Form Nuc-1-H - Household Employer Registration
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1Illinois Department of Revenue
NUC-1-H
Household Employer Registration
Read this information first.
Complete this form if you have a household employee ( i.e., you control how the work is performed by a person who does
domestic work around your home — for example, a babysitter, caretaker, cleaning person, driver, health aide, housekeeper,
nanny, private nurse, or yard worker) and you elect to file only one return each year, which is due on the 15th day of the fourth
month following the close of your tax year (generally April 15th). When we receive your completed form, we will register you as
a participating household employer and send you Booklet IL-700-H, Illinois Household Employer’s Tax Guide and Tables.
Booklet IL-700-H contains the information you need to know as a withholding agent, the forms you need to file or keep in your
records, and tax tables to help you figure the amount to withhold.
Note: You may choose this option any time. If, however, you have already sent a payment for tax withheld from your household
employee’s compensation, you must choose between one of two options to report and pay the tax you withhold the rest of the
calendar year. See “ What should I do if I have already sent a payment using Form IL-941 or Form IL-501?” in the instructions
on the back of this form.
Step 1: Provide the following information
1
______________________________________________________________________________________________________________
Household employer’s first name and middle initial
Household employer’s last name
______________________________________________________________________________________________________________
Mailing address
(
)
-
______________________________________________________________________________________________________________
City
State
ZIP
Daytime phone number
2
_____ _____ _____ — _____ _____ — _____ _____ _____ _____
Note: You must obtain your FEIN from the IRS. A social security
Household employer’s social security number
number is not acceptable. You must write your FEIN on the W-2 form
that you give your household employee each year. If you do not have
3
_____ _____ — _____ _____ _____ _____ _____ _____ _____
this number, please apply for one with the IRS and tell us your FEIN
Household employer’s federal employer identification number (FEIN)
as soon as you receive it.
4
Write the date you will, or did, start withholding tax from your household employee’s compensation.
___ ___ / ___ ___/ ___ ___ ___ ___
Month
Day
Year
5
Have you ever reported or paid withheld Illinois Income Tax using Form IL-941 or Form IL-501?
Yes
No
_____
_____
If the answer is “Yes,” have you sent us payments for tax you withheld this calendar year?
_____
Yes
_____
No
(See instructions.)
6
Do you have any other employees who are not household employees?
Yes
No
_____
_____
If the answer is “Yes,” you must continue to report the tax you withhold from these employees using
Form IL-941 and Form IL-W-3. You may, however, report and pay the tax you withhold from your household
employee’s compensation once each year .
Step 2: Sign below
Under penalties of perjury, I state that to the best of my knowledge, this form is true, correct, and complete.
_______________________________________________________
____ ____ / ____ ____ / ____ ____ ____ ____
Household employer’s signature
Month
Day
Year
Step 3: Complete your return label and mail us your request
Mail to:
Write your name and address (including ZIP code) in the
ILLINOIS DEPARTMENT OF REVENUE
space provided below. Please print clearly; this will be
PO BOX 19010
your return mailing label.
SPRINGFIELD IL 62794-9010
_______________________________________________
Name
_______________________________________________
Address
_______________________________________________
City
State
ZIP
This form is authorized as outlined by the Illinois Income Tax Act. Disclosure of this information is REQUIRED. Failure to provide
information could result in a penalty. This form has been approved by the Forms Management Center.
IL-492-3827
NUC-1-H front (R-12/00)
Booklet IL-700-H (R-12/00)
Page 13
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