Notice to Employee
to figure the social security and Medicare tax owed on tips you didn’t report to
Do you have to file? Refer to the Form 1040 instructions to determine if you are
your employer. Enter this amount on the wages line of your tax return. (Form
required to file a tax return. Even if you don’t have to file a tax return, you may be
1040-SS filers, see the instructions for Form 1040-SS, Part I, line 5.) By filing this
eligible for a refund if box 2 shows an amount or if you are eligible for any credit.
form, your social security tips will be credited to your social security record (used
Copies B and C; corrections. File Copy B of this form with your 2017 U.S. Virgin
to figure your benefits).
Islands income tax return. Keep Copy C for your records. If your name, social
(Also see the Instructions for Employee on this page and the back of Copy C.)
security number (SSN), or address is incorrect, correct Copies B and C and ask
your employer to correct your employment record. Be sure to ask your employer
to file Form W-2c, Corrected Wage and Tax Statement, with the Social Security
Instructions for Employee
Administration (SSA) to correct any name, amount, or SSN error reported to the
(Also see Notice to Employee on this page.)
Estimated tax. If you expect to owe $1,000 or more in tax (including self-
Box 5. You may be required to report this amount on Form 8959, Additional
employment tax) for 2018, you may have to make estimated tax payments to the
Medicare Tax. See Form 1040 instructions to determine if you are required to
U.S. Internal Revenue Service. Use Form 1040-ES, Estimated Tax for Individuals.
complete Form 8959.
Clergy and religious workers. If you aren’t subject to social security and
Box 6. This amount includes the 1.45% Medicare Tax withheld on all Medicare
Medicare taxes, see Pub. 517, Social Security and Other Information for Members
wages and tips shown in box 5, as well as the 0.9% Additional Medicare Tax on
of the Clergy and Religious Workers.
any of those Medicare wages and tips above $200,000.
Cost of employer-sponsored health coverage (if such cost is provided by the
Box 11. This amount is (a) reported in box 1 if it is a distribution made to you from
employer). The reporting in box 12, using code DD, of the cost of employer-
a nonqualified deferred compensation or nongovernmental section 457(b) plan or
sponsored health coverage is for your information only. The amount reported
(b) included in box 3 and/or 5 if it is a prior year deferral under a nonqualified or
with code DD is not taxable.
section 457(b) plan that became taxable for social security and Medicare taxes this
Credit for excess social security tax. If one employer paid you wages during
year because there is no longer a substantial risk of forfeiture of your right to the
2017 and more than $7,886.40 in social security tax was withheld, you can claim a
deferred amount. This box shouldn’t be used if you had a deferral and a
refund of the excess by filing Form 1040 with the V.I. Bureau of Internal Revenue,
distribution in the same calendar year. If you made a deferral and received a
6115 Estate Smith Bay, Suite 225, St. Thomas, VI 00802.
distribution in the same calendar year, and you are or will be age 62 by the end of
the calendar year, your employer should file Form SSA-131, Employer Report of
If you had more than one employer in 2017 and more than $7,886.40 in social
Special Wage Payments, with the Social Security Administration and give you a
security tax was withheld, you can have the excess refunded by filing Form 843,
Claim for Refund and Request for Abatement, with the Department of the
Treasury, Internal Revenue Service Center, Austin, TX 73301-0215, USA. However,
Box 12. The following list explains the codes shown in box 12. You may need this
if you are required to file Form 1040 with the United States, you must claim the
information to complete your tax return. Elective deferrals (codes D, E, F, and S)
excess tax as a credit on Form 1040.
and designated Roth contributions (codes AA, BB, and EE) under all plans are
Unreported tip income. You must file Form 4137, Social Security and Medicare
generally limited to a total of $18,000 ($12,500 if you have only SIMPLE plans;
$21,000 for section 403(b) plans if you qualify for the 15-year rule explained in
Tax on Unreported Tip Income, with your income tax return to report at least the
Pub. 571). Deferrals under code G are limited to $18,000. Deferrals under code H
allocated tip amount unless you can prove a smaller amount with adequate
are limited to $7,000.
records. If you have records that show the actual amount of tips you received,
report that amount even if it is more or less than the allocated tips. Use Form 4137
(continued on back of Copy C)