Form H-14 - 2011 Instructions For Schedule H (Form 1040) Household Employment Taxes - Household Employers Page 11
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14Household Employment Taxes
SCHEDULE H
OMB No. 1545-1971
2011
(Form 1040)
(For Social Security, Medicare, Withheld Income, and Federal Unemployment (FUTA) Taxes)
Attach to Form 1040, 1040NR, 1040-SS, or 1041.
Attachment
Department of the Treasury
44
See separate instructions.
(99)
Sequence No.
Internal Revenue Service
Name of employer
Social security number
0 0 0 1 1 1 1 1 1
Susan Green
Employer identification number
0 0 1 2 3 4 5 6 7
A
Did you pay any one household employee cash wages of $1,700 or more in 2011? (If any household employee was your
spouse, your child under age 21, your parent, or anyone under age 18, see the line A instructions before you answer this
question.)
Yes. Skip lines B and C and go to line 1.
No. Go to line B.
Part I
Social Security, Medicare, and Federal Income Taxes
2, 3 0 0 0 0
1
1
Total cash wages subject to social security taxes
2 3 9 2 0
2
2
Social security taxes. Multiply line 1 by 10.4% (.104)
2, 3 0 0 0 0
3
3 Total cash wages subject to Medicare taxes
6 6 7 0
4
4
Medicare taxes. Multiply line 3 by 2.9% (.029)
5
5
Federal income tax withheld, if any
3 0 5
9 0
6
6
Total social security, Medicare, and federal income taxes (add lines 2, 4, and 5)
7
Did you pay total cash wages of $1,000 or more in any calendar quarter of 2010 or 2011 to all household employees?
(Do not count cash wages paid in 2010 or 2011 to your spouse, your child under age 21, or your parent.)
No.
Stop. Include the amount from line 6 above on Form 1040, line 59a. If you are not required to file Form 1040, see
the line 7 instructions.
H-11
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