Social Security and Medicare Tax                                                             OMB No. 1545-0074
Form  4137                                          on Unreported Tip Income
Department of the Treasury  
                                                          Attach to your tax return.                                                      Attachment  2022
Internal Revenue Service                    Go to www.irs.gov/Form4137 for the latest information.                                        Sequence No. 24
Name of person who received tips. If married, complete a separate Form 4137 for each spouse with unreported tips.                     Social security number 

1              (a)  Name of employer to whom you were required to         (b)  Employer                           (c)  Total cash and   (d)  Total cash and 
               but didn’t report all your tips (see instructions)       identification number  charge tips you received charge            tips you reported 
                                                                         (see instructions)       (including unreported tips)            to your employer
                                                                                                                  (see instructions)

   A 

   B 

   C 

   D 

   E 
2      Total cash and charge tips you received in 2022. Add the amounts from line 1, 
       column (c)        .  . . .  . .    . .  .    . . . .       . . . .  .    . .    . .        2 
3      Total cash and charge tips you     reported    to your employer(s) in 2022. Add the amounts from line 1, 
       column (d)        .  . . .  . .    . .  .    . . . .       . . . .  .    . .    . .      . .               .    . . . .      .  3
4      Subtract line 3 from line 2. You must include this amount on line 1c of Form 1040, 1040-SR, or 1040-NR. 
       See Allocated tips on page 2 .     . .  .    . . . .       . . . .  .    . .    . .      . .               .    . . . .      .  4
5      Cash and charge tips you received but didn’t report to your employer because the total was less than 
       $20 in a calendar month (see instructions)  .    . .       . . . .  .    . .    . .      . .               .    . . . .      .  5
6      Unreported tips subject to Medicare tax. Subtract line 5 from line 4 .     .    . .      . .               .    . . . .      .  6 
7      Maximum amount of wages (including tips) subject to social security tax  .        .        7                        147,000
8      Total  social  security  wages  and  social  security  tips  (total  of  boxes  3  and  7
       shown  on  your  Form(s)  W-2)  and  railroad  retirement  (RRTA)  compensation
       (subject to 6.2% rate) (see instructions)  .   . . .       . . . .  .    . .    . .        8
9      Subtract line 8 from line 7. If line 8 is more than line 7, enter -0-  . . .    . .      . .               .    . . . .      .  9
10     Unreported tips subject to social security tax. Enter the    smaller of line 6 or line 9. If you received tips
       as a federal, state, or local government employee, see instructions  .     .    . .      . .               .    . . . .      .  10
11     Multiply line 10 by 0.062 (social security tax rate)  .    . . . .  .    . .    . .      . .               .    . . . .      .  11 
12     Multiply line 6 by 0.0145 (Medicare tax rate)    . .       . . . .  .    . .    . .      . .               .    . . . .      .  12 
13     Add lines 11 and 12. Enter here and  include as tax on Schedule 2 (Form 1040), line 5; Form 1040-PR, 
       Part I, line 6; or Form 1040-SS, Part I, line 6. See your tax return instructions .      . .               .    . . . .      .  13 
General Instructions                                                     Purpose of form. Use Form 4137 only to figure the social 
                                                                         security and Medicare tax owed on tips you didn’t report to your 
Future Developments                                                      employer, including any allocated tips shown on your Form(s) 
                                                                         W-2 that you must report as income. You must also report the 
For the latest information about developments related to Form            income on Form 1040, 1040-SR, or 1040-NR, line 1c. By filing 
4137 and its instructions, such as legislation enacted after they        this form, your social security and Medicare tips will be credited 
were published, go to www.irs.gov/Form4137.                              to your social security record (used to figure your benefits). 
What’s New                                                               Don’t use Form 4137 as a substitute Form W-2.
For 2022, the maximum wages and tips subject to social                                 If you believe you’re an employee and you received 
security tax increases to $147,000. The social security tax rate                       Form 1099-MISC, Miscellaneous Information, or Form 
an employee must pay on tips remains at 6.2%.                             ▲!           1099-NEC, Nonemployee Compensation, instead of 
                                                                          CAUTION      Form W-2, Wage and Tax Statement, because your  
Reminder                                                                 employer didn’t consider you an employee, don’t use this form 
                                                                         to report the social security and Medicare tax on that income. 
A 0.9% Additional Medicare Tax applies to Medicare wages,                Instead, use Form 8919, Uncollected Social Security and 
Railroad Retirement Tax Act (RRTA) compensation, and self-               Medicare Tax on Wages. 
employment income over a threshold amount based on your 
filing status. Use Form 8959, Additional Medicare Tax, to figure         Who must file. You must file Form 4137 if you received cash 
this tax. See the Instructions for Form 8959 for more information        and charge tips of $20 or more in a calendar month and didn’t 
on the Additional Medicare Tax.                                          report all of those tips to your employer. You must also file Form 
                                                                         4137 if your Form(s) W-2, box 8, shows allocated tips that you 
                                                                         must report as income.

For Paperwork Reduction Act Notice, see your tax return instructions.                       Cat. No. 12626C                                  Form 4137 (2022) 

Form 4137 (2022)                                                                                                                Page 2 

Allocated tips. You must report all your tips from 2022,           Specific Instructions 
including both cash tips and noncash tips, as income on Form 
1040, 1040-SR, or 1040-NR. Any tips you reported to your           Line 1. Complete a separate row for each employer. If you had 
employer in 2022 are included in the wages shown on your           more than five employers in 2022, attach a statement that 
Form W-2, box 1. Enter on Form 1040, 1040-SR, or 1040-NR,          contains all of the information (and in a similar format) as 
line 1c, only the tips you received in 2022 and didn’t report to   required on Form 4137, line 1, or complete and attach line 1 of 
your employer. This should include any allocated tips shown on     additional Form(s) 4137. Complete lines 2 through 13 on only 
your Form(s) W-2, box 8, unless you have adequate records to       one Form 4137. The line 2 and line 3 amounts on that Form 
show that your unreported tips are less than the amount in box     4137 should be the combined totals of all your Forms 4137 and 
8. Although allocated tips are shown on your Form W-2, they        attached statements. Include your name, social security 
aren’t included in box 1 on that form and no tax is withheld from  number, and calendar year (2022) on the top of any attachment.  
these tips.                                                          Column (a). Enter your employer’s name exactly as shown on 
Tips you must report to your employer. If you receive $20 or       your Form W-2.
more in cash tips (defined next), you must report 100% of those      Column (b).For each employer’s name you entered in column 
tips to your employer through a written report. Cash tips include  (a), enter the employer identification number (EIN) or the words 
tips paid by cash, check, debit card, and credit card. The         “Applied For” exactly as shown on your Form W-2. 
written report should include tips your employer paid to you for     Columns (c) and (d). Include all cash and charge tips you 
charge customers, tips you received directly from customers,       received. All of the following tips must be included.
and tips you received from other employees under any tip-          • Total tips you reported to your employer on time. Tips you 
sharing arrangement. If, in any month, you worked for two or       reported, as required, by the 10th day of the month following the 
more employers and received tips while working for each, the       month you received them are considered income in the month 
$20 rule applies separately to the tips you received while         you reported them. For example, tips you received in December 
working for each employer and not to the total you received.       2021 that you reported to your employer after December 31, 
You must report your tips to your employer by the 10th day of      2021, but by January 10, 2022, are considered income in 2022 
the month following the month you received them. If the 10th       and should be included on your 2022 Form W-2 and reported on 
day of the month falls on a Saturday, Sunday, or legal holiday,    Form 4137, line 1. Report these tips in column (d). 
give your employer the report by the next business day. For 
example, because June 10, 2023, is a Saturday, you must            •  Tips you received in December 2022 that you reported to 
report your tips received in May 2023 by June 12, 2023.            your employer after December 31, 2022, but by January 10, 
                                                                   2023, are considered income in 2023. Don’t include these tips 
Employees subject to the Railroad Retirement Tax Act. Don’t        on line 1 for 2022. Instead, report these tips on line 1, column 
use Form 4137 to report tips received for work covered by the      (d), on your 2023 Form 4137.
Railroad Retirement Tax Act. To get railroad retirement credit, 
you must report these tips to your employer.                       • Tips you didn’t report to your employer on time. Report these 
                                                                   tips in column (d). For example, tips you received in December 
Payment of tax.Tips you reported to your employer are subject      2022 that you reported to your employer after January 10, 2023, 
to social security and Medicare tax (or railroad retirement tax),  are considered income in 2022 because you didn’t report them 
Additional Medicare Tax, and income tax withholding. Your          to your employer on time. 
employer collects these taxes from wages (excluding tips) or 
other funds of yours available to cover them. If your wages        • Tips you didn’t report at all (include any allocated tips (see 
weren’t enough to cover these taxes, you may have given your       Allocated tips, earlier) shown in box 8 on your Form(s) W-2 
employer the additional amounts needed. Your Form W-2 will         unless you can prove that your unreported tips are less than the 
include the tips you reported to your employer and the taxes       amount in box 8). Report these tips in column (c). These tips are 
withheld. If there wasn’t enough money to cover the social         considered income to you in the month you actually received 
security and Medicare tax (or railroad retirement tax), your Form  them. 
W-2 will also show the uncollected tax due in box 12 with codes    • Tips you received that you weren’t required to report to your 
A and B. See the instructions for Schedule 2 (Form 1040), line     employer because they totaled less than $20 during the month. 
13, to see how to report the tax due. If you worked in American    Report these tips in column (c). 
Samoa, Guam, or the U.S. Virgin Islands, the amount of             Line 5. Enter only the tips you weren’t required to report to your 
uncollected tax due is identified in box 12 on Form W-2AS,         employer because the total received was less than $20 in a 
W-2GU, or W-2VI with codes A and B. If you worked in Puerto        calendar month. These tips aren’t subject to social security and 
Rico, Form 499R-2/W-2PR shows the uncollected tax due in the       Medicare tax. 
boxes for “Seguro Social no Retenido en Propinas - Uncollected     Line 6. Enter this amount on Form 8959, line 2, if you’re 
Social Security Tax on Tips” and “Contrib. Medicare no             required to file that form.
Retenida en Propinas - Uncollected Medicare Tax on Tips.” 
Unlike the uncollected portion of the regular (1.45%) Medicare     Line 8. For railroad retirement (RRTA) compensation, don’t 
tax, the uncollected Additional Medicare Tax isn’t reported on     include an amount greater than $147,000, which is the amount 
Form W-2, box 12, with code B.                                     subject to the 6.2% rate for 2022.
Penalty for not reporting tips. If you didn’t report tips to your  Line 10. If line 6 includes tips you received for work you did as a 
employer as required, you may be charged a penalty equal to        federal, state, or local government employee and your pay was 
50% of the social security, Medicare, and Additional Medicare      subject only to the 1.45% Medicare tax, subtract the amount of 
Taxes due on those tips. You can avoid this penalty if you can     those tips from the line 6 amount only for the purpose of 
show (in a statement attached to your return) that your failure to comparing lines 6 and 9. Don’t reduce the actual entry on line 6. 
report tips to your employer was due to reasonable cause and       Enter “1.45% tips” and the amount you subtracted on the 
not due to willful neglect.                                        dotted line next to line 10.              
Additional information. See Pub. 531, Reporting Tip Income. 
See Rev. Rul. 2012-18 for guidance on taxes imposed on tips 
and the difference between tips and service charges. You can 
find Rev. Rul. 2012-18, 2012-26 I.R.B. 1032, at 
www.irs.gov/irb/2012-26_IRB#RR-2012-18.