8919 Uncollected Social Security and Medicare Tax on Wages

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FORM 8919, PAGE 1 of 2 (PAGE 2 IS BLANK)
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8919

Action

Revised proofs
requested

OMB No. 1545-XXXX

2007

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Signature

O.K. to print

Uncollected Social Security and
Medicare Tax on Wages

Department of the Treasury
Internal Revenue Service

Attachment
Sequence No.

Attach to Form 1040 or Form 1040NR.

Name of person who received wages. If married, complete a separate Form 8919 for each spouse.

Reason Codes:

Date

XX

Social security number

For each employer listed below, enter the applicable reason codes for filing this form in column (c). Enter the
date you received the Determination Letter or correspondence in column (d).

A

I filed Form SS-8 and received a determination letter stating that I am an employee of this company.

B

I was designated as a “section 530 employee” by my employer or by the IRS prior to January 1, 1997.

C I received other correspondence from the IRS which designates me as an employee.
D I was previously treated as an employee by this company.
E

My co-workers in substantially the same position as me are treated as employees.

F

My co-workers filed Form SS-8 for this company and received a determination that they were employees.

G I filed Form SS-8 with the IRS and have not received a reply.

H My employer has the right to direct and control my work, determines the work to be done, and determines how it is to be
done.
(a) Name of employer

(b) Employer’s EIN

(c) Reason Code
from above

(d) Date IRS Determination
or Correspondence, as
indicated in column (c),
was received

(e) Check if
Form 1099-MISC
was received

(f) Total wages received
with no Social Security
or Medicare tax
withholding

1
2
3
4
5
6

Total wages. Combine lines 1 through 5 in column (f). Enter here and on line 7 of Form 1040 or
line 8 of Form 1040NR

7

Maximum amount of wages subject to social security tax

7

8

Total social security wages and tips (total of boxes 3 and 7 on
Form(s) W-2) from employers who treated you as an employee and
who withheld social security and Medicare taxes or railroad retirement
(tier 1) compensation

8

9

6

XX,XXX

9

Subtract line 8 from line 7. If line 8 is more than line 7, enter -0- here and on line 10

10 Wages subject to social security tax. Enter the smaller of line 6 or line 9

10

11 Multiply line 10 by .062

11

12 Multiply line 6 by .0145

12

13 Add lines 11 and 12. Enter here and on Form 1040, line XX, or Form 1040NR, line XX
For Paperwork Reduction Act Notice, see instructions.

Cat. No. 37730B

©

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Form

8919

(2007)