Form 4137 - Social Security And Medicare Tax On Unreported Tip Income
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2OMB No. 1545-0074
Social Security and Medicare Tax
4137
2008
Form
on Unreported Tip Income
See instructions below and on back.
Attachment
Department of the Treasury
24
Attach to Form 1040, Form 1040NR, Form 1040NR-EZ, Form 1040-SS, or Form 1040-PR.
(99)
Sequence No.
Internal Revenue Service
Social security number
Name of person who received tips. If married, complete a separate Form 4137 for each spouse with unreported tips.
1
(a) Name of employer to whom
(b) Employer
(c) Total cash and charge
(d) Total cash and charge
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 2008. Add the amounts
2
from line 1, column (c)
3
Total cash and charge tips you reported to your employer(s) in 2008. Add the amounts from line
3
1, column (d)
4
Subtract line 3 from line 2. This amount is income you must include in the total on Form 1040,
4
line 7; Form 1040NR, line 8; or Form 1040NR-EZ, line 3
5
Cash and charge tips you received but did not report to your employer because the total was
5
less than $20 in a calendar month (see instructions)
6
6
Unreported tips subject to Medicare tax. Subtract line 5 from line 4
7
Maximum amount of wages (including tips) subject to social security
102,000
00
7
tax
8
Total social security wages and social security tips (total of boxes 3
and 7 shown on your Form(s) W-2) or railroad retirement (tier 1)
8
compensation
9
Subtract line 8 from line 7. If line 8 is more than line 7, enter -0- here and on line 10 and go to
9
line 12
10
Unreported tips subject to social security tax. Enter the smaller of line 6 or line 9. If you received
10
tips as a federal, state, or local government employee, (see instructions)
11
11
Multiply line 10 by .062 (social security tax rate)
12
12
Multiply line 6 by .0145 (Medicare tax rate)
13
Add lines 11 and 12. Enter the result here and on Form 1040, line 58; Form 1040NR, line 53; or
Form 1040NR-EZ, line 16
13
General Instructions
the social security and Medicare taxes on that income.
Instead, use Form 8919, Uncollected Social Security and
What’s new. For 2008, the maximum amount of wages
Medicare Taxes on Wages.
and tips subject to social security tax is $102,000.
Who must file. You must file Form 4137 if you received
Purpose of form. Use Form 4137 only to figure the
cash and charge tips of $20 or more in a calendar month
social security and Medicare tax owed on tips you did not
and did not report all of those tips to your employer. You
report to your employer, including any allocated tips
must also file Form 4137 if box 8 of your Form(s) W-2
shown on your Form(s) W-2 that you must report as
shows allocated tips that you must report as income.
income. You must also report the income on Form 1040,
line 7; Form 1040NR, line 8; or Form 1040NR-EZ, line 3.
Allocated tips. You must report as income on
By filing this form, your social security and Medicare tips
Form 1040, line 7; Form 1040NR, line 8; or Form
will be credited to your social security record (used to
1040NR-EZ, line 3, at least the amount of allocated tips
figure your benefits).
shown in box 8 of your Form(s) W-2 unless you can prove
a smaller amount with adequate records. If you have
If you believe you are an employee and you
records that show the actual amount of tips you received,
received Form 1099-MISC, Miscellaneous
report that amount even if it is more or less than the
Income, instead of Form W-2, Wage and Tax
allocated tips. Although allocated tips are shown on your
CAUTION
Statement, because your employer did not
consider you an employee, do not use this form to report
4137
For Paperwork Reduction Act Notice, see instructions on back.
Cat. No. 12626C
Form
(2008)
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