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Instructions for Employee 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
(See alsoNotice to Employee on the back of Copy B.) SSA-131, Employer Report of Special Wage Payments, with the Social
Box 1. Enter this amount on the wages line of your tax return. Security Administration and give you a copy.
Box 2. Enter this amount on the federal income tax withheld line of your Box 12. The following list explains the codes shown in box 12. You may
tax return. need this information to complete your tax return. Elective deferrals
Box 5. You may be required to report this amount on Form 8959, (codes D, E, F, and S) and designated Roth contributions (codes AA,
Additional Medicare Tax. See the Form 1040 instructions to determine if BB, and EE) under all plans are generally limited to a total of $20,500
you are required to complete Form 8959. ($14,000 if you only have SIMPLE plans; $23,500 for section 403(b)
plans if you qualify for the 15-year rule explained in Pub. 571). Deferrals
Box 6. This amount includes the 1.45% Medicare Tax withheld on all under code G are limited to $20,500. Deferrals under code H are limited
Medicare wages and tips shown in box 5, as well as the 0.9% Additional to $7,000.
Medicare Tax on any of those Medicare wages and tips above However, if you were at least age 50 in 2022, your employer may have
$200,000. allowed an additional deferral of up to $6,500 ($3,000 for section
Box 8. This amount is not included in box 1, 3, 5, or 7. For information 401(k)(11) and 408(p) SIMPLE plans). This additional deferral amount is
on how to report tips on your tax return, see the Form 1040 instructions. not subject to the overall limit on elective deferrals. For code G, the limit
You must file Form 4137, Social Security and Medicare Tax on on elective deferrals may be higher for the last 3 years before you reach
Unreported Tip Income, with your income tax return to report at least retirement age. Contact your plan administrator for more information.
the allocated tip amount unless you can prove with adequate records Amounts in excess of the overall elective deferral limit must be included
that you received a smaller amount. If you have records that show the in income. See the Form 1040 instructions.
actual amount of tips you received, report that amount even if it is more Note: If a year follows code D through H, S, Y, AA, BB, or EE, you made
or less than the allocated tips. Use Form 4137 to figure the social a make-up pension contribution for a prior year(s) when you were in
security and Medicare tax owed on tips you didn’t report to your military service. To figure whether you made excess deferrals, consider
employer. Enter this amount on the wages line of your tax return. By these amounts for the year shown, not the current year. If no year is
filing Form 4137, your social security tips will be credited to your social shown, the contributions are for the current year.
security record (used to figure your benefits). A—Uncollected social security or RRTA tax on tips. Include this tax on
Box 10. This amount includes the total dependent care benefits that Form 1040 or 1040-SR. See the Form 1040 instructions.
your employer paid to you or incurred on your behalf (including amounts B—Uncollected Medicare tax on tips. Include this tax on Form 1040 or
from a section 125 (cafeteria) plan). Any amount over your employer’s 1040-SR. See the Form 1040 instructions.
plan limit is also included in box 1. See Form 2441.
Box 11. This amount is (a) reported in box 1 if it is a distribution made to C—Taxable cost of group-term life insurance over $50,000 (included in
you from a nonqualified deferred compensation or nongovernmental boxes 1, 3 (up to the social security wage base), and 5)
section 457(b) plan, or (b) included in box 3 and/or box 5 if it is a prior D—Elective deferrals to a section 401(k) cash or deferred arrangement.
year deferral under a nonqualified or section 457(b) plan that became Also includes deferrals under a SIMPLE retirement account that is part
taxable for social security and Medicare taxes this year because there is of a section 401(k) arrangement.
no longer a substantial risk of forfeiture of your right to the deferred E—Elective deferrals under a section 403(b) salary reduction agreement
amount. This box shouldn’t be used if you had a deferral and a (continued on back of Copy 2)
distribution in the same calendar year. If you made a deferral and
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