Form
8919
Department of the Treasury
Internal Revenue Service
Uncollected Social Security and
Medicare Tax on Wages
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See instructions on back.

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Attach to Form 1040, Form 1040NR, Form 1040NR-EZ, Form 1040-SS, or Form 1040-PR.
OMB No. 1545-0074
2010
Attachment
Sequence No.
72
Name of person who must file this form. If married, complete a separate Form 8919 for each spouse who must file this form.
Social security number
Who must file.
You must file Form 8919 if
all of the following apply.
• You performed services for a firm.
• The firm did not withhold your share of social security and Medicare taxes from your pay.
• Your pay from the firm was not for services as an independent contractor.
• One or more of the reasons listed below under Reason codes apply to you.
Reason codes: For each firm listed below, enter the applicable reason code(s) for filing this form in column (c). If none of the
reason codes apply to you, but you believe you should have been treated as an employee, enter reason
code G, and file Form SS-8 on or before the date you file your tax return.
A I filed Form SS-8 and received a determination letter stating that I am an employee of this firm.
B I was designated as a “section 530 employee” by my employer or by the IRS prior to January 1, 1997.
C I received other correspondence from the IRS that states I am an employee.
D I was previously treated as an employee by this firm and am performing services in a substantially similar capacity
and under substantially similar direction and control. (You must also enter reason code G.)
E My co-workers, performing substantially similar services under substantially similar direction and control, are treated
as employees. (You must also enter reason code G.)
F My co-workers, performing substantially similar services under substantially similar direction and control, filed Form
SS-8 for this firm and received a determination that they were employees. (You must also enter reason code G.)
G I filed Form SS-8 with the IRS and have not received a reply.
(a) Name of firm
(b) Firm’s
federal

identification

number
(see instructions)
(c) Enter
reason

code(s) from

above
(d) Date IRS
determination or

correspondence
was
received
(MM/DD/YYYY)

(see instructions)
(e) Check
if Form

1099-MISC

was received
(f) Total wages received
with no social security or

Medicare tax

withholding and not

reported on Form W-2

1
2
3
4
5
6
Total wages. Combine lines 1 through 5 in column (f). Enter here and include on Form 1040,
line 7; Form 1040NR, line 8; or Form 1040NR-EZ, line 3
. . . . . . . . . . . . .
6
7
Maximum amount of wages subject to social security tax . . .
7
8


Total social security wages and tips (total of boxes 3 and 7 on
Form(s) W-2) or railroad retirement (tier 1) compensation, and
unreported tips subject to social security tax from Form 4137,
line 10 . . . . . . . . . . . . . . . . . . . .
8
9
Subtract line 8 from line 7. If line 8 is more than line 7, enter -0- here and on line 10 . . . .
9
10
Wages subject to social security tax. Enter the smaller of line 6 or line 9 . . . . . . . .
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 here and on Form 1040, line 57; Form 1040NR, line 55; or
Form 1040NR-EZ, line 16. (Form 1040-SS and Form 1040-PR filers, see instructions) . . .
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13
For Paperwork Reduction Act Notice, see your tax return instructions.
Cat. No. 37730B
Form
8919
(2010)
106,800 00

Form 8919 (2010)
Page
2
General Instructions
Purpose of form. Use Form 8919 to figure and report your
share of the uncollected social security and Medicare taxes

due on your compensation if you were an employee but were

treated as an independent contractor by your employer. By

filing this form, your social security and Medicare taxes will

be credited to your social security record. For an explanation

of the difference between an independent contractor and an

employee, see Pub. 1779, Independent Contractor or

Employee.
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!
CAUTION
Do not use this form:
• For services you performed as an independent contractor.
Instead, use Schedule C (Form 1040), Profit or Loss From
Business, or Schedule C-EZ (Form 1040), Net Profit From
Business, to report the income. And use Schedule SE (Form
1040), Self-Employment Tax, to figure the tax on net earnings
from self-employment.
• To figure the social security and Medicare tax owed on tips
you did not report to your employer, including any allocated tips
shown on your Form(s) W-2 that you must report as income.
Instead, use Form 4137, Social Security and Medicare Tax on
Unreported Tip Income.
Firm. For purposes of this form, the term “firm” means any
individual, business enterprise, company, nonprofit

organization, state, or other entity for which you performed

services. This firm may or may not have paid you directly for

these services.
Form SS-8, Determination of Worker Status for Purposes of
Federal Employment Taxes and Income Tax Withholding.
File
this form if you want the IRS to determine whether you are
an independent contractor or an employee. See the form

instructions for information on completing the form.
Section 530 employee. A section 530 employee is one who
was determined to be an employee by the IRS prior to

January 1, 1997, but whose employer has been granted relief

from payment of employment taxes under Section 530 of the

Revenue Act of 1978.
Specific Instructions
Lines 1 through 5. Complete a separate line for each firm. If
you worked as an employee for more than 5 firms in 2010,

attach additional Form(s) 8919 with lines 1 through 5

completed. Complete lines 6 through 13 on only one Form

8919. The line 6 amount on that Form 8919 should be the

combined totals of all lines 1 through 5 of all your Forms
8919.
Column (a). Enter the name of the firm for which you
worked. If you received a Form 1099-MISC from the firm,

enter the firm’s name exactly as it is entered on Form

1099-MISC.
Column (b). The federal identification number for a firm
can be an employer identification number (EIN) or a social

security number (SSN) (if the firm is an individual). An EIN is

a nine-digit number assigned by the IRS to a business. Enter

an EIN like this: XX-XXXXXXX. Enter an SSN like this: XXX-XX-
XXXX. If you received a Form 1099-MISC from the firm, enter
the firm’s federal identification number that is entered on Form
1099-MISC. If you do not know the firm’s federal identification
number, you can use Form W-9, Request for Taxpayer
Identification Number and Certification, to request it from the
firm. If you are unable to obtain the number, enter “unknown.”
Column (c). Enter the reason code for why you are filing
this form. You can enter more than one reason code for a

firm. If none of the reason codes apply to you, but you

believe you should have been treated as an employee, enter

reason code G, and file Form SS-8 on or before the date you

file your tax return.
If you enter reason code D, E, or F, you must file Form SS-8
to request a determination of your worker status. Also enter
reason code G.
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!
CAUTION
If you enter reason codes D, E, F, or G, you or the
firm that paid you may be contacted for additional
information. Use of these reason codes is not a
guarantee that the IRS will agree with your worker
status determination. If the IRS does not agree that you are an
employee, you may be billed for the additional tax, penalties,
and interest resulting from the change to your worker status.
Column (d). Complete only if reason code A, B, or C is
entered in column (c).
Line 13. Form 1040-SS and Form 1040-PR filers, include
the amount on line 5. See the instructions for line 5 of the

form you file on how to report the tax due.