Social Security and Medicare Tax                                                              OMB No. 1545-0074
Form  4137                                     on Unreported Tip Income
                                         ▶ Go to www.irs.gov/Form4137 for the latest information.                                         2021
                                                                                                                                          Attachment   
Department of the Treasury                            ▶ Attach to your tax return.                                                        Sequence No. 24
Internal Revenue Service (99)
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 2021. Add the amounts from line 1, 
       column (c)            . . . . . . . . .   .  . . .         . . . .  .    . . .    .        2 
3      Total cash and charge tips you    reported   to your employer(s) in 2021. Add the amounts from line 1, 
       column (d)            . . . . . . . . .   .  . . .         . . . .  .    . . .    .      . .               .    . . . .      .  3
4      Subtract line 3 from line 2. This amount is income you         must include in the total on Form 1040 or 
       1040-SR, line 1; or Form 1040-NR, line 1a  .   . .         . . . .  .    . . .    .      . .               .    . . . .      .  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                        142,800
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 or 1040-SR, line 1; or Form 1040-NR, line 
4137 and its instructions, such as legislation enacted after they       1a. By filing this form, your social security and Medicare tips will 
were published, go to www.irs.gov/Form4137.                             be credited to your social security record (used to figure your 
What’s New                                                              benefits). Don’t use Form 4137 as a substitute Form W-2.
For 2021, the maximum wages and tips subject to social                              If you believe you’re an employee and you received 
security tax increases to $142,800. 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 (2021) 

Form 4137 (2021)                                                                                                                Page 2 

Allocated tips. You must report all your tips from 2021,           Specific Instructions 
including both cash tips and noncash tips, as income on Form 
1040 or 1040-SR, line 1; or Form 1040-NR, line 1a. Any tips you    Line 1. Complete a separate row for each employer. If you had 
reported to your employer in 2021 are included in the wages        more than five employers in 2021, attach a statement that 
shown on your Form W-2, box 1. Add to the amount in box 1          contains all of the information (and in a similar format) as 
only the tips you received in 2021 and didn’t report to your       required on Form 4137, line 1, or complete and attach line 1 of 
employer. This should include any allocated tips shown on your     additional Form(s) 4137. Complete lines 2 through 13 on only 
Form(s) W-2, box 8, unless you have adequate records to show       one Form 4137. The line 2 and line 3 amounts on that Form 
that your unreported tips are less than the amount in box 8.       4137 should be the combined totals of all your Forms 4137 and 
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 (2021) 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, you must report 100% of those tips to your      Column (b).For each employer’s name you entered in column 
employer through a written report. Cash tips include tips paid by  (a), enter the employer identification number (EIN) or the words 
cash, check, debit card, and credit card. The written report       “Applied For” exactly as shown on your Form W-2. 
should include tips your employer paid to you for charge           Columns (c) and (d). Include all cash and charge tips you 
customers, tips you received directly from customers, and tips     received. All of the following tips must be included.
you received from other employees under any tip-sharing            • Total tips you reported to your employer on time. Tips you 
arrangement. If, in any month, you worked for two or more          reported, as required, by the 10th day of the month following 
employers and received tips while working for each, the $20 rule   the month you received them are considered income in the 
applies separately to the tips you received while working for      month you reported them. For example, tips you received in 
each employer and not to the total you received. You must          December 2020 that you reported to your employer after 
report your tips to your employer by the 10th day of the month     December 31, 2020, but by January 11, 2021, are considered 
following the month you received them. If the 10th day of the      income in 2021 and should be included on your 2021 Form W-2 
month falls on a Saturday, Sunday, or legal holiday, give your     and reported on Form 4137, line 1. Report these tips in column 
employer the report by the next business day. For example,         (d). 
because July 10, 2022, is a Sunday, you must report your tips 
received in June 2022 by July 11, 2022.                            •  Tips you received in December 2021 that you reported to 
                                                                   your employer after December 31, 2021, but by January 10, 
Employees subject to the Railroad Retirement Tax Act. Don’t        2022, are considered income in 2022. Don’t include these tips 
use Form 4137 to report tips received for work covered by the      on line 1 for 2021. Instead, report these tips on line 1, column 
Railroad Retirement Tax Act. To get railroad retirement credit,    (d), on your 2022 Form 4137.
you must report these tips to your employer. 
                                                                   • Tips you didn’t report to your employer on time. Report these 
Payment of tax.Tips you reported to your employer are subject      tips in column (d). For example, tips you received in December 
to social security and Medicare tax (or railroad retirement tax),  2021 that you reported to your employer after January 10, 2022, 
Additional Medicare Tax, and income tax withholding. Your          are considered income in 2021 because you didn’t report them 
employer collects these taxes from wages (excluding tips) or       to your employer on time. 
other  funds of yours available to cover them. If your wages 
weren’t enough to cover these taxes, you may have given your       • Tips you didn’t report at all (include any allocated tips (see 
employer the additional amounts needed. Your Form W-2 will         Allocated tips, earlier) shown in box 8 on your Form(s) W-2 
include the tips you reported to your employer and the taxes       unless you can prove that your unreported tips are less than the 
withheld. If there wasn’t enough money to cover the social         amount in box 8). Report these tips in column (c). These tips are 
security and Medicare tax (or railroad retirement tax), your Form  considered income to you in the month you actually received 
W-2 will also show the uncollected tax due in box 12 with codes    them. 
A and B. See the instructions for Schedule 2 (Form 1040), line     • Tips you received that you weren’t required to report to your 
13, to see how to report the tax due. If you worked in American    employer because they totaled less than $20 during the month. 
Samoa, Guam, or the U.S. Virgin Islands, the amount of             Report these tips in column (c). 
uncollected tax due is identified in box 12 on Form W-2AS,         Line 5. Enter only the tips you weren’t required to report to your 
W-2GU, or W-2VI with codes A and B. If you worked in Puerto        employer because the total received was less than $20 in a 
Rico, Form 499R-2/W-2PR shows the uncollected tax due in the       calendar month. These tips aren’t subject to social security and 
boxes for “Seguro Social no Retenido en Propinas - Uncollected     Medicare tax. 
Social Security Tax on Tips” and “Contrib. Medicare no             Line 6. Enter this amount on Form 8959, line 2, if you’re 
Retenida en Propinas - Uncollected Medicare Tax on Tips.”          required to file that form.
Unlike the  uncollected portion of the regular (1.45%) Medicare 
tax, the uncollected Additional Medicare Tax isn’t reported on     Line 8. For railroad retirement (RRTA) compensation, don’t 
Form W-2, box 12, with code B.                                     include an amount greater than $142,800, which is the amount 
                                                                   subject to the 6.2% rate for 2021.
Penalty for not reporting tips. If you didn’t report tips to your 
employer as required, you may be charged a penalty equal to        Line 10. If line 6 includes tips you received for work you did as a 
50% of the social security, Medicare, and Additional Medicare      federal, state, or local government employee and your pay was 
Taxes due on those tips. You can avoid this penalty if you can     subject only to the 1.45% Medicare tax, subtract the amount of 
show (in a statement attached to your return) that your failure to those tips from the line 6 amount only for the purpose of 
report tips to your employer was due to reasonable cause and       comparing lines 6 and 9. Don’t reduce the actual entry on line 6. 
not due to willful neglect.                                        Enter “1.45% tips” and the amount you subtracted on the 
                                                                   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.