Form 4137 - Social Security And Medicare Tax On Unreported Tip Income - 2017
Download a blank fillable Form 4137 - Social Security And Medicare Tax On Unreported Tip Income - 2017 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 4137 - Social Security And Medicare Tax On Unreported Tip Income - 2017 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
24137
Social Security and Medicare Tax
OMB No. 1545-0074
on Unreported Tip Income
2017
Form
Go to for the latest information.
▶
Department of the Treasury
Attachment
24
Attach to Form 1040, Form 1040NR, Form 1040NR-EZ, Form 1040-SS, or Form 1040-PR.
Internal Revenue Service (99)
▶
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 didn’t
identification number
tips you received (including
tips you reported to your
report all your tips (see instructions)
(see instructions)
employer
unreported tips) (see instructions)
A
B
C
D
E
2 Total cash and charge tips you received in 2017. Add the
amounts from line 1, column (c) .
.
.
.
.
.
.
.
.
.
.
2
3 Total cash and charge tips you reported to your employer(s) in 2017. Add the amounts from
line 1, column (d) .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
3
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 .
.
.
.
.
.
.
.
.
.
5 Cash and charge tips you received but didn’t report to your employer because the total was
less than $20 in a calendar month (see instructions)
.
.
.
.
.
.
.
.
.
.
.
.
.
5
6 Unreported tips subject to Medicare tax. Subtract line 5 from line 4
6
.
.
.
.
.
.
.
.
7 Maximum amount of wages (including tips) subject to
127,200 00
social security tax .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
7
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
8
instructions) .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
9 Subtract line 8 from line 7. If line 8 is more than line 7, enter -0-
.
.
.
.
.
.
.
.
.
9
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 .
.
.
.
10
11 Multiply line 10 by 0.062 (social security tax rate)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
11
12 Multiply line 6 by 0.0145 (Medicare tax rate) .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
12
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.) .
.
.
13
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). Don’t use Form 4137
For the latest information about developments
compensation, and self-employment income
as a substitute Form W-2.
related to Form 4137 and its instructions,
over a threshold amount based on your filing
If you believe you’re an employee
such as legislation enacted after they were
▲
status. Use Form 8959, Additional Medicare
!
published, go to .
and you received Form 1099-
Tax, to figure this tax. For more information
MISC, Miscellaneous Income,
on the Additional Medicare Tax, see “What is
What’s New
instead of Form W-2, Wage and
the Additional Medicare Tax?” at
CAUTION
Tax Statement, because your
For 2017, the maximum wages and tips
gov/uac/what-is-the-additional-medicare-tax.
employer didn’t consider you an employee,
subject to social security tax increases to
Purpose of form. Use Form 4137 only to
don’t use this form to report the social
$127,200. The social security tax rate an
figure the social security and Medicare tax
security and Medicare tax on that income.
employee must pay on tips remains at 6.2%
owed on tips you didn’t report to your
Instead, use Form 8919, Uncollected Social
(0.062).
employer, including any allocated tips shown
Security and Medicare Tax on Wages.
on your Form(s) W-2 that you must report as
income. You also must 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
(2017)
Cat. No. 12626C
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial