Form Schedule H (Form 1 Schedule H (Form 1 Household Employment Taxes

Userid: YBLAWR00

PAGER/XML

Fileid:

DTD I1040AZ04

Leadpct: 12% Pt. size: 10

D:\Users\c4jcb\documents\epicfiles\Sch H\2009\I1040SH.XML

❏

❏

Draft

Ok to Print

(Init. & date)

Page 1 of 12 of 2009 Instructions for Schedule H (Form 1040) 10:44 - 18-AUG-2009
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Department of the Treasury
Internal Revenue Service

2009 Instructions for Schedule H (Form 1040)
Household Employment Taxes
Household
Employers

Here is a list of forms you need to complete:
• Schedule H for figuring your household employment taxes.
• Form W-2 for reporting wages paid to your employees.
• Form W-3 for sending Copy A of Form W-2 to the Social Security Administration.
For more information, see What Forms Must You File? in Pub. 926, Household
Employer’s Tax Guide.
No household employees in 2009? If you did not have any household employees in 2009,
you do not have to file Schedule H (Form 1040) for 2009.

We have been asked:
What do I do after I fill in Schedule H? Enter the taxes from Schedule H on the “Household
employment taxes” line of your Form 1040, 1040NR, 1040-SS, or 1041. You do this because
these taxes are added to your income taxes.
How do I file Schedule H? File Schedule H with your Form 1040, 1040NR, 1040-SS, or

1041. If you are not filing a 2009 tax return, file Schedule H by itself.
Do I make a separate payment? No. You pay all the taxes to the United States Treasury,

even the social security taxes.
When do I pay? Most filers must pay by April 15, 2010.
How many copies of Form W-3 do I send to the Social Security Administration (SSA)?

Send one copy of Form W-3 with Copy A of Form(s) W-2 to the SSA, and keep one copy of
Form W-3 for your records.

Contents

Page

Contents

Page

Form W-2 and Form W-3 . . . . . . . . . . . . . . . H-6
The Basics . . . . . . . . . . . . . . . . . . . . . . . . . . H-2
What’s New . . . . . . . . . . . . . . . . . . . . .
Who Needs To File Schedule H? . . . . . .
Who Needs To File Form W-2 and Form
W-3? . . . . . . . . . . . . . . . . . . . . . . . . .
Do You Have an Employer Identification
Number (EIN)? . . . . . . . . . . . . . . . . . .
Can Your Employee Legally Work in the
United States? . . . . . . . . . . . . . . . . . .
What About State Employment Taxes? . .

You Should Also Know . . . . . . . . . . . . . . . . . H-5

. . . . H-2
. . . . H-2

What’s New for 2010 . . . . . . . . . . . . . . .
Estimated Tax Penalty . . . . . . . . . . . . . . .
What Records To Keep . . . . . . . . . . . . . .
What Is the Earned Income Credit (EIC)? .
Rules for Business Employers . . . . . . . . .
State Disability Payments . . . . . . . . . . . .
How To Correct Schedule H . . . . . . . . . .
How To Get Forms and Publications . . . .
Privacy Act and Paperwork Reduction Act
Notice . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . H-2
. . . . H-2
. . . . H-3
. . . . H-3

.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.

. H-6
. H-6
. H-6
. H-6
. H-7
. H-7
. H-7
. H-7

. . . H-7

When and Where To File . . . . . . . . . . . . . . . H-3
Schedule H . . . . . . . . . . . . . . . . . . . . . . . . . H-3
Form W-2 and Form W-3 . . . . . . . . . . . . . . . H-3

Completed Example of Schedule H, Form
W-2, and Form W-3 . . . . . . . . . . . . . . . . . H-7

How To Fill In Schedule H, Form W-2, and
Form W-3 . . . . . . . . . . . . . . . . . . . . . . . . . H-3

Contact List for State Unemployment Tax
Agencies . . . . . . . . . . . . . . . . . . . . . . . . . H-11

Schedule H . . . . . . . . . . . . . . . . . . . . . . . . . H-3

H-1
Cat. No. 21451X

Page 2 of 12 of 2009 Instructions for Schedule H (Form 1040) Household Employment
Taxes
10:44 - 18-AUG-2009
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Example. You paid Betty Oak to babysit your child and do light
housework 4 days a week in your home. Betty followed your
specific instructions about household and child care duties. You
provided the household equipment and supplies Betty needed to do
her work. Betty is your household employee.

Important Dates!
By . . . . . . . . . . . . .

You must . . . . . . . . . . . . . . . . . . .

February 1, 2010

Give your employee Form W-2.

March 1, 2010
(March 31, 2010, if
you file
electronically)

Send Copy A of Form W-2 with
Form W-3 to the Social Security
Administration.

April 15, 2010 (see
page H-3 for
exceptions)

File Schedule H and pay your
household employment taxes with
your 2009 tax return.

Household work is work done in or around your home. Some
examples of workers who do household work are:

Babysitters
Caretakers
Cleaning people

Drivers
Health aides
Housekeepers

Nannies
Private nurses
Yard workers

If a worker is your employee, it does not matter whether the
work is full or part-time or that you hired the worker through an
agency or from a list provided by an agency or association. Also, it
does not matter if the wages paid are for work done hourly, daily,
weekly, or by the job.

The Basics

Note. If a government agency files Schedule H for the worker, you

do not need to file Schedule H.
Workers who are not your employees. Workers you get from an

What’s New

agency are not your employees if the agency is responsible for who
does the work and how it is done. Self-employed workers are also
not your employees. A worker is self-employed if only he or she
can control how the work is done. A self-employed worker usually
provides his or her own tools and offers services to the general
public in an independent business.

Credit reduction state. A state that has not repaid money it bor-

rowed from the federal government to pay unemployment benefits
is a “credit reduction state.” The Department of Labor determines
these states. If an employer pays wages that are subject to the
unemployment tax laws of a credit reduction state, that employer
must pay additional federal unemployment tax. For 2009, XXXXX
is a credit reduction state. If you paid any wages that are subject to
the unemployment compensation laws of the State of XXXXX, you
are not allowed .xxx of the regular .054 credit. See the instructions
for line 24 on page H-5 for more information

Example. You made an agreement with Paul Brown to care for
your lawn. Paul runs a lawn care business and offers his services to
the general public. He hires his own helpers and provides his own
tools and supplies. Neither Paul nor his helpers are your employees.

For more information, see Pub. 926, Household Employer’s
Tax Guide.

Reminders
Who Needs To File Form W-2 and
Form W-3?

Paid preparers may be required to sign Schedule H. Your paid

preparer must sign Schedule H in Part IV unless you are attaching
Schedule H to form 1040, 1040NR, 1040-SS, or Form 1041. A paid
preparer must sign Schedule H and provide the information requested in the Paid Preparer’s Use Only section if the preparer was
paid to prepare Schedule H and is not your employee. The preparer
must give you a copy of the return in addition to the copy to be filed
with the IRS.

You must file Form W-2 for each household employee to whom
you paid $1,700 or more of cash wages in 2009 that are subject to
social security and Medicare taxes. To find out if the wages are
subject to these taxes, see the instructions for Schedule H, lines 1
and 3, on page H-4. If the wages are not subject to these taxes but
you withheld federal income tax from the wages of any household
employee, you must file Form W-2 for that employee.

If you must file a 2009 Form W-2, Wage and Tax Statement, for
any household employee, you must also send Form W-3, Transmittal of Wage and Tax Statement, with Copy A of Form(s) W-2 to the
Social Security Administration. You are encouraged to file your
Forms W-2 and W-3 electronically. Visit the Social Security website at www.socialsecurity.gov/employer to learn about electronic
filing.

If you file one or more Forms W-2, you must also file
Form W-3.

Do You Have an Employer
Identification Number (EIN)?

Who Needs To File Schedule H?

If you have household employees, you will need an EIN to file
Schedule H. If you do not have an EIN, see Form SS-4, Application
for Employer Identification Number. The Instructions for Form
SS-4 explain how you can get an EIN immediately over the internet
or by telephone, in 4 business days by fax, or in about 4 weeks if
you apply by mail. See How To Get Forms and Publications on
page H-7 for details on how to get forms and publications including
Form SS-4. Do not use a social security number in place of an EIN.
To get an EIN over the internet, visit www.irs.gov and click on
“Apply for an Employer Identification Number (EIN) Online.”

You must file Schedule H (Form 1040) if you answer “Yes” to any
of the questions on lines A, B, or C.
Did you have a household employee? If you hired someone to do
household work and you were able to control what work he or she
did and how he or she did it, you had a household employee. This is
true even if you gave the employee freedom of action. What matters
is that you had the right to control the details of how the work was
done.

H-2

Page 3 of 12 of 2009 Instructions for Schedule H (Form 1040) Household Employment
Taxes
10:44 - 18-AUG-2009
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Can Your Employee Legally Work in
the United States?

Form W-2 and Form W-3
By February 1, 2010, you must give Copies B, C, and 2 of Form
W-2 to each employee. You will meet this requirement if the form
is properly addressed, mailed, and postmarked no later than
February 1, 2010.

It is unlawful to employ an alien who cannot legally work in the
United States. When you hire a household employee to work for
you on a regular basis, you and the employee must each complete
part of the U.S. Citizenship and Immigration Services (USCIS)
Form I-9, Employment Eligibility Verification. The Bureau was
formerly called the Immigration and Naturalization Service, or INS.
You must verify that the employee is either a U.S. citizen or an alien
who can legally work and you must keep Form I-9 for your records.
You can get the form and the USCIS Handbook for Employers by
calling 1-800-870-3676, or by visiting the USCIS website at
www.uscis.gov.

By March 1, 2010, (March 31, 2010, if you file electronically)
send Copy A of all Forms W-2 with Form W-3 to the Social
Security Administration (SSA). Mail Copy A of all Forms W-2
with Form W-3 to:
Social Security Administration
Data Operations Center
Wilkes-Barre, PA 18769-0001
For certified mail, the ZIP code is 18769-0002. If you use a carrier
other than the U.S. Postal Service, add “ATTN: W-2 Process, 1150
E. Mountain Dr.” to the address and change the ZIP code to
“18702-7997.”

What About State Employment
Taxes?
If you employed a household employee in 2009, you probably have
to pay contributions to your state unemployment fund for 2009. To
find out if you do, contact your state unemployment tax agency
right away. See page H-11 for some helpful contact information for
each state. You should also find out if you need to pay or collect
other state employment taxes or carry workers’ compensation insurance.

!

CAUTION

If you file Forms W-2 and W-3 electronically, do not
mail the paper Forms W-2 and W-3 to the Social Security Administration.

For additional information, visit the website for Social Security
at www.socialsecurity.gov/employer/whereto.htm.
Note. Check with your state, city, or local tax department to find
out if you must send Copy 1 of Form W-2 and where to file Copy 1.

See the Appendix in Pub. 926 for a complete listing of contact
information for state unemployment tax agencies.

Penalties. You may have to pay a penalty if you do not give Forms
W-2 to your employees or file Copy A of the forms with the SSA by
the due dates shown above. You may also have to pay a penalty if
you do not show your employee’s social security number on Form
W-2 or do not provide correct information on the form.

When and Where To File
Schedule H

How To Fill In Schedule H, Form
W-2, and Form W-3

If you file Forms 1040, 1040NR, 1040-SS, or 1041 for 2009,
remember to attach Schedule H to it. Mail your return, by April 15,
2010, to the address shown in your tax return booklet.

Schedule H

Exceptions. If you get an extension of time to file your return, file

it with Schedule H by the extended due date. If you are a fiscal year
filer, file your return and Schedule H by the due date of your fiscal
year return, including extensions.

!

CAUTION

Note. If you are a calendar year taxpayer and have no household
employees for 2009, you do not have to file Schedule H (Form
1040) for 2009.

If you were notified that your household employee received payments from a state disability plan, see page
H-6.

Social security number. Enter your social security number. (Form
1041 filers, do not enter a number in this space. But be sure to enter
your EIN in the space provided.)

If you are not required to file a 2009 tax return (for example,
because your income is below the amount that requires you to file),
you must file Schedule H by April 15, 2010. Complete Schedule H
and put it in an envelope with your check or money order. Do not
send cash. See the list of filing addresses on page H-12. Mail your
completed Schedule H and payment to the address listed for the
place where you live. Make your check or money order payable to
the “United States Treasury” for the total household employment
taxes due. Enter your name, address, social security number, daytime phone number, and “2009 Schedule H” on your check or
money order. Household employers that are tax-exempt, such as
churches, may also file Schedule H by itself.

Employer identification number (EIN). An EIN is a nine-digit
number assigned by the IRS. The digits are arranged as follows:
00-0000000. Enter your EIN in the space provided. If you do not
have an EIN, see Do You Have an Employer Identification Number
(EIN)? earlier. If you applied for an EIN but have not received it,
enter “Applied For.” Do not use your social security number as an
EIN.
Line A. To figure the total cash wages you paid in 2009 to each
household employee, do not count amounts paid to any of the
following individuals.
• Your spouse.

H-3

Page 4 of 12 of 2009 Instructions for Schedule H (Form 1040) Household Employment
Taxes
10:44 - 18-AUG-2009
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

• Your child who was under age 21.
• Your parent. (See Exception for parents below.)
• Your employee who was under age 18 at any time during

!

CAUTION

2009. If the employee was not a student, see Exception for employees under age 18 below.

If you paid any household employee cash wages of
more than $106,800 in 2009, include on line 1 only the
first $106,800 of that employee’s cash wages.

Line 2. Multiply the amount on line 1 by 12.4% (.124) and enter the

result on line 2.

Exception for parents. Count the cash wages you paid your
parent for work in or around your home if both 1 and 2 below apply.

Line 3. Enter on line 3 the total of cash wages (see Cash wages

earlier) paid to each employee in 2009. There is no limit on wages
subject to the Medicare tax.

1. Your child who lived with you was under age 18 or had a
physical or mental condition that required the personal care of an
adult for at least 4 continuous weeks in a calendar quarter. A
calendar quarter is January through March, April through June, July
through September, and October through December.
2. You were divorced and not remarried, a widow or widower,
or married to and living with a person whose physical or mental
condition prevented him or her from caring for the child during that
4-week period.

Line 4. Multiply the amount on line 3 by 2.9% (.029) and enter the
result on line 4.
Line 5. Enter on line 5 any federal income tax you withheld from
the wages you paid to your household employees in 2009. See Pub.
15 (Circular E), Employer’s Tax Guide, for information on withholding federal income taxes.
Line 6. Add lines 2, 4, and 5 and enter the result on line 6.

Exception for employees under age 18. Count the cash wages
you paid to a person who was under age 18 and not a student if
providing household services was his or her principal occupation.

Line 7. Enter on line 7, any advance EIC payments you made to

your household employees in 2009.
Line 8. Subtract the amount on line 7 from the amount on line 6 and

Cash wages. Cash wages include wages paid by checks, money

enter the result on line 8.

orders, etc. Cash wages do not include the value of food, lodging,
clothing or other noncash items you give a household employee.
See Wages on page 7 of Pub. 926, Household Employer’s Tax
Guide.

Line 9. Review the cash wages you paid to all your household
employees for each calendar quarter of 2008 and 2009. Is the total
for any quarter in 2008 or 2009 $1,000 or more?

Yes. Complete Part II of Schedule H.

Transportation (commuting benefits). For 2009, you can generally give your employee transportation benefits such as transit
passes worth up to:
• $120 per month for the months of January and February and
• $230 per month for the months of March through December
2009.
However, the value of benefits over $120 a month for the months of
January and February, and over $230 a month after February is
included as wages. (See Transportation (Commuting Benefits) in
Pub. 15-B, Employer‘‘s Tax Guide to Fringe Benefits, for more
information.)

No. Follow the instructions in the chart below.

Part I. Social Security, Medicare, and Federal
Income Taxes

If you file
Form. . .

Then enter the amount from
Schedule H, line 8, on. . .

1040

line 59 and check box b

1040NR

line 56

1040-SS

Part I, line 4

1041

Schedule G, line 6

If you do not file any of the above forms, complete Part IV of
Schedule H and follow the instructions under When and Where To
File on page H-3.

Social security and Medicare taxes pay for retirement, disability,
and health benefits for workers and their families. You and your
employees pay these taxes in equal amounts.

Part II. Federal Unemployment (FUTA) Tax

For social security, the tax rate is 6.2% each for you and your
employee. For Medicare, the rate is 1.45% each. For 2009, the limit
on wages subject to social security tax is $106,800. There is no limit
on wages subject to the Medicare tax. If you did not deduct the
employee’s share from his or her wages, you must pay the
employee’s share and your share (a total of 12.4% for social security and 2.9% for Medicare). See Form W-2 and Form W-3 on page
H-6 for more information.

FUTA tax, with state unemployment systems, provides for payments of unemployment compensation to workers who have lost
their jobs. Most employers pay both a federal and state unemployment tax.

$1,700 test. If you pay a household employee $1,700 or more in
cash wages during 2009, you must report and pay social security
and Medicare taxes. The test applies to cash wages paid in 2009
regardless of when the wages were earned. See Pub. 926 for more
information. Or, visit the website for Social Security at www.
socialsecurity.gov/pubs/10021.html.

Credit for contributions paid to state. You may be able to take a
credit of up to 5.4% against the FUTA tax, resulting in a net tax rate
of 0.8%. But to do so, you must pay all the required contributions
for 2009 to your state unemployment fund by April 15, 2010. Fiscal
year filers must pay all required contributions for 2009 by the due
date of their federal income tax returns (not including extensions).

Line 1. Enter on line 1 the total of cash wages (see Cash wages

Contributions are payments that a state requires you, as an
employer, to make to its unemployment fund for the payment of
unemployment benefits. However, contributions do not include:

The FUTA tax rate is 6.2%. But see Credit for contributions paid
to state below. Do not deduct the FUTA tax from your employee’s
wages. You must pay it from your own funds. See page H-11 for a
listing of some helpful contact information for each state.

above) paid in 2009 to each household employee who meets the
$1,700 test, explained above.

H-4

Page 5 of 12 of 2009 Instructions for Schedule H (Form 1040) Household Employment
Taxes
10:44 - 18-AUG-2009
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

• Any payments deducted or deductible from your employees’

rate of 5.4% or higher, you must also complete columns (d) and (e).
If you were given a rate of less than 5.4%, you must complete all
columns.

pay;

• Penalties, interest, or special administrative taxes not included
in the contributions rate the state gave you; and
• Voluntary contributions you paid to get a lower experience
rate.

If you were given a rate for only part of the year, or the rate
changed during the year, you must complete a separate line for each
rate period.

If you paid contributions to the state of XXXXX, see the instructions for line 4.

Column (c). Enter the taxable wages on which you must pay
taxes to the unemployment fund of the state shown in column (a). If
your experience rate is zero percent, enter the amount of wages you
would have had to pay taxes on if that rate had not been granted.

Lines 10 through 12. Answer the questions on lines 10 through 12

to see if you should complete Section A or Section B of Part II.
Fiscal year filers. If you paid all state unemployment contributions for 2009 by the due date of your return (not including extensions), check the “Yes” box on line 11. Check the “No” box if you
did not pay all of your state contributions by the due date of your
return.

Column (i). Enter the total of contributions (defined earlier) you
paid to the state unemployment fund for 2009 by April 15, 2010.
Fiscal year filers, enter the total contributions you paid to the state
unemployment fund for 2009 by the due date of your return (not
including extensions). If you are claiming excess credits as payments of state unemployment contributions, attach a copy of the
letter from your state.

Line 13. Enter the two-letter abbreviation of the name of the state

(or the District of Columbia, Puerto Rico, or the U.S. Virgin Islands) to which you paid unemployment contributions.

Line 19. Add the amounts in columns (h) and (i) separately and

Line 14. Enter your state reporting number. If you do not have one,

enter the totals in the spaces provided.

contact your state’s unemployment tax agency. See the Appendix in
Pub. 926 for your state’s contact information.

Line 20. Add the amounts shown on line 19 and enter the total on

line 20.

Line 15. Enter the total of contributions (defined earlier) you paid
to your state unemployment fund for 2009. If you did not have to
make contributions because your state gave you a zero percent
experience rate, enter “0% rate” on line 15.

Line 24. Complete the worksheet below only if you are a XXXXX
State employer.

Line 16. Enter the total of cash wages (see Cash wages on page

Part III. Total Household Employment Taxes

H-4) you paid in 2009 to each household employee, including
employees paid less than $1,000. However, do not include cash
wages paid in 2009 to any of the following individuals.
• Your spouse.
• Your child who was under age 21.
• Your parent.

Line 26. Enter the amount from line 8. If there is no entry on line 8,

enter -0-.
Line 27. Add the amounts on lines 17 and 26. If you were required

to complete Section B, of Part II, add the amounts on lines 25 and
26 and enter the total on line 27.

If you paid any household employee more than $7,000 in 2009,
include on line 16 only the first $7,000 of that employee’s cash
wages.

!

Line 28. Follow the instructions in the chart below.

Complete lines 18 through 25 only if you checked a
“No” box on lines 10, 11, or 12.

CAUTION

Line 18. Complete all columns that apply. If you do not, you will

not get a credit. If you need more space, attach a statement using the
same format as line 18. Your state will provide the experience rate.
If you do not know your rate, contact your state unemployment tax
agency. See page H-11 for a listing of some helpful contact information for each state.

If you file
Form. . .

Then do not complete Part IV but
enter the amount from Schedule
H, line 27, on . . .

1040

line 59 and check box b

1040NR

line 56

1040-SS

Part I, line 4

1041

Schedule G, line 6

If you do not file any of the above forms, complete Part IV of
Schedule H and follow the instructions under When and Where To
File on page H-3.

You must complete columns (a), (b), (c), and (i), even if you
were not given an experience rate. If you were given an experience

Keep for Your Records

Worksheet for XXXXXX State Employers —Line 24

1. Enter the smaller of the amounts from Schedule H, line 20 or 23. . . . . . . . . . . . . . . . . . . . 1.
2. Enter your XXXXX wages from Schedule H, line 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Multiply the amount from line 2 of this worksheet by .XXX and enter the result here. . . . . 3.
4. Subtract line 3 of this worksheet from line 1 of this worksheet and enter the result here and
on Schedule H, line 24. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.

H-5

Page 6 of 12 of 2009 Instructions for Schedule H (Form 1040) Household Employment
Taxes
10:44 - 18-AUG-2009
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Estimated tax payments must be made as the tax liability is incurred: by April 15, June 15, September 15, and
the following January 15. If you file your Form 1040 by
CAUTION
January 31 and pay the rest of the tax that you owe, you
do not need to make the payment due on January 15.

Paid Preparers

!

Paid preparer’s use only. You must complete this part if you were

paid to prepare Schedule H (Form 1040), and are not an employee
of the filing entity, and are not attaching Schedule H to Form 1040,
1040NR, 1040-SS, or Form 1041. You must sign in the space
provided and give the filer a copy of the return in addition to the
copy to be filed with the IRS.

Exception. You will not be penalized for failure to make estimated
tax payments if both 1 and 2 below apply for the year.

1. You will not have federal income tax withheld from wages,
pensions, or any other payments you receive.
2. Your income taxes, excluding your household employment
taxes, would not be enough to require payment of estimated taxes.

Form W-2 and Form W-3
If you file Form W-2, you must also file Form W-3.
You must report both cash and noncash wages in box 1, as well
as tips and other compensation. The completed Forms W-2 and
W-3 in the example (see page H-9) show how the entries are made.
Employee’s portion of taxes paid by employer. If you paid all of

What Records To Keep

your employee’s share of social security and Medicare taxes, without deducting them from the employee, follow steps 1 through 3.
(See the example on pages H-7, H-8, and H-9.)

You must keep copies of Schedule H and related Forms W-2, W-3,
W-4, and W-5, Earned Income Credit Advance Payment Certificate, for at least 4 years after the due date for filing Schedule H or
the date the taxes were paid, whichever is later. If you have to file
Form W-2, also keep a record of each employee’s name and social
security number. Each payday, you should record the dates and
amounts of:
• Cash and noncash wage payments.
• Any employee social security tax withheld.
• Any employee Medicare tax withheld.
• Any federal income tax withheld.
• Any advance EIC payments you made.

1. Enter the amounts you paid on your employee’s behalf in
boxes 4 and 6 (do not include your share of these taxes).
2. Add the amounts in boxes 3, 4, and 6. (However, if box 5 is
greater than box 3, then add the amounts in boxes 4, 5, and 6.)
3. Enter the total in box 1.

TIP

On Form W-3, put an “X” in the “Hshld. emp.” box
located in box b, Kind of Payer.

For information on filing Forms W-2 and W-3 electronically,
visit the website for Social Security, Business Services Online, at
www.socialsecurity.gov/bso/bsowelcome.htm.

What Is the Earned Income Credit
(EIC)?
The EIC is a refundable tax credit for certain workers.

You Should Also Know

Which employees must I notify about the EIC? You must notify

your household employee about the EIC if you agreed to withhold
federal income tax from the employee’s wages but did not do so
because the income tax withholding tables showed that no tax
should be withheld.

What’s New for 2010
Changes to tax rates and wage threshold. The tax rates mentioned

Note. You are encouraged to notify each employee whose wages
for 2009 were less than $43,279 ($48, 279 if married filing jointly)
that he or she may be eligible for the EIC.

in the instructions for Part I and Part II of Schedule H will not
change. However, the cash wage threshold that you pay to any one
household employee increases to $XXXX for 2010. The 2010 Employee Social Security and Medicare Tax Withholding Table is in
Pub. 926, Household Employer’s Tax Guide.

How and when must I notify my employees? You must give the
employee one of the following:
• The official IRS Form W-2, that has the required information
about the EIC on the back of Copy B.
• A substitute Form W-2 with the same EIC information on the
back of the employee’s copy that is on Copy B of the official IRS
Form W-2.
• Notice 797, Possible Federal Tax Refund Due to the Earned
Income Credit (EIC).
• Your written statement with the same wording as Notice 797.

Limit on wages subject to social security tax. The $106,800
amount in the instructions for Part I of Schedule H will increase to
$XXX,XXX.

Estimated Tax Penalty
You may need to increase the federal income tax withheld from
your pay, pension, annuity, etc. or make estimated tax payments to
avoid an estimated tax penalty based on your household employment taxes shown on line 27 of Schedule H. You may increase your
federal income tax withheld by filing a new Form W-4, Employee’s
Withholding Allowance Certificate, or Form W-4P, Withholding
Certificate for Pension or Annuity Payments. Make estimated tax
payments by filing Form 1040-ES, Estimated Tax for Individuals.
For more information, see Pub. 505, Tax Withholding and Estimated Tax.

If you are not required to give the employee a Form W-2, you
must provide the notification by February 10, 2010.
You must hand the notice directly to the employee or send it by
First-Class Mail to the employee’s last known address.
How do my employees claim the EIC? Eligible employees claim

the EIC on their 2009 tax returns.

H-6

Page 7 of 12 of 2009 Instructions for Schedule H (Form 1040) Household Employment
Taxes
10:44 - 18-AUG-2009
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

How do my employees get advance EIC payments? Eligible em-

Privacy Act and Paperwork
Reduction Act Notice

ployees who have a qualifying child can get part of the credit with
their pay during the year by giving you a completed Form W-5 or
Form W-5(SP), its Spanish translation. You must include advance
EIC payments with wages paid to these employees. For details,
including tables that show you how to figure the amount to add to
the employee’s net pay, see Pub.15 (Circular E), Employer’s Tax
Guide.

We ask for the information on this form to carry out the Internal
Revenue laws of the United States. You are required to give us the
information. We need it to ensure that you are complying with these
laws and to allow us to figure and collect the right amount of tax. If
you do not provide the information we ask for, or provide false or
fraudulent information, you may be subject to penalties.

Rules For Business Employers

You are not required to provide the information requested on a
form that is subject to the Paperwork Reduction Act unless the form
displays a valid OMB control number. Books or records relating to
a form or instructions must be retained as long as their contents may
become material in the administration of any Internal Revenue law.

Do not use Schedule H if you chose to report employment taxes for
your household employees along with your other employees on
Form 941, Employer’s QUARTERLY Federal Tax Return, Form
943, Employer’s Annual Federal Tax Return for Agricultural Employees, or Form 944, Employer’s ANNUAL Federal Tax Return.
If you report this way, be sure to include your household employees’ wages on your Form 940, Employer’s Annual Federal Unemployment (FUTA) Tax Return.

Subtitle C, Employment Taxes, of the Internal Revenue Code
imposes employment taxes on wages, including income tax withholding. This form is used to determine the amount of the taxes that
you owe. Section 6011 requires you to provide the requested information if the tax is applicable to you. Section 6109 requires taxpayers and paid preparers to provide their identification numbers.
Generally, tax returns and return information are confidential, as
required by section 6103. However, section 6103 allows or requires
the IRS to disclose or give the information shown on your tax return
to others as described in the Code. For example, we may disclose
your tax information to the Department of Justice for civil and
criminal litigation, and to cities, states, the District of Columbia,
and U.S. commonwealths and possessions to administer their tax
laws. We may also disclose this information to other countries
under a tax treaty, to federal and state agencies to enforce federal
nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.

State Disability Payments
Certain state disability plan payments to household employees are
treated as wages subject to social security and Medicare taxes. If
your employee received payments from a plan that withheld the
employee’s share of social security and Medicare taxes, include the
payments on lines 1 and 3 of Schedule H and complete the rest of
Part I through line 5. Add lines 2, 4, and 5. From that total, subtract
the amount of these taxes withheld by the state. Enter the result on
line 6. Also, enter “disability” and the amount subtracted on the
dotted line next to line 6. See the notice issued by the state for more
details.

The time needed to complete and file this form will vary depending on individual circumstances. The estimated burden for individual taxpayers filing this form is approved under OMB control
number 1545-0074 and is included in the estimates shown in the
instructions for their individual income tax return. The estimated
burden for all other taxpayers who file this form is shown below.
Recordkeeping, 1hr., 38 min.; Learning about the law or the
form, 1 hr., 1min.; Preparing the form, 1 hr., 9 min.; Copying,
assembling, and sending the form to the IRS, 34 min.

How To Correct Schedule H
If you discover an error on a Schedule H that you previously filed
with Form 1040, 1040NR, or Form 1040-SS, file Form 1040X and
attach a corrected Schedule H. If you discover an error on a Schedule H that you previously filed with Form 1041, file an “Amended”
Form 1041 and attach a corrected Schedule H.

If you have comments concerning the accuracy of these time
estimates or suggestions for making this form simpler, we would be
happy to hear from you. You can write to: Internal Revenue Service, Tax Products Coordinating Committee,
SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-6526,
Washington, DC 20224. Do not send Schedule H (Form 1040) to
this address. Instead, see When and Where to File on page H-3.

If you discover an error on a Schedule H that you filed as a
stand-alone return, file another stand-alone Schedule H with the
corrected information. In the top margin of your corrected Schedule
H write (in red ink if possible) “CORRECTED” followed by the
date you discovered the error.
If you owe tax, pay in full with your Form 1040X, Form 1041, or
stand-alone Schedule H. If you overpaid tax on a previously filed
Schedule H, you must certify that you repaid or reimbursed the
employee’s share of social security and Medicare taxes. See Pub.
926, Household Employer’s Tax Guide, for complete instructions.

Completed Example of Schedule H,
Form W-2, and Form W-3
On February 13, 2009, Susan Green hired Helen Maple to clean her
house every Wednesday. Susan did not have a household employee
in 2008 and had no household employees other than Helen during
2009.

How To Get Forms and Publications
To get the IRS forms and publications mentioned in these instructions (including Notice 797), visit the IRS website at www.irs.gov
or call 1-800-TAX-FORM (1-800-829-3676).

Susan paid Helen $50 every Wednesday for her day’s work.
Susan decided not to withhold Helen’s share of the social security

H-7

Page 8 of 12 of 2009 Instructions for Schedule H (Form 1040) Household Employment
Taxes
10:44 - 18-AUG-2009
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

and Medicare taxes from the wages she paid Helen. Instead, she
will pay Helen’s share of these taxes from her own funds. Susan did
not withhold federal income tax because Helen did not give her a
Form W-4 to request withholding and no withholding is otherwise
required. Susan also did not pay Helen advance earned income
credit payments because Helen did not give her a Form W-5.

1st quarter .
2nd quarter
3rd quarter .
4th quarter .

Helen’s share of the:
Social security tax . . . . . .
Medicare tax . . . . . . . . . .

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

$300.00
$650.00
$700.00
$650.00

($50
($50
($50
($50

x
x
x
x

6 weeks)
13 weeks)
14 weeks)
13 weeks)

Amount included in box 1 of Form W-2 and Form W-3:
Cash wages . . . . . . . . . . . . . . . . . . . . . . . . . $2,300.00
Helen’s share of social security tax paid by
Susan . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
142.60
Helen’s share of Medicare tax paid by Susan
33.35
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $2,475.95

Helen was employed by Susan for the rest of the year (a total of
46 weeks). The following is some of the information Susan will
need to complete Schedule H, Form W-2, and Form W-3.

Helen’s total cash wages . . . . .

.
.
.
.

$2,300.00
($50 x 46 weeks)

Because Susan paid less than $1,000 per quarter to household
employees during 2008 (no employees) and 2009 (see above), she
is not liable for FUTA tax.

$142.60
($2,300 x 6.2% (.062))

TIP

$33.35
($2,300 x 1.45% (.0145))

Helen’s total cash wages each quarter:

H-8

See Pub 926 for an example showing how to complete
Schedule H and Forms W-2 and W-3 if the employer
withheld social security and Medicare taxes from the
employee’s wages.

Page 9 of 12 of 2009 Instructions for Schedule H (Form 1040) Household Employment
Taxes
10:44 - 18-AUG-2009
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Note: Although not shown, Susan also enters on Form W-2 the
required state or local income tax information in boxes 15 through 20.
a Employee’s social security number

22222

Void

Visit the SSA website at www.socialsecurity.gov/employer to file
Copy A of Form W-2 electronically.
For Official Use Only

000-00-4567

䊳

OMB No. 1545-0008

b Employer identification number (EIN)

Wages, tips, other compensation

1

2

Federal income tax withheld

4

Social security tax withheld

6

Medicare tax withheld

8

Allocated tips

2475.95

00-1234567
c Employer’s name, address, and ZIP code

3

Social security wages

2300.00

Susan Green
16 Gray Street
Anyplace, CA 92665

5

142.60

Medicare wages and tips

2300.00

d Control number

e Employee’s first name and initial

Social security tips

9

Advance EIC payment

Suff. 11

Last name

Helen R.

33.35

7

10

12a See instructions for box 12

Nonqualified plans

C
o
d
e

Maple
13

19 Pine Avenue
Anycity, CA 92666

Statutory
employee

14

Retirement
plan

Dependent care benefits

Third-party
sick pay

12b
C
o
d
e

12c

Other

C
o
d
e

12d
C
o
d
e

f Employee’s address and ZIP code
15 State

Form

Employer’s state ID number

16 State wages, tips, etc.

17 State income tax

2009

Wage and Tax
Statement

W-2

18 Local wages, tips, etc.

a

b

Kind
of
Payer

Control number

20 Locality name

Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction
Act Notice, see back of Copy D.

Copy A For Social Security Administration — Send this entire page with
Form W-3 to the Social Security Administration; photocopies are not acceptable.

33333

19 Local income tax

Cat. No. 10134D

䊳

For Official Use Only
OMB No. 1545-0008

䊳

941

Military

CT-1

Hshld.
emp.

943

944

Medicare
govt. emp.

Third-party
sick pay

1

Wages, tips, other compensation

3

Social security wages

Total number of Forms W-2

d

e

Employer identification number (EIN)

Establishment number

Federal income tax withheld

4

Social security tax withheld

6

Medicare tax withheld

8

Allocated tips

2300.00

X

c

2

2475.95
142.60

5

Medicare wages and tips

7

Social security tips

9

Advance EIC payments

10

Dependent care benefits

11

Nonqualified plans

12

Deferred compensation

13

For third-party sick pay use only

14

Income tax withheld by payer of third-party sick pay

16

State wages, tips, etc.

17

State income tax

18

Local wages, tips, etc.

19

Local income tax

2300.00

33.35

00-1234567
f Employer’s name

Susan Green
16 Gray Street
Anyplace, CA 92665

g

Employer’s address and ZIP code

h

Other EIN used this year

15

State

Employer’s state ID number

Contact person

Telephone number

(
Email address

123 )

For Official Use Only

456-7890

Fax number

(

)

Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief,
they are true, correct, and complete.

Signature

Form

䊳

Title

䊳

Date

W-3 Transmittal of Wage and Tax Statements

Note: When you fill in Forms W-2 and W-3, please—
● Type or print entries, if possible, using black ink.
● Enter all money amounts without the dollar sign and comma,
but with the decimal point (for example, 2475.95 not $2,475.95).

2009

䊳

1/29/10

Department of the Treasury
Internal Revenue Service

● Do not round money amounts—show the cents portion.

H-9

Page 10 of 12 of 2009 Instructions for Schedule H (Form 1040) Household Employment
Taxes
10:44 - 18-AUG-2009
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

SCHEDULE H
(Form 1040)
Department of the Treasury
Internal Revenue Service (99)

OMB No. 1545-1971

Household Employment Taxes
(For Social Security, Medicare, Withheld Income, and Federal Unemployment (FUTA) Taxes)
䊳 Attach to Form 1040, 1040NR, 1040-SS, or 1041.
䊳 See separate instructions.

Name of employer

44

Social security number

0 0 0

Susan Green

A

2009

Attachment
Sequence No.

11

1 1 1 1

Employer identification number

0 0 1

2 3 4 5 6 7

Did you pay any one household employee cash wages of $1,700 or more in 2009? (If any household employee was your
spouse, your child under age 21, your parent, or anyone under age 18, see the line A instructions on page H-4 before you
answer this question.)
⻫ 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
1

2, 3 0 0

00

1

Total cash wages subject to social security taxes (see page H-4)

2

Social security taxes. Multiply line 1 by 12.4% (.124)

3

Total cash wages subject to Medicare taxes (see page H-4)

4

Medicare taxes. Multiply line 3 by 2.9% (.029)

4

5

Federal income tax withheld, if any

5

6

Total social security, Medicare, and federal income taxes (add lines 2, 4, and 5)

6

7

Advance earned income credit (EIC) payments, if any

7

8

Net taxes (subtract line 7 from line 6)

8

9

Did you pay total cash wages of $1,000 or more in any calendar quarter of 2008 or 2009 to all household employees?
(Do not count cash wages paid in 2008 or 2009 to your spouse, your child under age 21, or your parent.)

2
3

2, 3 0 0

285

20

00
66 70

351

90

351

90

⻫ No. Stop. Include the amount from line 8 above on Form 1040, line 59, and check box b on that line. If you are not
required to file Form 1040, see the line 9 instructions on page H-4.

H-10

Page 11 of 12 of 2009 Instructions for Schedule H (Form 1040) Household Employment
Taxes
10:44 - 18-AUG-2009
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Contact List for State Unemployment Tax Agencies
See the Appendix in Pub. 926, Household Employer’s Tax Guide for complete contact information.
State

Telephone

Alabama . . . . . . . .
Alaska . . . . . . . . . .
Arizona . . . . . . . . .
Arkansas . . . . . . . .
California . . . . . . . .
Colorado . . . . . . . .
Connecticut . . . . . .
Delaware . . . . . . . .
District of Columbia
Florida . . . . . . . . . .
Georgia . . . . . . . . .
Hawaii . . . . . . . . . .
Idaho . . . . . . . . . . .
Illinois . . . . . . . . . .
Indiana . . . . . . . . .
Iowa . . . . . . . . . . .
Kansas . . . . . . . . . .
Kentucky . . . . . . . .
Louisiana . . . . . . . .
Maine . . . . . . . . . .
Maryland . . . . . . . .
Massachusetts . . . . .
Michigan . . . . . . . .
Minnesota . . . . . . .
Mississippi . . . . . . .
Missouri . . . . . . . .
Montana . . . . . . . .
Nebraska . . . . . . . .
Nevada . . . . . . . . .
New Hampshire . . .
New Jersey . . . . . .
New Mexico . . . . .
New York . . . . . . .
North Carolina . . . .
North Dakota . . . . .
Ohio . . . . . . . . . . .
Oklahoma . . . . . . .
Oregon . . . . . . . . .

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

Pennsylvania .
Puerto Rico . .
Rhode Island .
South Carolina
South Dakota .
Tennessee . . .
Texas . . . . . .
Utah . . . . . . .
Vermont . . . .
Virginia . . . . .
Virgin Islands .
Washington . .
West Virginia .
Wisconsin . . .
Wyoming . . . .

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

Web Address

(334) 242-8830 . . . . . . .
(888) 448-3527 . . . . . . .
(602) 771-6601 . . . . . . .
(501) 682-3798 . . . . . . .
(888) 745-3886 . . . . . . .
(800) 480-8299 . . . . . . .
(860) 263-6550 . . . . . . .
(302) 761-8484 . . . . . . .
(202) 698-7550 . . . . . . .
(800) 482-8293 . . . . . . .
(404) 232-3301 . . . . . . .
(808) 586-8913 . . . . . . .
(800) 448-2977 . . . . . . .
(800) 247-4984 . . . . . . .
(317) 232-7436 . . . . . . .
(515) 281-5339 . . . . . . .
(785) 296-5027 . . . . . . .
(502) 564-2272 . . . . . . .
(225) 342-2944 . . . . . . .
(207) 621-5120 . . . . . . .
(800) 492-5524 . . . . . . .
(617) 626-5050 . . . . . . .
(313) 456-2180 . . . . . . .
(651) 296-6141 . . . . . . .
(866) 806-0272 . . . . . . .
(573 751-3340 . . . . . . . .
(406) 444-3834 . . . . . . .
(402) 471-9935 . . . . . . .
(775) 684-6300 . . . . . . .
(603) 228-4033 . . . . . . .
(609) 633-6400 . . . . . . .
(505) 841-8576 . . . . . . .
(518 )457-4179 . . . . . . .
(919) 733-7396 . . . . . . .
(701) 328-2814 . . . . . . .
(614) 466-2319 . . . . . . .
(405) 557-7143 . . . . . . .
(503) 947-1488, option 5
(503) 947-1537 FUTA . .
(717) 787-7679 . . . . . . .
(787) 754-5818
(401) 574-8700 . . . . . . .
(803) 737-3075 . . . . . . .
(605) 626-2312 . . . . . . .
(615) 741-2486 . . . . . . .
(512) 463-2700 . . . . . . .
(801) 526-9400 . . . . . . .
(802) 828-4252 . . . . . . .
(804) 371-7159 . . . . . . .
(340) 776-1440 . . . . . . .
(360) 902-9360 . . . . . . .
(304) 558-2676 . . . . . . .
(608) 261-6700 . . . . . . .
(307) 235-3217 . . . . . . .

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

www.dir.alabama.gov
www.labor.state.ak.us
www.azdes.gov/esa/uitax/uithome.asp
www.state.ar.us/esd
www.edd.cahwnet.gov
www.coworkforce.com
www.ctdol.state.ct.us
www.delawareworks.com
www.dcnetworks.org
http://dor.myflorida.com/dor/uc
www.dol.state.ga.us
www.hawaii.gov/labor
www.labor.state.id.us
www.ides.state.il.us
www.in.gov/dwd
www.iowaworkforce.org/ui
www.dol.ks.gov
www.oet.ky.gov
www.laworks.net/homepage.asp
www.state.me.us/labor
www.dllr.state.md.us
www.detma.org
www.michigan.gov/uia
www.uimn.org/tax
www.mdes.ms.gov
www.dolir.mo.gov
www.uid.dli.mt.gov
www.dol.state.ne.us
https://uitax.nvdetr.org
www.nhes.state.nh.us
http://lwd.dol.state.nj.us
www.dws.state.nm.us
www.labor.state.ny.us
www.ncesc.com
www.jobsnd.com
www.jfs.ohio.gov
www.oesc.state.ok.us

. . . . . . . . . . . . . . . www.oregon.gov/EMPLOY/TAX
. . . . . . . . . . . . . . . www.dli.state.pa.us
.
.
.
.
.
.
.
.
.
.
.
.
.

H-11

.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.

www.uitax.ri.gov
www.sces.org/ui
www.state.sd.us
www.state.tn.us/labor-wfd/esdiv.html
www.twc.state.tx.us
www.jobs.utah.gov
www.labor.vermont.gov
www.VaEmploy.com
www.vidol.gov
www.esd.wa.gov/uitax/index.php
www.wvbep.org/bep/uc
www.dwd.state.wi.us
http://wydoe.state.wy.us

Page 12 of 12 of 2009 Instructions for Schedule H (Form 1040) Household Employment
Taxes
10:44 - 18-AUG-2009
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Do You Have To File Form 1040, 1040NR, 1040-SS, or Form 1041?
Yes — Attach Schedule H to that form and mail to the address in your tax return booklet.
No — Mail your completed Schedule H and payment to the Department of the Treasury, Internal Revenue Service Center for the place where
you live. No street address is needed. See When and Where To File on page H-3 for the information to enter on your payment.

IF you live in...

THEN use this address...

Florida, Georgia, North Carolina, South Carolina

Atlanta, GA 39901 – 0002

Alabama, Kentucky, Louisiana, Mississippi, Tennessee, Texas

Austin, TX 73301 – 0002

Alaska, Arizona, California, Colorado, Hawaii, Idaho, Illinois, Indiana, Iowa,
Kansas, Michigan, Minnesota, Montana, Nebraska, Nevada, New Mexico,
North Dakota, Oklahoma, Oregon, South Dakota, Utah, Washington,
Wisconsin, Wyoming

Fresno, CA 93888 – 0002

Arkansas, Connecticut, Delaware, District of Columbia, Indiana, Maine,
Maryland, Massachusetts, Missouri, New Hampshire, New Jersey, New York,
Ohio, Pennsylvania, Rhode Island, , Vermont, Virginia,
West Virginia

Kansas City, MO 64999 – 0002

APO, FPO, American Samoa, the Commonwealth of the Northern Marian
Islands, nonpermanent residents of Guam or the U.S. Virgins Islands*, Puerto
Rico, dual-satatus aliens, a foreign country

Austin, TX 73301 – 0215

* Permanent residents of Guam should use: Department of Revenue and Taxation, Government of Guam, P.O. Box 23607, GMF, GU
96921; permanent residents of the U.S. Virgin Islands should use: V.I. Bureau of Internal Revenue, 9601 Estate Thomas, Charlotte Amalie,
St. Thomas, VI 00802.

H-12
Printed on recycled paper

SCHEDULE H
(Form 1040)

Version A, Cycle 2

Household Employment Taxes

OMB No. 1545-1971

(For Social Security, Medicare, Withheld Income, and Federal Unemployment (FUTA) Taxes)
' Attach

Department of the Treasury
Internal Revenue Service (99)
Name of employer

to Form 1040, 1040NR, 1040-SS, or 1041.
' See separate instructions.

2009

Attachment
Sequence No. 44
Social security number
Employer identification number

A Did you pay any one household employee cash wages of $1,700 or more in 2009? (If any household employee was your
spouse, your child under age 21, your parent, or anyone under age 18, see the line A instructions on page H-4 before you
answer this question.)
Yes. Skip lines B and C and go to line 1.
No. Go to line B.

DRAFT AS OF
July 9, 2009

B Did you withhold federal income tax during 2009 for any household employee?
Yes. Skip line C and go to line 5.
No. Go to line C.

C Did you pay total cash wages of $1,000 or more in any calendar quarter of 2008 or 2009 to all household employees?
(Do not count cash wages paid in 2008 or 2009 to your spouse, your child under age 21, or your parent.)
No. Stop. Do not file this schedule.
Yes. Skip lines 1-9 and go to line 10 on the back. (Calendar year taxpayers having no household employees in
2009 do not have to complete this form for 2009.)

Part I

Social Security, Medicare, and Federal Income Taxes

1 Total cash wages subject to social security taxes (see page H-4) .

.

2 Social security taxes. Multiply line 1 by 12.4% (.124)

1
.

.

.

.

.

.

.

2

.

.

.

.

.

.

.

.

4

.

.

.

.

.

.

.

.

5

6 Total social security, Medicare, and federal income taxes. Add lines 2, 4, and 5 .

.

.

.

.

6

7 Advance earned income credit (EIC) payments, if any .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

7

8 Net taxes (subtract line 7 from line 6) .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

8

.

.

.

.

3 Total cash wages subject to Medicare taxes (see page H-4) .

.

.

.

4 Medicare taxes. Multiply line 3 by 2.9% (.029)

.

.

.

.

.

.

.

.

.

5 Federal income tax withheld, if any .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.
3

9 Did you pay total cash wages of $1,000 or more in any calendar quarter of 2008 or 2009 to all household employees?
(Do not count cash wages paid in 2008 or 2009 to your spouse, your child under age 21, or your parent.)

No. Stop. Include the amount from line 8 above on Form 1040, line 59, and check box b on that line. If you are not
required to file Form 1040, see the line 9 instructions on page H-4.
Yes. Go to line 10 on the back.
For Privacy Act and Paperwork Reduction Act Notice, see page H-7 of the instructions.

Cat. No. 12187K

Schedule H (Form 1040) 2009

Version A, Cycle 2
Schedule H (Form 1040) 2009

Page

2

Part II Federal Unemployment (FUTA) Tax
Yes No
10 Did you pay unemployment contributions to only one state? (If you paid contributions to XXXXX, check "No.")
11 Did you pay all state unemployment contributions for 2009 by April 15, 2010? Fiscal year filers, see page H-4
12 Were all wages that are taxable for FUTA tax also taxable for your state’s unemployment tax? . . . . .

10
11
12

Next: If you checked the “Yes” box on all the lines above, complete Section A.
If you checked the “No” box on any of the lines above, skip Section A and complete Section B.

Section A

13 Name of the state where you paid unemployment contributions '
14 State reporting number as shown on state unemployment tax return '
15 Contributions paid to your state unemployment fund (see page H-5) .
16 Total cash wages subject to FUTA tax (see page H-5) . . . . . .

15
. .

.

.

.

16

17 FUTA tax. Multiply line 16 by .008. Enter the result here, skip Section B, and go to line 26 .

.

.

17

.

.

.

.

DRAFT AS OF
July 9, 2009
Section B

18 Complete all columns below that apply (if you need more space, see page H-5):
(b)
(a)
State reporting number
Name
as shown on state
of
unemployment tax
state
return

(c)
Taxable wages (as
defined in state act)

(d)
State experience rate
period
From

To

(e)
State
experience
rate

(f)
Multiply col. (c)
by .054

19
20
21
22
23
24

(g)
Multiply col. (c)
by col. (e)

Totals
. . . . . . . . . . . . . . . . . . . . . . . . . .
20
Add columns (h) and (i) of line 19 . . . . . . . . . . . . .
Total cash wages subject to FUTA tax (see the line 16 instructions on page H-5) . .
Multiply line 21 by 6.2% (.062) . . . . . . . . . . . . . . . . . .
23
Multiply line 21 by 5.4% (.054) . . . . . . . . . . . . .
Enter the smaller of line 20 or line 23 . . . . . . . . . . . . . . . .
(XXXX employers must use the worksheet in the separate instructions and check here)
25 FUTA tax. Subtract line 24 from line 22. Enter the result here and go to line 26 . .

Part III Total Household Employment Taxes

(h)
Subtract col. (g)
from col. (f). If
zero or less,
enter -0-.

(i)
Contributions
paid to state
unemployment
fund

19

.

.

.
.

.
.

.
.

.
.

.
.
.

.
.
.

.
.
.

.
.

21
22

24
25

26 Enter the amount from line 8. If you checked the “Yes” box on line C of page 1, enter -0- . . .
26
27 Add line 17 (or line 25) and line 26 (see page H-5) . . . . . . . . . . . . . . . .
27
28 Are you required to file Form 1040?
Yes. Stop. Include the amount from line 27 above on Form 1040, line 59, and check box b on that line. Do not complete
Part IV below.
No. You may have to complete Part IV. See page H-5 for details.

Part IV Address and Signature— Complete this part only if required. See the line 28 instructions on page H-5.
Address (number and street) or P.O. box if mail is not delivered to street address

Apt., room, or suite no.

City, town or post office, state, and ZIP code
Under penalties of perjury, I declare that I have examined this schedule, including accompanying statements, and to the best of my knowledge and belief, it is true,
correct, and complete. No part of any payment made to a state unemployment fund claimed as a credit was, or is to be, deducted from the payments to employees.
Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

'

Employer’s signature

Paid
Preparer’s
Use Only

Preparer’s
signature

'

Firm's name (or
yours if self-employed),
address, and Zip code

'
Date

'

Date

Check if
self-employed

Preparer's SSN or PTIN

EIN
Phone no.
Schedule H (Form 1040) 2009