Form  
8919
Department of the Treasury 
Internal Revenue Service
Uncollected Social Security and  
Medicare Tax on Wages
a
 
 
Information about Form 8919 and its instructions is at 
www.irs.gov/form8919.
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Attach to your tax return. 
OMB No. 1545-0074
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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.
• You believe your pay from the firm was not for services as an independent contractor.
• The firm did not withhold your share of social security and Medicare taxes from your pay.
• One of the reasons listed below under 
Reason codes 
applies to you.
Reason codes:
For each firm listed below, enter in column (c) the applicable reason code for filing this form. 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.
C
I received other correspondence from the IRS that states I am an employee.
G
I filed Form SS-8 with the IRS and have not received a reply.
H
I received a Form W-2 and a Form 1099-MISC from this firm for 2013. The amount on Form 1099-MISC should have 
been included as wages on Form W-2. 
(Do not file Form SS-8 if you select reason code H.)
(a) 
Name of firm
(b) 
Firm’s
 
federal
 
identification
 
number       
(see instructions) 
(c) 
Enter
 
reason code    
from
 
above
(d) 
Date of IRS
 
determination or
 
correspondence 
 
(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 social security tips (total of boxes 3 
and 7 on Form(s) W-2), railroad retirement (RRTA) compensation 
(subject to the 6.2% rate), and unreported tips subject to social 
security tax from Form 4137, line 10. See instructions 
....
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 for 2013) 
.............
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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For Paperwork Reduction Act Notice, see your tax return instructions.
Cat. No. 37730B
Form 
8919 
(2013)
113,700 00
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