12
Multiply line 6 by .0145 (Medicare tax rate)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
13
Add lines 11 and 12. Enter here and on Form 1040, line 57; Form 1040NR, line 55; or
Form 1040NR-EZ, line 16. (Form 1040-SS and Form 1040-PR filers, see instructions)
13
. . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice, see your tax return instructions.
Form 8919 (2011)
EEA

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