Form 1040 (Sch H) Household Employment Taxes

Version A, Cycle 5

SCHEDULE H
(Form 1040)

Household Employment Taxes

OMB No. 1545-1971

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

Department of the Treasury
Internal Revenue Service (99)

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

2011

Attachment
Sequence No. 44
Social security number

Name of employer

Employer identification number

A Did you pay any one household employee cash wages of $1,700 or more in 2011? (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-X 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 2011 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 2010 or 2011 to all household employees?
(Do not count cash wages paid in 2010 or 2011 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. (Calendar year taxpayers having no household employees in 2011 do not have
to complete this form for 2011.)

Part I

DRAFT AS OF
August 9, 2011

Social Security, Medicare, and Federal Income Taxes

1 Total cash wages subject to social security taxes

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2 Social security taxes. Multiply line 1 by 10.4% (.104)

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

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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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2

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4

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

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6

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3

7 Did you pay total cash wages of $1,000 or more in any calendar quarter of 2010 or 2011 to all household employees?
(Do not count cash wages paid in 2010 or 2011 to your spouse, your child under age 21, or your parent.)
No. Stop. Include the amount from line 6 above on Form 1040, line 59a. If you are not required to file Form 1040, see the
line 7 instructions.
Yes. Go to line 8.
For Privacy Act and Paperwork Reduction Act Notice, see page H-X of the instructions.

Cat. No. 12187K

Schedule H (Form 1040) 2011

Version A, Cycle 5
Schedule H (Form 1040) 2011

Page

2

Part II Federal Unemployment (FUTA) Tax
Yes No
8 Did you pay unemployment contributions to only one state? (If you paid contributions to a
state, and check “No.”) . . . . . . . . . . . . . . . . . . . . . . . .
9 Did you pay all state unemployment contributions for 2011 by April 17, 2012? Fiscal year filers
10 Were all wages that are taxable for FUTA tax also taxable for your state’s unemployment tax?

credit
. .
. .
. .

reduction
. . .
. . .
. . .

8
9
10

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

11 Name of the state where you paid unemployment contributions

12 Contributions paid to your state unemployment fund .
13 Total cash wages subject to FUTA tax . . . . . .

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a

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12
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14 FUTA tax. Multiply the portion of the wages on line 13 paid before July 1 by .008. Multiply the
portion of the wages on line 13 paid after June 30 by .006. Enter the sum of those two amounts on
line 14, skip Section B, and go to line 23 . . . . . . . . . . . . . . . . . . .

Section B

14

15 Complete all columns below that apply (if you need more space, see instructions):
(a)
Name of state

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

(c)
State experience rate
period
From

To

(d)
State
experience
rate

(e)
Multiply col. (b)
by .054

(f)
Multiply col. (b)
by col. (d)

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

DRAFT AS OF
August 9, 2011

16
17
18
19

Totals
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16
Add columns (g) and (h) of line 16 . . . . . . . . . . . .
17
Total cash wages subject to FUTA tax (see the line 13 instructions) . . . . . . . . . .
Multiply the portion of the wages on line 18 paid before July 1 by 6.2% (.062). Multiply the portion
of the wages on line 18 paid after June 30 by 6.0% (.60). Enter the sum of those amounts on line 19
20 Multiply line 18 by 5.4% (.054) . . . . . . . . . . . . .
20
21 Enter the smaller of line 17 or line 20 . . . . . . . . . . . . . . . . . . . .
(Employers in a credit reduction state must use the worksheet on page H-X and check here) .
22 FUTA tax. Subtract line 21 from line 19. Enter the result here and go to line 23 . . . . . .

(h)
Contributions
paid to state
unemployment
fund

18
19

21
22

Part III Total Household Employment Taxes
23 Enter the amount from line 6. If you checked the “Yes” box on line C of page 1, enter -0- . . .
23
24 Add line 14 (or line 22) and line 23 . . . . . . . . . . . . . . . . . . . . .
24
25 Are you required to file Form 1040?
Yes. Stop. Include the amount from line 24 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 instructions for details.

Part IV Address and Signature— Complete this part only if required. See the line 25 instructions.
Apt., room, or suite no.

Address (number and street) or P.O. box if mail is not delivered to street address
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.

Paid
Preparer
Use Only

▲

▲

Employer’s signature
Print/Type preparer’s name

Preparer's signature

Date
Date

Check
if
self-employed

Firm’s name

a

Firm's EIN

Firm's address

a

Phone no.

PTIN

a

Schedule H (Form 1040) 2011