U.S. Individual Income Tax Return Forms

U.S. Individual Income Tax Return

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U.S. Individual Income Tax Return Forms

OMB: 1545-0074

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Department of the Treasury
Internal Revenue Service

2021 Instructions for Schedule H

DRAFT AS OF
November 29, 2021
Household
Employment
Taxes

Here is a list of forms that household employers need to
complete.

•
•
•

Schedule H (Form 1040) 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(s) W-2 to the Social Security Administration (SSA).

For more information, see What Forms Must You File? in Pub. 926, Household
Employer's Tax Guide.

We have been asked:

Do I need to pay household employment taxes for 2021? If you have a household
employee, you need to withhold and pay social security and Medicare taxes if you
paid cash wages of $2,300 or more in 2021 to any one household employee. See Did
you have a household employee? and the Line A instructions for more information.
You need to pay federal unemployment tax if you paid total cash wages of $1,000 or
more in any calendar quarter of 2020 or 2021 to household employees. See the Part II.
Federal Unemployment (FUTA) Tax instructions for more information.
How do I file Schedule H? File Schedule H with your Form 1040, 1040-SR,
1040-NR, 1040-SS, or 1041. If you’re not filing a 2021 tax return, file Schedule H by
itself.
Do I make a separate payment? No. You pay both income and employment taxes to
the United States Treasury when you file Schedule H with your return.
When do I pay? Most filers must pay by April 18, 2022.
How many copies of Form W-3 do I send to the 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.

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

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

January 31, 2022

Give your employee Form W-2 and send Copy A of Form(s)
W-2 with Form W-3 to the SSA. Go to SSA.gov/employer
for details.
File Schedule H and pay your household employment taxes
with your 2021 tax return.

April 18, 2022

Contents
When and Where To File . . . . . . . . . . . . . . . . . . . .
How To Fill In Schedule H, Form W-2, and Form W-3
Schedule H . . . . . . . . . . . . . . . . . . . . . . . . . .
Worksheet 1. Credit for Late Contributions . . . . .
Worksheet 2. Worksheet 2 for Household
Employers in a Credit Reduction State . . . . . .
Form W-2 and Form W-3 . . . . . . . . . . . . . . . . .
Worksheet 3. Credit for Qualified Sick and Family
Leave Wages for Leave Taken Before April 1,
2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section references are to the Internal Revenue Code unless
otherwise noted.

Contents
What's New . . . . . . . . . . . . . . . . . . . . . . . . . .
Reminders . . . . . . . . . . . . . . . . . . . . . . . . . . .
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? . . . . . . . .

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H-1
Nov 23, 2021

Cat. No. 21451X

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Contents
Worksheet 4. Credit for Qualified Sick and Family
Leave Wages for Leave Taken After March 31,
2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Estimated Tax Penalty . . . . . . . . . . . . . . . . . . . .
What Records To Keep . . . . . . . . . . . . . . . . . . .
What Is the Earned Income Credit (EIC)? . . . . . . .
Rules for Business Employers . . . . . . . . . . . . . . .
How To Correct Schedule H . . . . . . . . . . . . . . . .
How To Get Forms and Publications . . . . . . . . . .
Completed Examples of Schedule H, Form W-2, and
Form W-3 . . . . . . . . . . . . . . . . . . . . . . . . .
Privacy Act and Paperwork Reduction Act Notice . .

Page

Relief Act of 2020. The credits under sections 3131 and 3132
are available for qualified leave wages paid for leave taken after March 31, 2021, and before October 1, 2021. Below are the
major changes made under the ARP.
• The ARP keeps the daily wage thresholds that previously
existed. The aggregate cap on qualified sick leave wages remains at 80 hours (10 days), but the limitation on the number
of days resets with respect to leave taken by employees beginning on April 1, 2021. The aggregate cap on qualified family
leave wages increases to $12,000 from the previous cap of
$10,000, and the aggregate cap resets with respect to leave taken by employees beginning on April 1, 2021.
• The ARP also created a new category of leave under the
Emergency Paid Sick Leave Act (EPSLA) and the Expanded
Family and Medical Leave Act (Expanded FMLA) to include
the time the employee is seeking or awaiting the results of a diagnostic test for, or a medical diagnosis of, COVID-19 (and the
employee has been exposed to COVID-19 or the employee's
employer has requested such test or diagnosis), or the employee is obtaining or accompanying an individual who is obtaining
immunizations related to COVID-19 or recovering from or caring for an individual recovering from an injury, disability, illness, or condition related to such immunization. Additionally,
employers may provide employees with paid family leave if
the employee is unable to work due to any of the conditions for
which eligible employers may provide paid sick leave under
the EPSLA.
• The credits are still increased by the qualified health plan
expenses allocable to the qualified sick and family leave wages
but the credits are now also increased, subject to the qualified
leave wage limitations, by certain amounts paid under collective bargaining agreements that are properly allocable to the
qualified leave wages. The collectively bargained contributions
paid by an eligible employer that are eligible for the credit are
collectively bargained defined benefit pension plan contributions and collectively bargained apprenticeship program contributions that are properly allocable to qualified leave wages.
• Under section 3133, the credits are increased by the
amount of the employer share of social security tax and Medicare tax on the qualified sick and family leave wages.
• Generally, the same wages can't be used as both qualified
sick leave wages and qualified family leave wages.
How you report qualified sick and family leave wages and
the credit for qualified sick and family leave wages has
changed. Taxable qualified sick and family leave wages for
leave taken after March 31, 2021, are included on line 1a and
taxed at 12.4% for social security tax purposes. However, if
you’re reporting any qualified sick and family leave wages for
leave taken before April 1, 2021, these wages are reported on
line 1b, and taxed at 6.2% for social security tax purposes. For
leave taken before April 1, 2021, the credit for qualified sick
and family leave wages is reported on line 8b (nonrefundable
portion) and, if applicable, line 8e (refundable portion). For
leave taken after March 31, 2021, the credit for qualified sick
and family leave wages is reported on line 8c (nonrefundable
portion) and, if applicable, line 8f (refundable portion); and the
nonrefundable portion of the credit is against the employer
share of Medicare tax. For more information, see the instructions for line 8b, line 8c, line 8e, and line 8f, later.

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DRAFT AS OF
November 29, 2021
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Future Developments

For the latest information about developments related to Schedule H and its instructions, such as legislation enacted after they
were published, go to IRS.gov/ScheduleH.

What's New
Social security and Medicare tax for 2021. The rate of social
security tax on taxable wages, including qualified sick leave
wages and qualified family leave wages for leave taken after
March 31, 2021, is 6.2% each for the employer and employee
or 12.4% for both. Qualified sick leave wages and qualified
family leave wages for leave taken before April 1, 2021, aren't
subject to the employer share of social security tax; therefore,
the tax rate on these wages is 6.2%. The social security wage
base limit is $142,800.
The Medicare tax rate is 1.45% each for the employee and
employer, unchanged from 2020. There is no wage base limit
for Medicare tax.
Social security and Medicare taxes apply to the wages of
household workers you pay $2,300 or more in cash wages in
2021. For more information, see Cash wages and $2,300 test,
later.
For information about the rates and wage threshold that will
apply in 2022, see Pub. 926.
The COVID-19 related credit for qualified sick and family
leave wages has been extended and amended. The Families
First Coronavirus Response Act (FFCRA) was amended by recent legislation. The FFCRA requirement that employers provide paid sick and family leave for reasons related to COVID-19 (the employer mandate) expired on December 31, 2020;
however, the COVID-related Tax Relief Act of 2020 extends
the periods for which employers providing leave that otherwise
meets the requirements of the FFCRA may continue to claim
tax credits for qualified sick and family leave wages paid for
leave taken before April 1, 2021.
The American Rescue Plan Act of 2021 (the ARP) adds new
sections 3131, 3132, and 3133 to the Internal Revenue Code to
provide credits for qualified sick and family leave wages similar to the credits that were previously enacted under the
FFCRA and amended and extended by the COVID-related Tax

H-2

(TDD). To pay the deferred amount, select Payment due on an
IRS notice.
To pay by credit or debit card, go to IRS.gov/PayByCard. If
you pay by check or money order, make it payable to “United
States Treasury.” Enter your EIN, “Schedule H,” and the calendar year in which you originally deferred the payment (for example, “TY2020”). Payment of the deferral isn't reported on
Schedule H (Form 1040).
Bicycle commuting reimbursements. The Tax Cuts and Jobs
Act (P.L. 115-97) suspends the exclusion of qualified bicycle
commuting reimbursements from your employee's income for
tax years beginning after 2017 and before 2026.
Outsourcing payroll duties. You’re responsible to ensure that
tax returns are filed and deposits and payments are made, even
if you contract with a third party to perform these acts. You remain responsible if the third party fails to perform any required
action. Before you choose to outsource any of your payroll and
related tax duties (that is, withholding, reporting, and paying
over social security, Medicare, FUTA, and income taxes) to a
third-party payer, such as a payroll service provider or reporting agent, go to IRS.gov/OutsourcingPayrollDuties for helpful
information on this topic. For more information on the different
types of third-party payer arrangements, see section 16 of Pub.
15.
Paid preparers. If you use a paid preparer, your paid preparer must sign Schedule H in Part IV unless you’re attaching
Schedule H to Form 1040, 1040-SR, 1040-NR, 1040-SS, or
1041. A paid preparer must sign Schedule H and provide the
information requested in the Paid Preparer Use Only section
only if the preparer was paid to prepare Schedule H and isn't
your employee. The preparer must give you a copy of the return in addition to the copy to be filed with the IRS.
If you’re required to file a 2021 Form W-2 for any household employee, you must also send Form W-3 with Copy A of
Form(s) W-2 to the SSA. You’re encouraged to file your
Forms W-2 and W-3 electronically. If filing electronically via
the SSA's Form W-2 Online service, the SSA generates Form
W-3 data from the electronic submission of Form(s) W-2. Go
to the SSA's Employer W-2 Filing Instructions & Information
website at SSA.gov/employer to learn about electronic filing.

Deferral of the employer share of social security tax expired. The Coronavirus Aid, Relief, and Economic Security
(CARES) Act allowed employers to defer the deposit and payment of the employer share of social security tax. The deferred
amount of the employer share of social security tax was only
available for deposits due on or after March 27, 2020, and before January 1, 2021, as well as deposits and payments due after January 1, 2021, that are required for wages paid on or after
March 27, 2020, and before January 1, 2021. One-half of the
employer share of social security tax is due by December 31,
2021, and the remainder is due by December 31, 2022. Because both December 31, 2021, and December 31, 2022, are
nonbusiness days, payments made on the next business day
will be considered timely. Any payments or deposits you make
before December 31, 2021, are first applied against your payment due on December 31, 2021, and then applied against your
payment due on December 31, 2022. For more information
about the deferral of employment tax deposits, go to IRS.gov/
ETD. See Paying the deferred amount of the employer share of
social security tax, later, for information about paying the deferred amount of the employer share of social security tax.
Qualified parking exclusion and commuter transportation
benefit. For 2021, the monthly exclusion for qualified parking
is $270 and the monthly exclusion for commuter highway vehicle transportation and transit passes is $270.
Credit reduction state. A state that hasn't repaid money it
borrowed 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 2021, the U.S. Virgin Islands (USVI) is the only credit
reduction state. If you paid wages that were subject to the unemployment compensation laws of the USVI, your credit
against federal unemployment tax will be reduced based on the
credit reduction rate (for example, 0.033) for that credit reduction state. See Worksheet 2 to figure your credit reduction for
2021.

DRAFT AS OF
November 29, 2021

Reminders

Who Needs To File Schedule H?

Paying the deferred amount of the employer share of social
security tax. One-half of the employer share of social security
tax is due by December 31, 2021, and the remainder is due by
December 31, 2022. Because both December 31, 2021, and
December 31, 2022, are nonbusiness days, payments made on
the next business day will be considered timely. Any payments
you make before December 31, 2021, are first applied against
your payment due on December 31, 2021, and then applied
against your payment due on December 31, 2022. For additional information, go to IRS.gov/ETD.

You must file Schedule H if you answer “Yes” to any of the
questions on lines A, B, and C of Schedule H.
Did you have a household employee? If you hired someone
to do household work and you could 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.
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 childcare duties.
You provided the household equipment and supplies Betty needed to do her work. Betty is your household employee.
Household work is work done in or around your home.
Some examples of workers who do household work are:

How to pay the deferred amount of the employer share of
social security tax. You may pay the amount you owe electronically using the Electronic Federal Tax Payment System
(EFTPS), by credit or debit card, or by a check or money order.
The preferred method of payment is EFTPS. For more information, go to EFTPS.gov, or call 800-555-4477 or 800-733-4829

H-3

Babysitters
Butlers
Caretakers
Cleaning people

Cooks
Drivers
Health aides
Housekeepers

go to the SSA's Employer W-2 Filing Instructions & Information website at SSA.gov/employer.

Maids
Nannies
Private nurses
Yard workers

Do You Have an Employer
Identification Number (EIN)?
If you have household employees, you will need an EIN to file
Schedule H. If you don't have an EIN, you may apply for one
online by going to IRS.gov/EIN. You may also apply for an
EIN by faxing or mailing Form SS-4 to the IRS. Don't use your
social security number (SSN) in place of an EIN. The Instructions for Form SS-4 explain how you can get an EIN immediately over the Internet, generally within 4 business days by fax,
or in about 4 weeks if you apply by mail. Go to IRS.gov/Forms
to get forms and publications, including Form SS-4.

If a worker is your employee, it doesn't 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 doesn't matter if the wages paid are for work done
hourly, daily, weekly, or by the job.
If you’re a home care service recipient receiving home care
services through a program administered by a federal, state, or
local government agency, and the person who provides your
care is your household employee, you can ask the IRS to authorize an agent under section 3504 to report, file, and pay all
federal employment taxes, including FUTA taxes, on your behalf. See Form 2678, Employer/Payer Appointment of Agent,
for more information.

DRAFT AS OF
November 29, 2021
Can Your Employee Legally Work in
the United States?

It is unlawful to employ a person who can't 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. You
must verify that the employee is either a U.S. citizen or a person who can legally work in the United States and you must
keep Form I-9 for your records. You can get the form and the
USCIS Handbook for Employers by going to the USCIS website at USCIS.gov/I-9-Central. You may use E-Verify at everify.gov to confirm the employment eligibility of newly hired
employees.

If a government agency or third-party agent reports

TIP and pays the employment taxes on wages paid to your
household employee on your behalf, you don't need to
file Schedule H to report those taxes.
Workers who aren't your employees. Workers you get from
an agency aren't 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.

What About State Employment
Taxes?

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, instructs them how to do their jobs, and provides his own tools
and supplies. Neither Paul nor his helpers are your employees.
For more information, see Pub. 926.

If you employed a household employee in 2021, you probably
have to pay contributions to your state unemployment fund for
2021. To find out if you do, contact your state unemployment
tax agency. For a list of state unemployment tax agencies, go to
the U.S. Department of Labor's website at oui.doleta.gov/
unemploy/agencies.asp. You should also find out if you need to
pay or collect other state employment taxes or carry workers'
compensation insurance.

Who Needs To File Form W-2 and
Form W-3?
You must file Form W-2 for each household employee to
whom you paid $2,300 or more of cash wages in 2021 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, line 1a, line 3, and line 5, later. Even if the wages aren't
subject to these taxes, if you withheld federal income tax from
the wages of any household employee, you must file Form W-2
for that employee. However, when not subject to social security and Medicare taxes, leave boxes 3, 4, 5, and 6 blank on
Form W-2; only complete boxes 1 and 2. If the wages are below $2,300 for 2021 and you complete boxes 3, 4, 5, and 6 on
Form W-2, the SSA will reject your Form W-2.

When and Where To File
Schedule H
If you file Form 1040, 1040-SR, 1040-NR, 1040-SS, or 1041
for 2021, remember to attach Schedule H to it. Mail your return, by April 18, 2022, to the address shown in your tax return
instructions.
Exceptions. If you get an extension of time to file your return,
file your return with Schedule H by the extended due date. If
you’re a fiscal year filer, file your return and Schedule H by the
due date of your fiscal year return, including extensions.

If you file one or more Forms W-2, you must also file Form
W-3. If filing electronically via the SSA's Form W-2 Online
service, the SSA generates Form W-3 automatically based on
your Form(s) W-2. For more information on electronic filing,

If you’re a calendar year taxpayer and have no house-

TIP hold employees for 2021, you don't have to file Schedule H for 2021.

H-4

If you have household employees for 2021, but you’re not
required to file a 2021 tax return (for example, because your income is below the amount that requires you to file), you must
file Schedule H by itself by April 18, 2022. Complete Schedule H and put it in an envelope with your check or money order. Don't send cash. See the list of filing addresses later in
these instructions. 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 “United States Treasury” for the total household employment taxes due. Enter your
name, address, SSN, daytime phone number, and “2021 Schedule H” on your check or money order. Household employers
that are tax exempt and don't have to file a tax return (for example, churches that pay a household worker to take care of a
minister's home) may also file Schedule H by itself.

How To Fill In Schedule H, Form
W-2, and Form W-3
Schedule H
If you were notified that your household employee received payments from a state disability plan, see State
Disability Payments, later.

DRAFT AS OF
November 29, 2021
!

CAUTION

Social security number (SSN). Enter your SSN. Form 1041
filers, don't enter a number in this space. But be sure to enter
your EIN in the space provided.
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 don't have an EIN, see Do You Have an Employer Identification Number (EIN), earlier. If you applied for an EIN but
haven't received it, enter “Applied For” and the date you applied. Don't use your SSN as an EIN.
Line A. To figure the total cash wages you paid in 2021 to
each household employee, don't include amounts paid to any of
the following individuals.
• Your spouse.
• 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
2021. If the employee wasn't a student, see Exception for employees under age 18 below.

Form W-2 and Form W-3

You're encouraged to file your Forms W-2 and W-3 electronically. Go to the SSA's Employer W-2 Filing Instructions & Information website at SSA.gov/employer to learn about electronic filing. If filing electronically via the SSA's Form W-2 Online
service, the SSA generates Form W-3 automatically based on
your Form(s) W-2.

By January 31, 2022, send Copy A of all Forms W-2 with
Form W-3 to the SSA and give Copies B, C, and 2 of Form
W-2 to each employee. For paper forms, you will meet this requirement if the form is properly addressed, mailed, and postmarked no later than January 31, 2022.

If you file Forms W-2 and W-3 electronically, don't
mail the paper Forms W-2 and W-3 to the SSA.

Exception for parents. Include the cash wages you paid
your parent for work in or around your home if both (1) and (2)
below apply.
1. Your child (including an adopted child or stepchild) 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 during the calendar quarter in which services were performed. A calendar quarter is January through
March, April through June, July through September, or 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
for at least 4 continuous weeks during the calendar quarter in
which services were performed.

CAUTION

If filing on paper, mail Copy A of all Forms W-2 with Form
W-3 to:
Social Security Administration
Direct Operations Center
Wilkes-Barre, PA 18769-0001
If you use “Certified Mail” to file, change the ZIP code to
“18769-0002.” If you use an IRS-approved private delivery
service (PDS), add “Attn: W-2 Process, 1150 E. Mountain Dr.”
to the address and change the ZIP code to “18702-7997.” Go to
IRS.gov/PDS for the current list of IRS-approved PDSs.
Check with your state, city, or local tax department to

Exception for employees under age 18. Include 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.
Cash wages. Cash wages include wages paid by check, money
order, etc. Cash wages don't include the value of food, lodging,
clothing, transit passes, or other noncash items you give a
household employee. However, cash you give your employee
in place of these items is included in cash wages.
Noncash wages paid to household employees aren't subject
to social security taxes or Medicare taxes; however, they are
subject to federal income tax unless a specific exclusion applies. Report the value of taxable noncash wages in box 1 of

TIP find out if you must file Copy 1 of Form W-2.
Penalties. You may have to pay a penalty if you don't give
Forms W-2 to your employees or file Copy A of the forms with
the SSA by the due dates. You may also have to pay a penalty
if you don't show your employee's SSN on Form W-2 or don't
provide correct information on the form.

H-5

Form W-2 together with cash wages. Don't show noncash wages in box 3 or in box 5 of Form W-2. See section 5 of Pub. 15
for more information on cash and noncash wages, and Pub.
15-B for more information on fringe benefits.

For more information on Additional Medicare Tax, go to
IRS.gov/ADMT.
$2,300 test. If you pay a household employee $2,300 or
more in cash wages during 2021, you must report and pay social security and Medicare taxes on all the wages, including the
first $2,300 paid to that employee. The test applies to cash wages paid in 2021 regardless of when the wages were earned.
See Pub. 926 for more information.

Transportation (commuting) benefits. If you reimburse
your employee for qualified parking, transportation in a commuter highway vehicle, or transit passes, you may be able to
exclude the cash reimbursement amounts from counting as
cash wages subject to social security and Medicare taxes.
Qualified parking is parking at or near your home or at or near
a location from which your employee commutes to your home.
It doesn't include parking at or near your employee's home. For
2021, you can reimburse your employee up to $270 per month
for qualified parking and $270 per month for combined commuter highway vehicle transportation and transit passes. See
Transportation (Commuting) Benefits in Pub. 15-B for more
information. Any cash reimbursement over these amounts is included as wages.

DRAFT AS OF
November 29, 2021
Line 1a. Enter on line 1a the total of cash wages (see Cash
wages, earlier) paid in 2021 to each household employee who
meets the $2,300 test, explained earlier.

CAUTION

If you paid any household employee cash wages of
more than $142,800 in 2021, include on line 1a only
the first $142,800 of that employee's cash wages.

Line 1b. Enter the qualified sick and family wages for leave
taken before April 1, 2021, included on line 1a. For more information on qualified sick and family wages for leave taken before April 1, 2021, see the instructions for line 8g and line 8i,
later.
Line 2a. Multiply the amount on line 1a by 12.4% (0.124) and
enter the result on line 2a.
Line 2b. Multiply the amount on line 1b by 6.2% (0.062) and
enter the result on line 2b.
Line 2c. Enter the total social security tax. Subtract line 2b
from line 2a.
Line 3. Enter on line 3 the total of cash wages (see Cash wages, earlier) paid in 2021 to each employee who meets the
$2,300 test, explained earlier. There is no limit on wages subject to the Medicare tax.
Line 4. Multiply the amount on line 3 by 2.9% (0.029) and enter the result on line 4.
Line 5. Enter on line 5 the total cash wages (see Cash wages,
earlier) paid to each employee in 2021 that exceeded $200,000.
Line 6. Multiply the amount on line 5 by 0.9% (0.009) and enter the result on line 6.
Line 7. Enter on line 7 any federal income tax you withheld
from the wages you paid to your household employees in 2021.
See Pub. 926 and Pub. 15 for information on withholding federal income taxes.
Line 8a. Add lines 2c, 4, 6, and 7 and enter the result on
line 8a.

Part I. Social Security, Medicare, and
Federal Income Taxes
Social security and Medicare taxes fund retirement, survivor,
disability, and health benefits for workers and their families.
You and your employees generally pay these taxes in equal
amounts.
You’re not required to withhold federal income tax from
wages you pay a household employee. You should withhold
federal income tax only if your household employee asks you
to withhold it and you agree. The employee must give you a
completed Form W-4.
For 2021, the rate of social security tax on taxable wages,
except for qualified sick and qualified family leave wages for
leave taken before April 1, 2021, is 6.2% (0.062) each for the
employer and employee or 12.4% (0.124) for both. Qualified
sick and family leave wages for leave taken before April 1,
2021, aren’t subject to the employer share of social security
tax; therefore, the tax rate on those wages is 6.2% (0.062). The
limit on wages subject to social security tax is $142,800.
The Medicare tax rate is 1.45% (0.0145) each for the employee and employer, unchanged from 2020. There is no limit
on wages subject to the Medicare tax. If you didn't deduct the
employee's share from his or her wages, you must pay the employee's share of tax and your share of tax, a total of 12.4%
(0.124) for social security tax and 2.9% (0.029) for Medicare
tax. See Form W-2 and Form W-3, later, for more information.

Lines 8b Through 8f
If you aren't claiming a credit for qualified sick or family
leave wages, enter the amount from line 8a on line 8d and skip
to line 9.

In addition to withholding Medicare tax at 1.45% (0.0145),
you must withhold a 0.9% (0.009) Additional Medicare Tax
from wages you pay to an employee in excess of $200,000 in a
calendar year. You’re required to begin withholding Additional
Medicare Tax in the pay period in which you pay wages in excess of $200,000 to an employee and continue to withhold it
each pay period until the end of the calendar year. Additional
Medicare Tax is only imposed on the employee. There is no
employer share of Additional Medicare Tax. All wages that are
subject to Medicare tax are subject to Additional Medicare Tax
withholding if paid in excess of the $200,000 withholding
threshold.

The same wages can't be be both qualified sick leave wages
and qualified family leave wages. With regard to leave taken
before April 1, qualified leave wages can't be taken into account for purposes of the credit under section 45S. With regard
to leave taken after March 31, wages taken into account for
purposes of the credits under section 45A, 45P, 45S, 51, or
3134 can't be qualified leave wages.
EPSLA. Employers with fewer than 500 employees and, for
leave taken after March 31, 2021, and before October 1, 2021,

H-6

certain governmental employers without regard to number of
employees (except for the federal government and its agencies
and instrumentalities unless described in section 501(c)(1)) are
entitled to a credit if they provide paid sick leave to employees
that otherwise meets the requirements of the EPSLA. Under the
EPSLA, as amended for purposes of the ARP, wages are qualified sick leave wages if paid to employees that are unable to
work after March 31, 2021, and before October 1, 2021, because the employee:
1. Is subject to a federal, state, or local quarantine or isolation order related to COVID-19;
2. Has been advised by a health care provider to self-quarantine due to concerns related to COVID-19;
3. Is experiencing symptoms of COVID-19 and seeking a
medical diagnosis; or, for leave taken after March 31, 2021, is
seeking or awaiting the results of a diagnostic test for, or a
medical diagnosis of, COVID-19 (and the employee has been
exposed to COVID-19 or the employee's employer has requested such test or diagnosis), or the employee is obtaining immunizations related to COVID-19 or recovering from an injury,
disability, illness, or condition related to such immunization;
4. Is caring for an individual subject to an order described
in (1) or who has been advised as described in (2);
5. Is caring for a son or daughter because the school or
place of care for that child has been closed, or the childcare
provider for that child is unavailable, due to COVID-19 precautions; or
6. Is experiencing any other substantially similar condition
specified by the U.S. Department of Health and Human Services, including to accompany an individual to obtain immunization related to COVID-19, or to care for an individual who is
recovering from any injury, disability, illness, or condition related to the immunization.

wages can't exceed $5,110 for an employee for leave under (1),
(2), or (3), and it can't exceed $2,000 for an employee for leave
under (4), (5), or (6). These maximum amounts also reset and
apply to leave taken after March 31, 2021.
For more information about qualified sick and family leave
wages, go to IRS.gov/PLC.
Expanded FMLA. Employers with fewer than 500 employees
and, for leave taken after March 31, 2021, certain governmental employers without regard to number of employees (except
for the federal government and its agencies and instrumentalities unless described in section 501(c)(1)) are entitled to a credit under the FFCRA, as amended for purposes of the ARP, if
they provide paid family leave to employees that otherwise
meets the requirements of the Expanded FMLA. For leave taken before April 1, 2021, wages are qualified family leave wages if paid to an employee who has been employed for at least
30 calendar days when an employee is unable to work due to
the need to care for a son or daughter under 18 years of age or
incapable of self-care because of a mental or physical disability
because the school or place of care for that child has been
closed, or the childcare provider for that child is unavailable,
due to a public health emergency. See Son or daughter, earlier,
for more information. For leave taken after March 31, 2021,
the leave can be granted for any other reason provided by the
EPSLA, as amended for purposes of the ARP.
For leave taken before April 1, 2021, the first 10 days for
which an employee takes leave may be unpaid. During this period, employees may use other forms of paid leave, such as
qualified sick leave, accrued sick leave, annual leave, or other
paid time off. After an employee takes leave for 10 days, the
employer provides the employee paid leave (that is, qualified
family leave wages) for up to 10 weeks. For leave taken after
March 31, 2021, the 10-day rule discussed above doesn't apply
and the paid leave can be provided for up to 12 weeks.

Son or daughter. A son or daughter must generally have
been under 18 years of age or incapable of self-care because of
a mental or physical disability. A son or daughter includes a biological child, adopted child, stepchild, foster child, legal ward,
or child for whom the employee assumes parental status and
carries out the obligations of a parent.

Rate of pay and limit on wages. The rate of pay must be at
least two-thirds of the employee's regular rate of pay (as determined under the Fair Labor Standards Act of 1938), multiplied
by the number of hours the employee would have otherwise
been scheduled to work. For leave taken after March 31, 2020,
and before April 1, 2021, the qualified family leave wages can't
exceed $200 per day or $10,000 in the aggregate per employee.
For leave taken after March 31, 2021, the limit resets and the
total qualified leave wages can't exceed $200 per day or
$12,000 in the aggregate per employee.
For more information about qualified sick and family leave
wages, go to IRS.gov/PLC.

DRAFT AS OF
November 29, 2021

Limits on qualified sick leave wages. The EPSLA, as
amended for purposes of the ARP, provides different limitations for different circumstances under which qualified sick
leave wages are paid. For paid sick leave qualifying under (1),
(2), or (3) earlier, the amount of qualified sick leave wages is
determined at the employee's regular rate of pay, but the wages
may not exceed $511 for any day (or portion of a day) for
which the individual is paid sick leave. For paid sick leave
qualifying under (4), (5), or (6) earlier, the amount of qualified
sick leave wages is determined at two-thirds the employee's
regular rate of pay, but the wages may not exceed $200 for any
day (or portion of a day) for which the individual is paid sick
leave. The EPSLA also limits each individual to a maximum of
up to 80 hours of paid sick leave in total for leave taken after
March 31, 2020, and before April 1, 2021. The ARP resets this
limit at 80 hours of paid sick leave for leave taken after March
31, 2021. Therefore, for leave taken after March 31, 2020, and
before April 1, 2021, the maximum amount of paid sick leave

If you paid qualified sick or family leave wages for

TIP leave taken before April 1, complete lines 8g through
8i before completing Worksheet 3. If you paid qualified sick or family leave wages for leave taken after March 31,
complete lines 8k through 8n before completing Worksheet 4.
Line 8b. Enter the nonrefundable portion of the credit for
qualified sick and family leave wages for leave taken before
April 1, 2021, from Worksheet 3, Step 2, line 2j.
Businesses, tax-exempt organizations with fewer than 500
employees, and Schedule H filers that provide paid sick leave
under the EPSLA and/or provide paid family leave under the

H-7

Expanded FMLA are eligible to claim the credit for qualified
sick and family leave wages for leave taken before April 1,
2021. For purposes of this credit, qualified sick leave wages
and qualified family leave wages are wages for social security
and Medicare tax purposes, determined without regard to the
exclusions from the definition of employment under sections
3121(b)(1)–(22), that an employer pays that otherwise meet the
requirements of the EPSLA or Expanded FMLA. The credit for
qualified sick and family leave wages consists of the qualified
sick leave wages, the qualified family leave wages, the qualified health plan expenses allocable to those wages, and the employer share of Medicare tax allocable to those wages. The
nonrefundable portion of the credit is limited to the employer
share of social security tax.

Line 8e. Enter the refundable portion of qualified sick and
family leave wages for leave taken before April 1, 2021, from
Worksheet 3, Step 2, line 2k.
Businesses, tax-exempt organizations with fewer than 500
employees, and Schedule H filers that provide paid sick leave
under the EPSLA and/or provide paid family leave under the
Expanded FMLA are eligible to claim the credit for qualified
sick and family leave wages for leave taken before April 1,
2021. The refundable portion of the credit is allowed after the
employer share of social security tax is reduced to zero by nonrefundable credits.
Line 8f. Enter the refundable portion of the credit for qualified
sick and family leave wages for leave taken after March 31,
2021, and before October 1, 2021, from Worksheet 4, Step 2,
line 2m.
Businesses, tax-exempt organizations with fewer than 500
employees, and Schedule H filers are entitled to a credit if they
provide paid sick leave to employees that otherwise meets the
requirements of the EPSLA, as amended for purposes of the
ARP, and/or provide paid family leave to employees that otherwise meets the requirements under the Expanded FMLA, as
amended for purposes of the ARP, for leave taken after March
31, 2021, and before October 1, 2021. The refundable portion
of the credit is allowed after the employer share of Medicare
tax is reduced to zero by nonrefundable credits that are applied
against the employer share of Medicare tax.

DRAFT AS OF
November 29, 2021
You must include the full amount (both the nonrefund-

TIP able and refundable portions) of the credit for quali-

fied sick and family leave wages in your gross income
for the tax year that includes the last day of any calendar quarter in which a credit is allowed. See the instructions for the
form you file.

Line 8c. Enter the nonrefundable portion of credit for qualified sick and family leave wages for leave taken after March
31, 2021, and before October 1, 2021, from Worksheet 4, Step
2, line 2l.
Businesses, tax-exempt organizations with fewer than 500
employees, and Schedule H filers that provide paid sick leave
under the EPSLA, as amended for purposes of the ARP, and/or
provide paid family leave under the Expanded FMLA, as
amended for purposes of the ARP, are eligible to claim the
credit for qualified sick and family leave wages for leave taken
after March 31, 2021, and before October 1, 2021. The nonrefundable portion of the credit is limited to the employer share
of Medicare tax.
For purposes of this credit, qualified sick leave wages and
qualified family leave wages are wages for social security and
Medicare tax purposes, determined without regard to the exclusions from the definition of employment under sections
3121(b)(1)–(22), that an employer pays that otherwise meet the
requirements of the EPSLA or Expanded FMLA, as enacted
under the FFCRA and amended for purposes of the ARP.
The credit for qualified sick and family leave wages consists
of the qualified sick leave wages and/or qualified family leave
wages; qualified health plan expenses allocable to qualified
sick and family leave wages; collectively bargained defined
benefit pension plan contributions, subject to the qualified
leave wage limitations, allocable to the qualified sick and family leave wages; collectively bargained apprenticeship program
contributions, subject to the qualified leave wage limitations,
allocable to the qualified sick and family leave wages; and employer share of social security and Medicare tax allocable to
the qualified sick and family leave wages. For more information on the collectively bargained amounts discussed above,
see sections 3131 and 3132.
Line 8d. Enter the total social security, Medicare, and federal
income taxes after the nonrefundable credit. Add lines 8b and
8c and then subtract that total from line 8a.

Lines 8g Through 8n
Qualified health plan expenses allocable to qualified sick
and family leave wages. The credit for qualified sick leave
wages and qualified family leave wages is increased to cover
the qualified health plan expenses that are properly allocable to
the qualified leave wages for which the credit is allowed. These
qualified health plan expenses are amounts paid or incurred by
the employer to provide and maintain a group health plan but
only to the extent such amounts are excluded from the employees' income as coverage under an accident or health plan. The
amount of qualified health plan expenses generally includes
both the portion of the cost paid by the employer and the portion of the cost paid by the employee with pre-tax salary reduction contributions. However, qualified health plan expenses
don't include amounts that the employee paid for with after-tax
contributions. For more information, go to IRS.gov/PLC.
The amounts entered on lines 8g through 8n are

TIP amounts that you use on Worksheet 3 and Worksheet
4 at the end of these instructions to figure certain
credits. If you're claiming these credits, you must enter the applicable amounts.
Line 8g. Enter the qualified taxable sick leave wages you paid
to your employees for leave taken before April 1, 2021. Qualified sick leave wages for leave taken before April 1, 2021,
aren't subject to the employer share of social security tax;
therefore, the tax rate on these wages is 6.2% (0.062). Stop
paying social security tax on and entering an employee's wages
on line 1a when the employee's taxable wages, including wages
reported on line 1b, qualified sick leave wages, and qualified
family leave wages, reach $142,800 for the year. See the instructions for line 3, earlier, for reporting Medicare tax on

H-8

Part II. Federal Unemployment (FUTA) Tax

qualified sick leave wages, including the portion above the social security wage base. This amount is also entered on Worksheet 3, Step 2, line 2a.
Line 8h. Enter the qualified health plan expenses allocable to
qualified sick leave wages for leave taken before April 1, 2021.
This amount is also entered on Worksheet 3, Step 2, line 2b.
Line 8i. Enter the qualified taxable family leave wages you
paid to your employees for leave taken before April 1, 2021.
Qualified family leave wages for leave taken before April 1,
2021, aren't subject to the employer share of social security tax;
therefore, the tax rate on these wages is 6.2% (0.062). Stop
paying social security tax on and entering an employee's wages
on line 1a when the employee's taxable wages, including wages
reported on line 1b, qualified sick leave wages, and qualified
family leave wages, reach $142,800 for the year. See the instructions for line 3, earlier, for reporting Medicare tax on
qualified family leave wages, including the portion above the
social security wage base. This amount is also entered on
Worksheet 3, Step 2, line 2e.
Line 8j. Enter the qualified health plan expenses allocable to
qualified family leave wages for leave taken before April 1,
2021. This amount is also entered on Worksheet 3, Step 2,
line 2f.
Line 8k. Enter the qualified sick leave wages you paid to your
employees for leave taken after March 31, 2021, and before
October 1, 2021, including any qualified sick leave wages that
were above the social security wage base. See the instructions
for line 8c, earlier, for more information about qualified sick
leave wages for leave taken after March 31, 2021. This amount
is also entered on Worksheet 4, Step 2, line 2a.
Line 8l. Enter the qualified health plan expenses allocable to
qualified sick leave wages for leave taken after March 31,
2021, and before October 1, 2021. This amount is also entered
on Worksheet 4, Step 2, line 2b.
Line 8m. Enter the qualified family leave wages you paid to
your employees for leave taken after March 31, 2021, and before October 1, 2021, including any qualified family leave wages that were above the social security wage base. See the instructions for line 8c, earlier, for more information about
qualified family leave wages for leave taken after March 31,
2021. This amount is also entered on Worksheet 4, Step 2,
line 2f.
Line 8n. Enter the qualified health plan expenses allocable to
qualified family leave wages for leave taken after March 31,
2021, and before October 1, 2021. This amount is also entered
on Worksheet 4, Step 2, line 2g.
Line 9. Review the cash wages you paid to all your household
employees for each calendar quarter of 2020 and 2021.
If the total for any quarter in 2020 or 2021 is not $1,000 or
more, check "No," stop here, and include the amount from
line 8d above on Schedule 2 (Form 1040), line 9. Include the
amounts, if any, from line 8e on Schedule 3 (Form 1040),
line 13b; and from line 8f on Schedule 3 (Form 1040), line 13h.
If you don't file Form 1040, complete Schedule H, Part IV, and
follow the instructions under When and Where To File, earlier.
If the total for any quarter in 2020 or 2021 is $1,000 or
more, check "Yes" and complete Schedule H, Part II.

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.
The FUTA tax rate is 6.0% (0.060). But see Credit for contributions paid to state next. Don't collect or deduct the FUTA
tax from your employee's wages. You must pay it from your
own funds.
Credit for contributions paid to state. You may be able to
take a credit of up to 5.4% (0.054) against the FUTA tax, resulting in a net FUTA tax rate of 0.6% (0.006). But to do so,
you must pay all the required contributions for 2021 to your
state unemployment fund by April 18, 2022. Fiscal year filers
must pay all required contributions for 2021 by the due date of
their federal income tax returns (not including extensions).
State unemployment taxes are sometimes called contributions. 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 don't
include:
• Any payments deducted or deductible from your employees' pay;
• Penalties, interest, or special administrative taxes; or
• Voluntary contributions you paid to get a lower state experience rate.
If you paid contributions to any credit reduction state, see
the instructions for line 23, later.
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.

DRAFT AS OF
November 29, 2021

Fiscal year filers. If you paid all state unemployment contributions for 2021 by the due date of your return (not including extensions), check the “Yes” box on line 11. Check the
“No” box if you didn't pay all of your state contributions by the
due date of your return.
Section A
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.
For a list of states and their postal abbreviations, see State
Names and Postal Abbreviations, later.
Line 14. Enter the total of contributions (defined earlier) you
paid to your state unemployment fund for 2021. If you didn't
have to make contributions because your state gave you a 0%
experience rate, enter “0% rate” on line 14.
Line 15. Enter the total of cash wages (see Cash wages, earlier) you paid in 2021 to each household employee, including
employees paid less than $1,000. However, don't include cash
wages paid in 2021 to any of the following individuals.
• Your spouse.
• Your child who was under age 21.
• Your parent.

H-9

If you paid any household employee more than $7,000 in
2021, include on line 15 only the first $7,000 of that employee's cash wages.
Line 16. Multiply the wages on line 15 by 0.6% (0.006). Enter
the result on line 16.

Form 1040 or 1040-SR (not including extensions). You're in a
credit reduction state if you’re a household employer in a state
which has an amount greater than zero in the “Reduction Rate”
column of Worksheet 2.
If you paid state unemployment contributions late, use

TIP Worksheet 1 to figure the amount to enter on line 23.

Section B

If you're in a credit reduction state, use Worksheet 2
to figure the amount to enter on line 23. If you paid state contributions late and you're also in a credit reduction state, complete Worksheet 1 before completing Worksheet 2. If you didn't
pay any state unemployment contributions late and you're not
in a credit reduction state, you don't need to complete Worksheet 1 or Worksheet 2.

DRAFT AS OF
November 29, 2021
!

Complete lines 17 through 24 only if you checked a
“No” box on line 10, 11, or 12.

CAUTION

Credit for 2021. The credit you can take for any state unemployment fund contributions for 2021 that you pay after April
18, 2022, is limited to 90% (0.90) of the credit that would have
been allowable if the contributions were paid on or before
April 18, 2022.
Line 17. Complete all columns that apply. If you don't, you
won't get a credit. If you need more space, attach a statement
using the same format as line 17. Your state will provide the
experience rate. If you don't know your rate, contact your state
unemployment tax agency.
You must complete columns (a), (b), and (h), even if you
weren't given an experience rate. If you were given an experience rate of 5.4% (0.054) or higher, you must also complete
columns (c) and (d). If you were given a rate of less than 5.4%
(0.054), you must complete all columns.
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.

Part III. Total Household Employment Taxes

Line 25. Enter the amount from line 8d. If there is no entry on
line 8d, enter -0-.
Line 26. Add the amounts on lines 16 and 25. If you were required to complete Section B of Part II, add the amounts on
lines 24 and 25 and enter the total on line 26.
Line 27. Follow the instructions in the chart.

IF you file
Form. . .

Column (b). 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 0%, enter the amount of wages you would have had to pay taxes on if that rate hadn't been
granted.
Column (h). Enter the total contributions (defined earlier)
you paid to the state unemployment fund for 2021 by April 18,
2022. Fiscal year filers, enter the total contributions you paid to
the state unemployment fund for 2021 by the due date of your
return (not including extensions). If you’re claiming excess
credits as payments of state unemployment contributions, attach a copy of the letter from your state.
Line 18. Add the amounts in columns (g) and (h) separately
and enter the totals in the spaces provided.
Line 19. Add the amounts shown in columns (g) and (h) of
line 18 and enter the total on line 19.
Line 20. Enter the total cash wages subject to FUTA tax. See
the line 15 instructions for details.
Line 21. Multiply the wages on line 20 by 6.0% (0.060). Enter
the result on line 21.
Line 22. Multiply the wages on line 20 by 5.4% (0.054). Enter
the result on line 22.
Line 23. Enter the smaller of line 19 or 22. However, if you
paid state unemployment contributions late or you're in a credit
reduction state, don't enter the smaller of line 19 or 22, as discussed next. You paid state unemployment contributions late if
you paid any state contributions after the due date for filing

Enter the
amount from
Schedule H,
line 8d, or, if
applicable,
line 26 on...

Enter the
amount, if
any, from
Schedule H,
line 8e, on…

Enter the
amount, if
any, from
Schedule H,
line 8f, on…

1040 or 1040-SR

Schedule 2 (Form Schedule 3
1040), line 9.
(Form 1040),
line 13b.

Schedule 3
(Form 1040),
line 13h.

1040-NR

Schedule 2 (Form Schedule 3
1040), line 9.
(Form 1040),
line 13b.

Schedule 3
(Form 1040),
line 13h.

1040-SS

Form 1040-SS,
Part I, line 4.

See the
instructions for
line 11a in the
Instructions for
Form 1040-SS.

See the
instructions for
line 11b in the
Instructions
for Form
1040-SS.

1041

Form 1041,
Schedule G, Part
I, line 7.

Form 1041,
Schedule G,
Part II, line 17.

Form 1041,
Schedule G,
Part II, line 18.

If you don't file any of the above forms, complete Schedule H,
Part IV, and follow the instructions under When and Where To
File, earlier.

Paid Preparers
Paid Preparer Use Only. You must complete this part if you
were paid to prepare Schedule H, and aren't an employee of the
filing entity, and aren't attaching Schedule H to Form 1040,
1040-SR, 1040-NR, 1040-SS, or 1041. You must sign in the
space provided and give the filer a copy of Schedule H in addition to the copy to be filed with the IRS.

Form W-2 and Form W-3
If you file one or more Forms W-2, you must also file Form
W-3. We encourage you to file electronically. If filing electron-

H-10

Keep for Your Records

Worksheet 1. Credit for Late Contributions
1.

Enter the amount from Schedule H, line 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter the amount from Schedule H, line 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Subtract line 2 from line 1. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter total contributions paid to the state(s) after the Form 1040 or 1040-SR due date . . . . . .

Enter the smaller of line 3 or line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Multiply line 5 by 90% (0.90) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Add lines 2 and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter the smaller of the amount on line 1 or line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Are you in a credit reduction state?
Yes. Enter the amount from line 8 above, on Worksheet 2, line 1. Complete that Worksheet 2 to figure the amount to
enter on Schedule H, line 23.
No. Enter the amount from line 8 on Schedule H, line 23.

DRAFT AS OF
November 29, 2021
State Names and Postal Abbreviations
State

Postal
Abbreviation

State

Postal
Abbreviation

State

Postal
Abbreviation

State

Postal
Abbreviation

Alabama

Indiana

Nevada

Tennessee

Alaska

Iowa

New Hampshire

Texas

Arizona

Kansas

New Jersey

Utah

Arkansas

Kentucky

New Mexico

Vermont

California

Louisiana

New York

Virginia

Colorado

Maine

North Carolina

Washington

Connecticut

Maryland

North Dakota

West Virginia

Delaware

Massachusetts

Ohio

Wisconsin

District of Columbia

Michigan

Oklahoma

Wyoming

Florida

Minnesota

Oregon

Puerto Rico

Georgia

Mississippi

Pennsylvania

U.S. Virgin Islands

Hawaii

Missouri

Rhode Island

Idaho

Montana

South Carolina

Illinois

Nebraska

South Dakota

ically via the SSA's Form W-2 Online service, the SSA will
generate Form W-3 data from the electronic submission.
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 (later in these instructions) show
how the entries are made. For detailed information on preparing these forms, see the General Instructions for Forms W-2
and W-3.
Employee's portion of taxes paid by employer. If you paid
all of your employee's share of social security and Medicare
taxes, without deducting the amounts from the employee's pay,
the employee's wages are increased by the amount of that tax
for income tax withholding purposes. However, the tax you
paid isn't counted as social security and Medicare wages and

isn't included in boxes 3 and 5 of Form W-2. Also, don't count
the tax as wages for FUTA tax purposes. Follow steps 1
through 3 below. (See the example later in these instructions.)
1. Enter the amounts you paid on your employee's behalf
in boxes 4 and 6 (don't 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. Include the total in box 1. Also include in box 1 any taxable noncash wages which aren't reported in boxes 3 and 5.

H-11

On Form W-3, put an “X” in the “Hshld. emp.” box

TIP located in box b, Kind of Payer.

Worksheet 2. Worksheet 2 for Household Employers in a Credit Reduction
State

Keep for Your Records

1. Enter the smaller of the amount from Schedule H, line 19 or line 22. (However, if you completed Worksheet 1,
enter the amount from line 8 of that Worksheet 1.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Enter the total taxable FUTA wages from Schedule H, line 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DRAFT AS OF
November 29, 2021
3. Place an “X” in the box of EVERY state in which you had to pay state unemployment tax this year. If all of the states you check have a credit
reduction rate of zero, you don't have to complete this Worksheet 2. For each state with a credit reduction rate greater than zero, enter the FUTA
taxable wages, multiply by the reduction rate, and then enter the credit reduction amount. Don't enter your state unemployment wages in the FUTA
Taxable Wages box. Also don't include in the FUTA Taxable Wages box wages that were excluded from state unemployment tax. If any states don't
apply to you, leave them blank.
Postal Abbreviation

FUTA Taxable
Wages

Reduction
Rate

Credit Reduction

Postal Abbreviation

FUTA Taxable
Wages

Reduction
Rate

Credit Reduction

x 0.000

x 0.033

x 0.000

4. Total Credit Reduction. Add all amounts shown in the Credit Reduction boxes. Enter the total here . . . . . . . .

5. Subtract line 4 of this Worksheet 2 from line 1 of this Worksheet 2 and enter the result here and on Schedule H,
line 23. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

H-12

Worksheet 3. Credit for Qualified Sick and Family Leave Wages for Leave
Taken Before April 1, 2021

Keep for Your Records

Determine how you will complete this worksheet.
If you paid qualified sick leave wages and/or qualified family leave wages for leave taken before April 1, 2021, complete Step 1 and Step 2. Caution: Use
Worksheet 4 to figure the credit for qualified sick and family leave wages for leave taken after March 31, 2021.
Step 1.
Determine the employer share of social security tax this year
1a
Enter the amount of social security tax from Schedule H (Form 1040), Part I, line 2a . . . . . . 1a
1b
Multiply line 1a by 50% (0.50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b
1c
Enter the amount of social security tax from Schedule H (Form 1040), Part I, line 2b . . . . . . 1c
1d
Employer share of social security tax. Subtract line 1c from line 1b . . . . . . . . . . . . . . . . 1d
Step 2.
Figure the sick and family leave credit
2a
Qualified sick leave wages reported on Schedule H (Form 1040), Part I, line 8g . . . . . . . . . 2a
2a(i)
Qualified sick leave wages included on Schedule H (Form 1040), Part I, line 8g, but not
included on Schedule H (Form 1040), Part I, line 1a, because the wages reported on that line
were limited by the social security wage base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a(i)
2a(ii) Total qualified sick leave wages. Add lines 2a and 2a(i) . . . . . . . . . . . . . . . . . . . . . . . . . . 2a(ii)
2a(iii) Qualified sick leave wages excluded from the definition of employment under sections
3121(b)(1)–(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a(iii)
2b
Qualified health plan expenses allocable to qualified sick leave wages reported on
Schedule H (Form 1040), Part I, line 8h . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b
2c
Employer share of Medicare tax on qualified sick leave wages. Multiply line 2a(ii) by 1.45%
(0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2c
2d
Credit for qualified sick leave wages. Add lines 2a, 2a(ii), 2a(iii), 2b, and 2c . . . . . . . . . .
2d
2e
Qualified family leave wages reported on Schedule H (Form 1040), Part I, line 8i . . . . . . . . 2e
2e(i)
Qualified family leave wages included on Schedule H (Form 1040), Part I, line 8i, but not
included on Schedule H (Form 1040), Part I, line 3, because the wages reported on that line
were limited by the social security wage base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e(i)
2e(ii) Total qualified family leave wages. Add lines 2e and 2e(i) . . . . . . . . . . . . . . . . . . . . . . . . 2e(ii)
2e(iii) Qualified family leave wages excluded from the definition of employment under sections
3121(b)(1)–(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e(iii)
2f
Qualified health plan expenses allocable to qualified family leave wages reported on
Schedule H (Form 1040), Part I, line 8j . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2f
2g
Employer share of Medicare tax on qualified family leave wages. Multiply line 2e(ii) by
1.45% (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2g
2h
Credit for qualified family leave wages. Add lines 2e(ii), 2e(iii), 2f, and 2g . . . . . . . . . . .
2h
2i
Credit for qualified sick and family leave wages. Add lines 2d and 2h . . . . . . . . . . . . . . 2i
2j
Nonrefundable portion of credit for qualified sick and family leave wages for leave
taken before April 1, 2021. Enter the smaller of line 1d or line 2i. Enter this amount on
Schedule H (Form 1040), Part I, line 8b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2j
2k
Refundable portion of credit for qualified sick and family leave wages for leave taken
before April 1, 2021. Subtract line 2j from line 2i and enter this amount on Schedule H
(Form 1040), Part I, line 8e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2k

DRAFT AS OF
November 29, 2021

H-13

Worksheet 4. Credit for Qualified Sick and Family Leave Wages for Leave
Taken After March 31, 2021

Keep for Your Records

Determine how you will complete this worksheet.
If you paid qualified sick leave wages and/or qualified family leave wages for leave taken after March 31, 2021, complete Step 1 and Step 2. Caution: Use
Worksheet 3 to figure the credit for qualified sick and family leave wages for leave taken before April 1, 2021.
Step 1.
Determine the employer share of Medicare tax
1a
Enter the amount of Medicare tax from Schedule H (Form 1040), Part I, line 4 . . . . . . . . . . 1a
1b
Employer share of Medicare tax. Multiply line 1a by 50% (0.50) . . . . . . . . . . . . . . . . . .
1b
Step 2.
Figure the sick and family leave credit
2a
Qualified sick leave wages reported on Schedule H (Form 1040), Part I, line 8k . . . . . . . . . 2a
2a(i)
Qualified sick leave wages included on Schedule H (Form 1040), Part I, line 8k, that were
not included as wages reported on Schedule H (Form 1040), Part I, lines 3 and 4, because the
qualified sick leave wages were excluded from the definition of employment under sections
3121(b)(1)–(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a(i)
2a(ii) Subtract line 2a(i) from line 2a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a(ii)
2a(iii) Qualified sick leave wages included on Schedule H (Form 1040), Part I, line 8k, that were
not included as wages reported on Schedule H (Form 1040), Part I, line 3, because the
qualified sick leave wages were limited by the social security wage base . . . . . . . . . . . . . . 2a(iii)
2a(iv) Subtract line 2a(iii) from line 2a(ii) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a(iv)
2b
Qualified health plan expenses allocable to qualified sick leave wages reported on
Schedule H (Form 1040), Part I, line 8l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b
2b(i) Amounts under certain collectively bargained agreements allocable to qualified sick leave
wages for leave taken after March 31, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b(i)
2c
Employer share of social security tax on qualified sick leave wages. Multiply line 2a(iv) by
6.2% (0.062) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2c
2d
Employer share of Medicare tax on qualified sick leave wages. Multiply line 2a(ii) by 1.45%
(0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d
2e
Credit for qualified sick leave wages. Add lines 2a, 2b, 2b(i), 2c, and 2d . . . . . . . . . . . . .
2e
2f
Qualified family leave wages reported on Schedule H (From 1040), Part I, line 8m . . . . . . . 2f
2f(i)
Qualified family leave wages included on Schedule H (Form 1040), Part I, line 8m, that were
not included as wages reported on Schedule H (Form 1040), Part I, lines 3 and 4, because the
qualified family leave wages were excluded from the definition of employment under
sections 3121(b)(1)–(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2f(i)
2f(ii) Subtract line 2f(i) from line 2f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2f(ii)
2f(iii) Qualified family leave wages included on Schedule H (Form 1040), Part I, line 8m, that were
not included as wages reported on Schedule H (Form 1040), Part I, line 3, because the
qualified family leave wages were limited by the social security wage base . . . . . . . . . . . . 2f(iii)
2f(iv) Subtract line 2f(iii) from line 2f(ii) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2f(iv)
2g
Qualified health plan expenses allocable to qualified family leave wages reported on
Schedule H (Form 1040), Part I, line 8n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2g
2g(i) Amounts under certain collectively bargained agreements allocable to qualified family leave
wages for leave taken after March 31, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2g(i)
2h
Employer share of social security tax on qualified family leave wages. Multiply line 2f(iv) by
6.2% (0.062) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2h
2i
Employer share of Medicare tax on qualified family leave wages. Multiply line 2f(ii) by
1.45% (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2i
2j
Credit for qualified family leave wages. Add lines 2f, 2g, 2g(i), 2h, and 2i . . . . . . . . . . . .
2j
2k
Credit for qualified sick and family leave wages. Add lines 2e and 2j . . . . . . . . . . . . . . .
2k
2l
Nonrefundable portion of credit for qualified sick and family leave wages for leave
taken after March 31, 2021. Enter the smaller of line 1b or line 2k. Enter this amount on
Schedule H (Form 1040), Part I, line 8c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2l
2m
Refundable portion of credit for qualified sick and family leave wages for leave taken
after March 31, 2021. Subtract line 2l from line 2k and enter this amount on Schedule H
(Form 1040), Part I, line 8f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2m

DRAFT AS OF
November 29, 2021

H-14

For information on filing Forms W-2 and W-3 electronically, go to the SSA's Employer W-2 Filing Instructions & Information website at SSA.gov/employer.

You Should Also Know

You’re encouraged to notify each employee whose

TIP wages for 2021 were less than $51,464 ($57,414 if
married filing jointly) that he or she may be eligible
for the EIC for 2021.
How and when must I notify my employees? You must give
the employee one of the following items.
• The official IRS Form W-2, which 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.
If you’re not required to give the employee a Form W-2,
you must provide the notification by February 7, 2022.
If the notification isn't given on Form W-2 in a timely manner, 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 2021 tax returns.

DRAFT AS OF
November 29, 2021
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 Schedule H, line 26. You
may increase your federal income tax withheld by giving your
employer a new Form W-4, or by giving the payer of your pension a new Form W-4P. Make estimated tax payments by filing
Form 1040-ES, Estimated Tax for Individuals. For more information, see Pub. 505.

Estimated tax payments must be made as the tax liability is incurred by April 15, 2021; June 15, 2021;
CAUTION September 15, 2021; and January 17, 2022. If you file
your Form 1040 or 1040-SR by January 31, 2022, and pay the
rest of the tax that you owe with the form, you don't need to
make the payment due on January 17, 2022.

Exception. You won't be penalized for failure to make estimated tax payments if both (1) and (2) below apply for the year.
1. You won't have federal income tax withheld from wages, pensions, or any other payments you receive.
2. Your income taxes, excluding your household employment taxes, wouldn't be enough to require payment of estimated taxes.

What Records To Keep
You must keep copies of Schedule H and related Forms W-2,
W-3, and W-4 for at least 4 years after the due date for filing
Schedule H or the date the taxes were paid, whichever is later.
You must also keep records to support the information you enter on the forms you file. If you must file Form W-2, you will
need to keep a record of each employee's name, address, and
SSN. Each payday, you should record and keep the dates and
amounts of:
• Cash and noncash wage payments,
• Any employee social security tax you withhold or agree
to pay for your employee,
• Any employee Medicare tax you withhold or agree to pay
for your employee,
• Any federal income tax you withhold, and
• Any state employment taxes you withhold.

What Is the Earned Income Credit
(EIC)?

The EIC is a refundable tax credit for certain workers.
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
didn't do so because the income tax withholding tables showed
that no tax should be withheld.

Rules for Business Employers
Don't 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.

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 1a, 3, and, if applicable, 5
of Schedule H and complete the rest of Part I through line 7.
Add lines 2c, 4, 6, and 7. From that total, subtract the amount
of these taxes withheld by the state. Enter the result on line 8a.
Also, enter “disability” and the amount subtracted on the dotted
line next to line 8a. See the notice issued by the state for more
details.

How To Correct Schedule H
If you discover an error on a Schedule H that you previously
filed with Form 1040, 1040-SR, 1040-NR, or 1040-SS, file
Form 1040-X, Amended U.S. Individual Income Tax Return,
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 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 bold letters) “CORRECTED” followed
by the date you discovered the error.

H-15

If you owe tax, pay in full with your Form 1040-X, Form
1041, or stand-alone Schedule H. If you overpaid tax on a previously filed Schedule H, then, depending on whether you adjust or claim a refund, you must certify that you repaid or reimbursed the employee's share of social security and Medicare
taxes, or that you have obtained consents from your employees
to file a claim for refund for the employee tax. See Pub. 926 for
complete instructions.

an will need to complete Schedule H, Form W-2, and Form
W-3.
Helen's total cash wages . . . . . . . .
Helen's share of the:
Social security tax . . . . . .

$2,300.00
($50 x 46 weeks)
$142.60
($2,300 x 6.2% (0.062))

DRAFT AS OF
November 29, 2021
How To Get Forms and Publications

Medicare tax . . . . . . . . .

To get the IRS forms and publications mentioned in these instructions (including Notice 797), go to IRS.gov/Forms.

Helen's total cash wages each quarter:
1st quarter . . . . . . . . . .
2nd quarter . . . . . . . . .
3rd quarter . . . . . . . . . .
4th quarter . . . . . . . . . .

Completed Examples of
Schedule H, Form W-2, and Form
W-3

On February 11, 2021, Susan Green hired Helen Maple to
clean her house every Wednesday. Susan didn't have a household employee in 2020 and had no household employees other
than Helen during 2021.
Susan paid Helen $50 every Wednesday for her day's work.
Susan decided not to withhold Helen's share of the social security and Medicare taxes from the wages she paid Helen. Instead, she will pay Helen's share of these taxes from her own
funds. Susan didn't withhold federal income tax because Helen
didn't give her a Form W-4 to request withholding and no withholding is otherwise required.
Helen was employed by Susan for the rest of the year (a total of 46 weeks). The following is some of the information Sus-

$33.35
($2,300 x 1.45% (0.0145))
$350.00 ($50 x 7 weeks)
$650.00 ($50 x 13 weeks)
$650.00 ($50 x 13 weeks)
$650.00 ($50 x 13 weeks)

Amount included in box 1 of Form W-2 and Form W-3:
Cash wages . . . . . . . . . . . . . . . . . . . . . . .
Helen's share of social security tax paid by
Susan . . . . . . . . . . . . . . . . . . . . . . . . . .
Helen's share of Medicare tax paid by Susan . . . .
Total . . . . . . . . . . . . . . . . . . . . . . . . . . .

$2,300.00
142.60
33.35
$2,475.95

Because Susan paid less than $1,000 per quarter to household employees during 2020 (no employees) and 2021 (see
above), she isn't liable for FUTA tax.
See Pub. 926 for an example showing how to complete

TIP Forms W-2 and W-3 if the employer withheld social
security and Medicare taxes from the employee's wages.

H-16

SCHEDULE H
(Form 1040)

Department of the Treasury
Internal Revenue Service (99)

Household Employment Taxes

OMB No. 1545-0074

(For Social Security, Medicare, Withheld Income, and Federal Unemployment (FUTA) Taxes)
▶ Attach to Form 1040, 1040-SR, 1040-NR, 1040-SS, or 1041.
▶ Go to www.irs.gov/ScheduleH for instructions and the latest information.

2021

Attachment
Sequence No. 44

Social security number

Name of employer

001-11-1111

DRAFT AS OF
November 29, 2021
Employer identification number

Susan Green

0 0 1 2 3 4 5 6 7

Calendar year taxpayers having no household employees in 2021 don’t have to complete this form for 2021.
Did you pay any one household employee cash wages of $2,300 or more in 2021? (If any household employee was your spouse,
A
your child under age 21, your parent, or anyone under age 18, see the line A instructions before you answer this question.)
√ Yes. Skip lines B and C and go to line 1a.
No. Go to line B.

Part I

Social Security, Medicare, and Federal Income Taxes

1a Total cash wages subject to social security tax . . . . . . . . . .
1a
2,300
b Qualified sick and family wages for leave taken before April 1, 2021, included
on line 1a . . . . . . . . . . . . . . . . . . . . . . .
1b
2a Social security tax. Multiply line 1a by 12.4% (0.124) . . . . . . . . . . . . . . . .
2a
285
b Employer share of social security tax on qualified sick and family leave wages for leave taken before
April 1, 2021. Multiply line 1b by 6.2% (0.062) . . . . . . . . . . . . . . . . . . .
2b
c Total social security tax. Subtract line 2b from line 2a . . . . . . . . . . . . . . . .
2c
285
3
Total cash wages subject to Medicare tax . . . . . . . . . . . .
3
2,300
4
Medicare tax. Multiply line 3 by 2.9% (0.029) . . . . . . . . . . . . . . . . . . .
4
67
5
Total cash wages subject to Additional Medicare Tax withholding . . . .
5
6
Additional Medicare Tax withholding. Multiply line 5 by 0.9% (0.009) . . . . . . . . . . .
6
7
Federal income tax withheld, if any . . . . . . . . . . . . . . . . . . . . . .
7
8a Total social security, Medicare, and federal income taxes. Add lines 2c, 4, 6, and 7. . . . . . .
8a
352
b Nonrefundable portion of credit for qualified sick and family leave wages for leave taken before April 1,
2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8b
c Nonrefundable portion of credit for qualified sick and family leave wages for leave taken after March
31, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8c
d Total social security, Medicare, and federal income taxes after nonrefundable credits. Add lines 8b
and 8c and then subtract that total from line 8a . . . . . . . . . . . . . . . . . .
8d
e Refundable portion of credit for qualified sick and family leave wages for leave taken before April 1,
2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8e
f Refundable portion of credit for qualified sick and family leave wages for leave taken after March 31,
2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8f
g Qualified sick leave wages for leave taken before April 1, 2021 . . . . . . . . . . . . .
8g
h Qualified health plan expenses allocable to qualified sick leave wages reported on line 8g . . . .
8h
i Qualified family leave wages for leave taken before April 1, 2021
. . . . . . . . . . . .
8i
j Qualified health plan expenses allocable to qualified family leave wages reported on line 8i . . . .
8j
k Qualified sick wages for leave taken after March 31, 2021 . . . . . . . . . . . . . . .
8k
l Qualified health plan expenses allocable to qualified sick leave wages reported on line 8k . . . .
8l
m Qualified family leave wages for leave taken after March 31, 2021 . . . . . . . . . . . .
8m
n Qualified health plan expenses allocable to qualified family leave wages reported on line 8m . . .
8n
9
Did you pay total cash wages of $1,000 or more in any calendar quarter of 2020 or 2021 to all household employees?
(Don’t count cash wages paid in 2020 or 2021 to your spouse, your child under age 21, or your parent.)
√ No. Stop. Include the amount from line 8d above on Schedule 2 (Form 1040), line 9. Include the amounts, if any,
from line 8e on Schedule 3 (Form 1040), line 13b, and line 8f on Schedule 3 (Form 1040), line 13h. If you’re not
required to file Form 1040, see the line 9 instructions.
Yes. Go to line 10.

H-17

Note. Although not shown, Susan also enters on Form W-2
and Form W-3 the required state or local income tax information (boxes 15-20 on Form W-2; boxes 15-19 on Form W-3).

22222

a Employee’s social security number

VOID

Visit the SSA website at www.ssa.gov/employer to file Copy A
of Form W-2 electronically.

For Official Use Only
OMB No. 1545-0008

000-00-4567

b Employer identification number (EIN)

▶

1 Wages, tips, other compensation

2 Federal income tax withheld

2475.95

00-1234567

DRAFT AS OF
November 29, 2021
c Employer’s name, address, and ZIP code

3 Social security wages

4 Social security tax withheld

2300.00

142.60

5 Medicare wages and tips

Susan Green
16 Gray Street
Anyplace, CA 92665

6 Medicare tax withheld

2300.00

33.35

7 Social security tips

d Control number

8 Allocated tips

e Employee’s first name and initial

Last name

Helen R.

Suff.

10 Dependent care benefits

11 Nonqualified plans

12a See instructions for box 12
C
o
d
e

Maple

19 Pine Avenue
Anycity, CA 92666

Statutory
employee

Retirement
plan

Third-party
sick pay

14 Other

12b
C
o
d
e

12c
C
o
d
e

12d
C
o
d
e

f Employee’s address and ZIP code
15 State

Form

16 State wages, tips, etc. 17 State income tax

Employer’s state ID number

W-2

18 Local wages, tips, etc. 19 Local income tax

2021

Wage and Tax Statement

Department of the Treasury—Internal Revenue Service
For Privacy Act and Paperwork Reduction
Act Notice, see the separate instructions.

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

33333

(Check one)

For Official Use Only ▶

941

Military

CT-1

c Total number of Forms W-2

Hshld.
emp.

943

944

Medicare
govt. emp.

✗
d Establishment number

e Employer identification number (EIN)

Kind
of
Employer
(Check one)

None apply

▲

Kind
of
Payer

Cat. No. 10134D

OMB No. 1545-0008

▲

a Control number

20 Locality name

501c non-govt.

State/local
non-501c

1 Wages, tips, other compensation

2475.95

3 Social security wages

State/local 501c

f Employer’s name

4 Social security tax withheld

142.60

5 Medicare wages and tips

Susan Green

6 Medicare tax withheld

2300.00

33.35
8 Allocated tips

7 Social security tips

16 Gray Street
Anyplace, CA 92665

(Check if
applicable)

Federal govt.

2 Federal income tax withheld

2300.00

00-1234567

Third-party
sick pay

✗

10 Dependent care benefits

9
11 Nonqualified plans

12a Deferred compensation

h Other EIN used this year

13 For third-party sick pay use only

12b

15 State

14 Income tax withheld by payer of third-party sick pay

g Employer’s address and ZIP code

Employer’s state ID number

16 State wages, tips, etc.
Employer’s contact person

17 State income tax

18 Local wages, tips, etc.

19 Local income tax

Employer’s telephone number

For Official Use Only

(123) 456-7890
Employer’s fax number

Employer’s email address

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

W-3

Date ▶

Title ▶

Transmittal of Wage and Tax Statements

Note. When you fill in Forms W-2 and W-3, please:
• Type entries 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); and

2021

1/30/22
Department of the Treasury
Internal Revenue Service

• Show the cents portion of the money amounts.

H-18

Privacy Act and Paperwork Reduction Act Notice
We ask for the information on this form to carry out the Internal Revenue laws of the United States. You’re required to give us the
information. We need it to ensure that you’re complying with these laws and to allow us to figure and collect the right amount of
tax. If you don't provide the information we ask for, or provide false or fraudulent information, you may be subject to penalties.
You’re 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.

DRAFT AS OF
November 29, 2021
Subtitle C, Employment Taxes, of the Internal Revenue Code imposes employment taxes on wages and provides for 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 you to provide your identification number.

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.

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: Recordkeeping, 1 hr., 38 min.; Learning about the law or
the form, 39 min.; Preparing the form, 1 hr., 3 min.; Copying, assembling, and sending the form to the IRS, 34 min.
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 send us comments from IRS.gov/FormComments. Or you can send your comments to Internal
Revenue Service, Tax Forms and Publications Division, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Don't send
Schedule H (Form 1040) to this address. Instead, see When and Where To File, earlier.

Do You Have To File Form 1040, 1040-SR, 1040-NR, 1040-SS, or 1041?
Yes — Attach Schedule H to that form and mail to the address in your tax return instructions.
No — Mail your completed Schedule H and payment to the address shown below that applies to you. No street address is needed.
See When and Where To File, earlier, for the information to enter on your payment.
IF you live in...

THEN use this address...

Florida, Louisiana, Mississippi, Texas

Department of the Treasury
Internal Revenue Service
Austin, TX 73301-0002

Alaska, California, Hawaii, Illinois, Michigan, Minnesota, Ohio, Washington,
Wisconsin

Department of the Treasury
Internal Revenue Service
Fresno, CA 93888-0002

Alabama, Arkansas, Delaware, Georgia, Indiana, Iowa, Kentucky, Maine,
Massachusetts, Missouri, New Hampshire, New Jersey, New York, North
Carolina, Oklahoma, South Carolina, Tennessee, Vermont, Virginia

Department of the Treasury
Internal Revenue Service
Kansas City, MO 64999-0002

Arizona, Colorado, Connecticut, District of Columbia, Idaho, Kansas, Maryland,
Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon,
Pennsylvania, Rhode Island, South Dakota, Utah, West Virginia, Wyoming

Department of the Treasury
Internal Revenue Service
Ogden, UT 84201-0002

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

Department of the Treasury
Internal Revenue Service
Austin, TX 73301-0215
USA

* 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: USVI Bureau of Internal Revenue, 6115 Estate Smith Bay, St. Thomas, VI 00802.

H-19

File Type	application/pdf
File Title	2021 Instructions for Schedule H
Subject	2021 Instructions for Schedule H, HouseholdEmployment Taxes
Author	W:CAR:MP:FP
File Modified	2021-11-29
File Created	2021-11-23