Instructions for Employee (Also see Notice to Employee,
on the back of Copy B.)
Box 1. Enter this amount on the wages line of your tax return.
Box 2. Enter this amount on the federal income tax withheld line of your tax
Box 5. You may be required to report this amount on Form 8959, Additional
Medicare Tax. See Form 1040 instructions to determine if you are required to
complete Form 8959.
Box 6. This amount includes the 1.45% Medicare Tax withheld on all
Medicare wages and tips shown in Box 5, as well as the 0.9% Additional
Medicare Tax on any of those Medicare wages and tips above $200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on
how to report tips on your tax return, see your Form 1040 instructions
You must file Form 4137, Social Security and Medicare Tax on Unreported
Tip Income, with your income tax return to report at least the allocated tip
amount unless you can prove that you received a smaller amount. If you have
records that show the actual amount of tips you received, report that amount
even if it is more or less than the allocated tips. On Form 4137 you will
calculate the social security and Medicare tax owed on the allocated tips
shown on your Form(s) W-2 that you must report as income and on other tips
you did not report to your employer. By filing Form 4137, your social security
tips will be credited to your social security record (used to figure your
Box 10. This amount includes the total dependent care benefits that your
employer paid to you or incurred on your behalf (including amounts from a
section 125 (cafeteria) plan). Any amount over $5,000 is also included in box
1. Complete Form 2441, Child and Dependent Care Expenses, to compute
any taxable and nontaxable amounts.
Box 11. This amount is (a) reported in box 1 if it is a distribution made to you
from a nonqualified deferred compensation or nongovernmental section
457(b) plan or (b) included in box 3 and/or 5 if it is a prior year deferral under
a nonqualified or section 457(b) plan that became taxable for social security
and Medicare taxes this year because there is no longer a substantial risk of
forfeiture of your right to the deferred amount. This box should not be used if
you had a deferral and a distribution in the same calendar year. If you made a
deferral and received a distribution in the same calendar year, and you are or
will be age 62 by the end of the calendar year, your employer should file
Form SSA-131, Employer Report of Special Wage Payments, with the Social
Security Administration and give you a copy.
Box 12. The following list explains the codes shown in box 12. You may
need this information to complete your tax return. Elective deferrals (codes
D, E, F, and S) and designated Roth contributions (codes AA, BB, and EE)
under all plans are generally limited to a total of $17,500 ($12,000 if you only
have SIMPLE plans; $20,500 for section 403(b) plans if you qualify for the
15-year rule explained in Pub. 571). Deferrals under code G are limited to
$17,500. Deferrals under code H are limited to $7,000.
However, if you were at least age 50 in 2014, your employer may have
allowed an additional deferral of up to $5,500 ($2,500 for section 401(k)(11)
and 408(p) SIMPLE plans). This additional deferral amount is not subject to
the overall limit on elective deferrals. For code G, the limit on elective
deferrals may be higher for the last 3 years before you reach retirement age.
Contact your plan administrator for more information. Amounts in excess of
the overall elective deferral limit must be included in income. See the
“Wages, Salaries, Tips, etc.” line instructions for Form 1040.
Note. If a year follows code D through H, S, Y, AA, BB, or EE, you made a
make-up pension contribution for a prior year(s) when you were in military
service. To figure whether you made excess deferrals, consider these
amounts for the year shown, not the current year. If no year is shown, the
contributions are for the current year.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form
1040. See “Other Taxes” in the Form 1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See
“Other Taxes” in the Form 1040 instructions.
C—Taxable cost of group-term life insurance over $50,000 (included in boxes
1, 3 (up to social security wage base), and 5)
D—Elective deferrals to a section 401(k) cash or deferred arrangement. Also
includes deferrals under a SIMPLE retirement account that is part of a
section 401(k) arrangement.
E—Elective deferrals under a section 403(b) salary reduction agreement
(continued on back of Copy 2)