Last Updated : January 14, 2009
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Form 4137

Social Security and Medicare Tax on Unreported Tip Income

Use this form to figure the Social Security and Medicare tax owned on tips taxpayer did not report to his/her employer, including any allocated tips shown on taxpayer’s Form(s) W-2 that must report as income. Also, use this form to figure the social security and Medicare tips to be credited to taxpayer’s social security record.

If taxpayer received cash and charge tips $20 or more in a calendar month and did not report all of those tips to his employer, taxpayer is required to file this form.

Taxpayer must give his employer a written report of cash and charge tips if he received $20 or more in tips during a month. If, in any month, taxpayer worked for two or more employers and received tips while working for each, the $20 rule applies separately for each employer.

Employer’s Name:
Enter the employer’s name to whom taxpayer was required to inform tips, but did not report.

Line 1:
This line equals to total of line 2 and line 3 of this form.

Line 2:
The amount on this line comes from all instance of Form W-2 and W-2GU line 7.

Line 3:
Double click on this line to see the links of this line. Amount on this line is the total of Form W-2 Line 8 and Form 1099M Line 7.

Line 4:
Enter on this line the tips, taxpayer not reported to his employer because the total was less than $20 in calendar month.

Line 7:
Amount on this line is the total of line 3 and 7 of Form W-2 and W-2GU.

Line 9:
The amount on this line is the smaller of line 5 or line 8 on this form.

If line 5 includes tips that taxpayer received for work did as a federal, stat, of local government employee and taxpayer’s pay was subject only to the 1.45% Medicare tax, subtract the amount of those tips from the line 5 amount only for the purpose of comparing lines 5 and 8.

Schedule U – U.S. Schedule of Unreported Tip Income

Line 1:
The amount on this line comes form Line 9 of this form.

Line 2:
The amount on this line comes form Line 5 of this form.

Supported States

Supported States

Federal CA CO CT GA

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