4137 Social Security and Medicare Tax OMB No.

1545-0074

on Unreported Tip Income 2013

Form

Department of the Treasury ▶ Information about Form 4137 and its instructions is at www.irs.gov/form4137.
Attachment
Internal Revenue Service (99) ▶ Attach to Form 1040, Form 1040NR, Form 1040NR-EZ, Form 1040-SS, or Form 1040-PR. Sequence No. 24
Name of person who received tips. If married, complete a separate Form 4137 for each spouse with unreported tips. Social security number

1 (a) Name of employer to whom (b) Employer (c) Total cash and charge (d) Total cash and charge
you were required to, but did not identification number tips you received (including tips you reported to your
report all your tips (see instructions) (see instructions) unreported tips) (see instructions) employer

E
2 Total cash and charge tips you received in 2013. Add the
amounts from line 1, column (c) . . . . . . . . . . . 2
3 Total cash and charge tips you reported to your employer(s) in 2013. Add the amounts from
line 1, column (d) . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Subtract line 3 from line 2. This amount is income you must include in the total on Form 1040,
line 7; Form 1040NR, line 8; or Form 1040NR-EZ, line 3 . . . . . . . . . . . . . 4
5 Cash and charge tips you received but did not report to your employer because the total was
less than $20 in a calendar month (see instructions). . . . . . . . . . . . . . . 5

6 Unreported tips subject to Medicare tax. Subtract line 5 from line 4 . . . . . . . . . 6

7 Maximum amount of wages (including tips) subject to
social security tax . . . . . . . . . . . . . . . . 7 113,700 00
8 Total social security wages and social security tips (total of boxes
3 and 7 shown on your Form(s) W-2) and railroad retirement
(RRTA) compensation (subject to 6.2 percent rate), see
instructions . . . . . . . . . . . . . . . . . . 8
9 Subtract line 8 from line 7. If line 8 is more than line 7, enter -0- . . . . . . . . . . 9
10 Unreported tips subject to social security tax. Enter the smaller of line 6 or line 9. If you
received tips as a federal, state, or local government employee, see instructions . . . . . 10

11 Multiply line 10 by .062 (social security tax rate) . . . . . . . . . . . . . . . . 11

12 Multiply line 6 by .0145 (Medicare tax rate). . . . . . . . . . . . . . . . . . 12
13 Add lines 11 and 12. Enter the result here and on Form 1040, line 57; Form 1040NR, line 55; or
Form 1040NR-EZ, line 16 (Form 1040-SS and 1040-PR filers, see instructions.) . . . . . 13
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 12626C Form 4137 (2013)
Form 4137 (2013) Page 2

INTENTIONALLY LEFT BLANK

Form 4137 (2013) Page 3

General Instructions employees under any tip-sharing arrangement. You must

report your tips to your employer by the 10th day of the
Future developments. For the latest information about
month following the month you received them. If the 10th
developments related to Form 4137 and its instructions,
day of the month falls on a Saturday, Sunday, or legal
such as legislation enacted after this form and
holiday, give your employer the report by the next
instructions were published, go to www.irs.gov/form4137.
business day.
What's New Employees subject to the Railroad Retirement Tax
For 2013, the maximum wages and tips subject to social Act. Do not use Form 4137 to report tips received for
security tax increased to $113,700. The social security tax work covered by the Railroad Retirement Tax Act. In
rate an employee must pay on tips is 6.2% (.062). For tax order to get railroad retirement credit, you must report
years beginning after December 31, 2012, a 0.9% these tips to your employer.
Additional Medicare Tax applies to Medicare wages, Payment of tax. Tips you reported to your employer are
Railroad Retirement Tax Act compensation, and subject to social security and Medicare tax (or railroad
self-employment income over a threshold amount based retirement tax) and income tax withholding. Your
on your filing status. Use Form 8959, Additional Medicare employer collects these taxes from wages (excluding
Tax, to figure this tax. For more information on Additional tips) or other funds of yours available to cover them. If
Medicare Tax, go to IRS.gov and enter “Additional your wages were not enough to cover these taxes, you
Medicare Tax” in the search box. may have given your employer the additional amounts
Purpose of form. Use Form 4137 only to figure the needed. Your Form W-2 will include the tips you reported
social security and Medicare tax owed on tips you did not to your employer and the taxes withheld. If there was not
report to your employer, including any allocated tips enough money to cover the social security and Medicare
shown on your Form(s) W-2 that you must report as tax (or railroad retirement tax), your Form W-2 will also
income. You must also report the income on Form 1040, show the uncollected tax due in box 12 with codes A and
line 7; Form 1040NR, line 8; or Form 1040NR-EZ, line 3. B. See the instructions for Form 1040, line 60, or Form
By filing this form, your social security and Medicare tips 1040NR, line 59, to find out how to report the tax due. If
will be credited to your social security record (used to you worked in American Samoa, Guam, or the U.S. Virgin
figure your benefits). Islands, the amount of uncollected tax due is identified in
If you believe you are an employee and you box 12 on Form W-2AS, W-2GU, or W-2VI with codes A

▲
!CAUTION
received Form 1099-MISC, Miscellaneous
Income, instead of Form W-2, Wage and Tax
and B. If you worked in Puerto Rico, Form 499R-2/
W-2PR, boxes 22 and 23, show the uncollected tax due.
See the instructions for line 6 of Form 1040-PR or 1040-
Statement, because your employer did not
consider you an employee, do not use this form to report SS to find out how to report the tax due. Unlike the
the social security and Medicare tax on that income. uncollected portion of the regular (1.45%) Medicare tax,
Instead, use Form 8919, Uncollected Social Security and the uncollected Additional Medicare Tax is not reported in
Medicare Tax on Wages. box 12 of Form W-2 with code B.
Who must file. You must file Form 4137 if you received Penalty for not reporting tips. If you did not report tips
cash and charge tips of $20 or more in a calendar month to your employer as required, you may be charged a
and did not report all of those tips to your employer. You penalty equal to 50% of the social security, Medicare,
must also file Form 4137 if box 8 of your Form(s) W-2 and Additional Medicare taxes due on those tips. You can
shows allocated tips that you must report as income. avoid this penalty if you can show that your failure to
report tips to your employer was due to reasonable cause
Allocated tips. You must report all your tips from 2013, and not due to willful neglect. To do so, you can attach a
including both cash tips and noncash tips, as income on statement to your return explaining why you did not
Form 1040, line 7; Form 1040NR, line 8; or Form report them.
1040NR-EZ, line 3. Any tips you reported to your
employer in 2013 are included in the wages shown in box Additional information. See Pub. 531, Reporting Tip
1 of your Form W-2. Add to the amount in box 1 only the Income. See Rev. Rul. 2012-18 for guidance for
tips you received in 2013 and did not report to your employees in a question and answer format regarding
employer. This should include any allocated tips shown in taxes imposed on tips, including information on the
box 8 on your Form(s) W-2, unless you have adequate difference between tips and service charges. You can find
records to show that your unreported tips are less than Rev. Rul. 2012-18, 2012-26, I.R.B. 1032 at www.irs.gov/
the amount in box 8. Although allocated tips are shown irb/2012-26_IRB/ar07.html.
on your Form W-2, they are not included in the wages, Specific Instructions
tips, and other compensation box (box 1) on that form
and no income tax, social security tax, or Medicare tax Line 1. Complete a separate line for each employer. If
has been withheld from these tips. you had more than five employers in 2013, attach a
statement that contains all of the information (and in a
Tips you must report to your employer. You must give
similar format) as required on Form 4137, line 1, or
your employer a written report of cash and charge tips if
complete and attach line 1 of additional Form(s) 4137.
you received $20 or more in tips during a month. If, in any
Complete lines 2 through 13 on only one Form 4137. The
month, you worked for two or more employers and
line 2 and line 3 amounts on that Form 4137 should be
received tips while working for each, the $20 rule applies
the combined totals of all your Forms 4137 and attached
separately to the tips you received while working for each
statement. Include your name, social security number,
employer and not to the total you received. Your
and calendar year (2013) on the top of any attachment.
reportable tips include cash tips received from customers,
charged tips (credit and debit card charges) distributed to
you by your employer, and tips received from other
Form 4137 (2013) Page 4

Column (a). Enter your employer’s name exactly as it is • Tips you received that you were not required to report
entered in box c of your Form W-2. to your employer because they totaled less than $20
Column (b). For each employer’s name you entered in during the month.
column (a), enter the employer identification number or • Allocated tips you must report as income (see page 1).
the words “applied for” exactly as shown in box b of your Line 5. Enter only the tips you were not required to report
Form W-2. to your employer because the total received was less
Column (c). Include all cash and charge tips you than $20 in a calendar month. These tips are not subject
received. This includes the following: to social security and Medicare tax.
• Total tips you reported to your employer on time. Tips Line 8. For railroad retirement (RRTA) compensation, do
you reported, as required, by the 10th day of the month not include an amount greater than $113,700, which is
following the month you received them are considered the amount subject to the 6.2 percent rate for 2013.
income in the month you reported them. For example, Line 10. If line 6 includes tips you received for work you
tips you received in December 2012 that you reported to did as a federal, state, or local government employee and
your employer after December 31, 2012, but by January your pay was subject only to the 1.45% Medicare tax,
10, 2013, are considered income in 2013 and should be subtract the amount of those tips from the line 6 amount
included on your 2013 Form W-2 and reported on line 1 only for the purpose of comparing lines 6 and 9. Do not
of Form 4137. However, tips you received in December reduce the actual entry on line 6. Enter “1.45% tips” and
2013 that you reported to your employer after December the amount you subtracted on the dotted line next to line
31, 2013, but by January 10, 2014, are considered 10.
income in 2014. Do not include these tips on line 1. Line 11. Multiply the amount on line 10 by .062 (the social
• Tips you did not report to your employer on time or did security rate for 2013).
not report at all. This should include any allocated tips Line 13. Form 1040-SS and Form 1040-PR filers, include
shown in box 8 on your Form(s) W-2 unless you can the amount from line 13 on line 6 of Form 1040-SS or
prove that your unreported tips are less than the amount Form 1040-PR. See the instructions for Form 1040-SS or
in box 8. Tips you did not report to your employer on time Form 1040-PR for more information.
or did not report at all are considered income to you in
the month you actually received them. For example, tips
you received in December 2013 that you reported to your
employer after January 10, 2014, are considered income
in 2013 because you did not report them to your
employer on time.