Form 4137 - Social Security And Medicare Tax On Unreported Tip Income - 2012 Page 4
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Form 4137 (2012)
Page
• Tips you did not report to your employer on time or did
Line 5. Enter only the tips you were not required to report
not report at all. This should include any allocated tips
to your employer because the total received was less
shown in box 8 on your Form(s) W-2 unless you can
than $20 in a calendar month. These tips are not subject
prove that your unreported tips are less than the amount
to social security and Medicare tax.
in box 8. Tips you did not report to your employer on time
Line 10. If line 6 includes tips you received for work you
or did not report at all are considered income to you in
did as a federal, state, or local government employee and
the month you actually received them. For example, tips
your pay was subject only to the 1.45% Medicare tax,
you received in December 2012 that you reported to your
subtract the amount of those tips from the line 6 amount
employer after January 10, 2013, are considered income
only for the purpose of comparing lines 6 and 9. Do not
in 2012 because you did not report them to your
reduce the actual entry on line 6. Enter “1.45% tips” and
employer on time.
the amount you subtracted on the dotted line next to line
• Tips you received that you were not required to report
10.
to your employer because they totaled less than $20
Line 11. Multiply the amount on line 10 by .042 (the social
during the month.
security rate for 2012).
• Allocated tips you must report as income (see page 1).
Line 13. Form 1040-SS and Form 1040-PR filers, include
the amount from line 13 on line 5 of Form 1040-SS or
Form 1040-PR. See the instructions for Form 1040-SS or
Form 1040-PR for more information.
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