Schedule H (Form 1 Household Employment Taxes

SCHEDULE H
(Form 1040)

Household Employment Taxes

OMB No. 1545-1971

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

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

© Attach

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.
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) .

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

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

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

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

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8

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

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

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5 Federal income tax withheld, if any .

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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

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 Michigan, check "No.")
11 Did you pay all state unemployment contributions for 2009 by April 15, 2010? Fiscal year filers, see page H-5
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) . . . . . .

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

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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

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

19
20
21
22
23
24

Totals
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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 . . . . . . . . . . . . . . . . . .
(Michigan 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

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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

Date

©

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

©

Date

Check if
self-employed

Preparer's SSN or PTIN

EIN
Phone no.
Schedule H (Form 1040) 2009