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SCHEDULE H (Form 1040) Department of the Treasury Internal Revenue Service (99) Household Employment Taxes (For Social Security, Medicare, Withheld Income, and Federal Unemployment (FUTA) Taxes) a Attach to Form 1040, 1040NR, 1040-SS, or 1041. a Information about Schedule H and its separate instructions is at www.irs.gov/form1040. OMB No. 1545-1971 20 13 Attachment Sequence No. 44 Name of employer Social security number Employer identification number Calendar year taxpayers having no household employees in 2013 do not have to complete this form for 2013. A Did you pay any one household employee cash wages of $1,800 or more in 2013? (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. B Did you withhold federal income tax during 2013 for any household employee? Yes. Skip line C and go to line 7. No. Go to line C. C Did you pay total cash wages of $1,000 or more in any calendar quarter of 2012 or 2013 to all household employees? ( Do not count cash wages paid in 2012 or 2013 to your spouse, your child under age 21, or your parent.) No. Stop. Do not file this schedule. Yes. Skip lines 1-9 and go to line 10. Part I Social Security, Medicare, and Federal Income Taxes 1 Total cash wages subject to social security tax ........ 1 2 Social security tax. Multiply line 1 by 12.4% (.124) ................ 2 3 Total cash wages subject to Medicare tax .......... 3 4 Medicare tax. Multiply line 3 by 2.9% (.029) .................. 4 5 Total cash wages subject to Additional Medicare Tax withholding . . 5 6 Additional Medicare Tax withholding. Multiply line 5 by 0.9% (.009) .......... 6 7 Federal income tax withheld, if any ..................... 7 8 Total social security, Medicare, and federal income taxes. Add lines 2, 4, 6, and 7 .... 8 9 Did you pay total cash wages of $1,000 or more in any calendar quarter of 2012 or 2013 to all household employees? ( Do not count cash wages paid in 2012 or 2013 to your spouse, your child under age 21, or your parent.) No. Stop. Include the amount from line 8 above on Form 1040, line 59a. If you are not required to file Form 1040, see the line 9 instructions. Yes. Go to line 10. For Privacy Act and Paperwork Reduction Act Notice, see the instructions. Cat. No. 12187K Schedule H (Form 1040) 2013 ----------------Page (0) Break---------------- Schedule H (Form 1040) 2013 Page 2 Part II Federal Unemployment (FUTA) Tax Yes No 10 Did you pay unemployment contributions to only one state? (If you paid contributions to a credit reduction state, see instructions and check “No.”) ....................... 10 11 Did you pay all state unemployment contributions for 2013 by April 15, 2014? Fiscal year filers see instructions 11 12 Were all wages that are taxable for FUTA tax also taxable for your state’s unemployment tax? ..... 12 Next: If you checked the “Yes” box on all the lines above, complete Section A. If you checked the “No” box on any of the lines above, skip Section A and complete Section B. Section A 13 Name of the state where you paid unemployment contributions a 14 Contributions paid to your state unemployment fund ...... 14 15 Total cash wages subject to FUTA tax .................... 15 16 FUTA tax. Multiply line 15 by .6% (.006). Enter the result here, skip Section B, and go to line 25 16 Section B 17 Complete all columns below that apply (if you need more space, see instructions): (a) Name of state (b) Taxable wages (as defined in state act) (c) State experience rate period From To (d) State experience rate (e) Multiply col. (b) by .054 (f) Multiply col. (b) by col. (d) (g) Subtract col. (f) from col. (e). If zero or less, enter -0-. (h) Contributions paid to state unemployment fund 18 Totals ............................ 18 19 Add columns (g) and (h) of line 18 ............ 19 20 Total cash wages subject to FUTA tax (see the line 15 instructions) .......... 20 21 Multiply line 20 by 6.0% (.060) ...................... 21 22 Multiply line 20 by 5.4% (.054) ............. 22 23 Enter the smaller of line 19 or line 22 .................... (Employers in a credit reduction state must use the worksheet on page H-7 and check here) . 23 24 FUTA tax. Subtract line 23 from line 21. Enter the result here and go to line 25 ...... 24 Part III Total Household Employment Taxes 25 Enter the amount from line 8. If you checked the “Yes” box on line C of page 1, enter -0- . . . 25 26 Add line 16 (or line 24) and line 25 ..................... 26 27 Are you required to file Form 1040? Yes. Stop. Include the amount from line 26 above on Form 1040, line 59a. Do not complete Part IV below. No. You may have to complete Part IV. See instructions for details. Part IV Address and Signature— Complete this part only if required. See the line 27 instructions. Address (number and street) or P.O. box if mail is not delivered to street address Apt., room, or suite no. City, town or post office, state, and ZIP code Under penalties of perjury, I declare that I have examined this schedule, including accompanying statements, and to the best of my knowledge and belief, it is true, correct, and complete. No part of any payment made to a state unemployment fund claimed as a credit was, or is to be, deducted from the payments to employees. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. F Employer’s signature F Date Paid Preparer Use Only Print/Type preparer’s name Preparer's signature Date Check if self-employed PTIN Firm’s name a Firm's address a Firm's EIN a Phone no. Schedule H (Form 1040) 2013 mm/dd/yy mm/dd/yy ----------------Page (1) Break----------------