Publication 926 - Household Employer'S Tax Guide - Internal Revenue Service - 2012 Page 14
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20Household Employment Taxes—Schedule H (Form 1040)
Household Employment Taxes
SCHEDULE H
OMB No. 1545-1971
(Form 1040)
2012
(For Social Security, Medicare, Withheld Income, and Federal Unemployment (FUTA) Taxes)
Attach to Form 1040, 1040NR, 1040-SS, or 1041.
Department of the Treasury
Attachment
See separate instructions.
44
Internal Revenue Service (99)
Sequence No.
Social security number
Name of employer
000-00-1111
Employer identification number
Mary Brown
1 2 3 4 5 6 7 8 9
A Did you pay any one household employee cash wages of $1,800 or more in 2012? (If any household employee was your
spouse, 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 1.
No. Go to line B.
Part I
Social Security, Medicare, and Federal Income Taxes
1 Total cash wages subject to social security taxes
1
. . . . . . .
2,300 00
239 20
2 Social security taxes. Multiply line 1 by 10.4% (.104) . . . . . . . . . . . . . . .
2
3 Total cash wages subject to Medicare taxes . . . . . . . . .
3
2,300 00
66 70
4 Medicare taxes. Multiply line 3 by 2.9% (.029)
. . . . . . . . . . . . . . . . .
4
5 Federal income tax withheld, if any . . . . . . . . . . . . . . . . . . . . .
5
305 90
6 Total social security, Medicare, and federal income taxes. Add lines 2, 4, and 5 . . . . .
6
7 Did you pay total cash wages of $1,000 or more in any calendar quarter of 2011 or 2012 to all household employees?
(Do not count cash wages paid in 2011 or 2012 to your spouse, your child under age 21, or your parent.)
No. Stop. Include the amount from line 6 above on Form 1040, line 59a. If you are not required to le Form 1040, see the
line 7 instructions.
Yes. Go to line 8.
For Privacy Act and Paperwork Reduction Act Notice, see the instructions.
Cat. No. 12187K
Schedule H (Form 1040) 2012
Page 14
Publication 926 (March 2012)
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