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
Box 5. You may be required to report this amount on Form 8959,
Additional Medicare Tax. See the 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
Box 8. This amount is not included in box 1, 3, 5, or 7. For information
on how to report tips on your tax return, see your Form 1040
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 benefits).
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 also is
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 shouldn’t 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 $19,000
($13,000 if you only have SIMPLE plans; $22,000 for section 403(b)
plans if you qualify for the 15-year rule explained in Pub. 571). Deferrals
under code G are limited to $19,000. Deferrals under code H are limited
However, if you were at least age 50 in 2019, your employer may have
allowed an additional deferral of up to $6,000 ($3,000 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 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 the Form 1040 instructions.
B—Uncollected Medicare tax on tips. Include this tax on Form 1040.
See 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)