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Notice to Employee Unreported tip income. You must file Form 4137 with your income tax return to
figure the social security and Medicare tax owed on tips you didn’t report to your
Do you have to file? Refer to the Form 1040 instructions to determine if you are employer. Enter this amount on the wages line of your tax return. (Form 1040-SS
required to file a tax return. Even if you don’t have to file a tax return, you may be filers, see the instructions for Form 1040-SS, Part I, line 6.) By filing this form, your
eligible for a refund if box 2 shows an amount or if you are eligible for any credit. social security tips will be credited to your social security record (used to figure
Copies B and C; corrections. File Copy B of this form with your 2023 U.S. Virgin your benefits).
Islands income tax return. Keep Copy C for your records. If your name, social (See also the Instructions for Employee on this page and the back of Copy C.)
security number (SSN), or address is incorrect, correct Copies B and C and ask
your employer to correct your employment record. Be sure to ask your employer
to file Form W-2c, Corrected Wage and Tax Statement, with the Social Security Instructions for Employee
Administration (SSA) to correct any name, amount, or SSN error reported to the
SSA. Be sure to get your copies of Form W-2c from your employer for all (See also Notice to Employee on this page.)
corrections made so you may file them with your tax return. Box 5. You may be required to report this amount on Form 8959. See the Form
Estimated tax. If you expect to owe $1,000 or more in tax for 2024, you may have 1040 instructions to determine if you are required to complete Form 8959.
to make estimated tax payments to your local territory tax department. You may Box 6. This amount includes the 1.45% Medicare tax withheld on all Medicare
also have to make estimated tax payments to the U.S. Internal Revenue Service if wages and tips shown in box 5, as well as the 0.9% Additional Medicare Tax on
you are subject to self-employment taxes. See Pub. 570 for additional information. any of those Medicare wages and tips above $200,000.
Employee’s social security number (SSN). For your protection, this form may Box 11. This amount is (a) reported in box 1 if it is a distribution made to you from
show only the last four digits of your SSN. However, your employer has reported a nonqualified deferred compensation or nongovernmental section 457(b) plan, or
your complete SSN to the V.I. Bureau of Internal Revenue and the SSA. (b) included in box 3 and/or box 5 if it is a prior year deferral under a nonqualified
Clergy and religious workers. If you aren’t subject to social security and or section 457(b) plan that became taxable for social security and Medicare taxes
Medicare taxes, see Pub. 517. 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
Cost of employer-sponsored health coverage (if such cost is provided by the distribution in the same calendar year. If you made a deferral and received a
employer). The reporting in box 12, using code DD, of the cost of employer- distribution in the same calendar year, and you are or will be age 62 by the end of
sponsored health coverage is for your information only. The amount reported the calendar year, your employer should file Form SSA-131, Employer Report of
with code DD is not taxable. Special Wage Payments, with the Social Security Administration and give you a
Credit for excess social security tax. If one employer paid you wages during copy.
2023 and more than $9,932.40 in social security tax was withheld, you can claim a Box 12. The following list explains the codes shown in box 12. You may need this
refund of the excess by filing Form 1040 or 1040-SR with the V.I. Bureau of information to complete your tax return. Elective deferrals (codes D, E, F, and S)
Internal Revenue, 6115 Estate Smith Bay, Suite 225, St. Thomas, VI 00802. and designated Roth contributions (codes AA, BB, and EE) under all plans are
If you had more than one employer in 2023 and more than $9,932.40 in social generally limited to a total of $22,500 ($15,500 if you have only SIMPLE plans;
security tax was withheld, you can have the excess refunded by filing Form 843, $25,500 for section 403(b) plans if you qualify for the 15-year rule explained in
Claim for Refund and Request for Abatement, with the Department of the Pub. 571). Deferrals under code G are limited to $22,500. Deferrals under code H
Treasury, Internal Revenue Service Center, Austin, TX 73301-0215, USA. However, are limited to $7,000.
if you are required to file Form 1040 or 1040-SR with the United States, you must (continued on back of Copy C)
claim the excess tax as a credit on Form 1040 or 1040-SR.
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