US Internal Revenue Service: f1040sh - 2005
US Internal Revenue Service: f1040sh - 2005
US Internal Revenue Service: f1040sh - 2005
A Did you pay any one household employee cash wages of $1,400 or more in 2005? (If any household employee was your
spouse, your child under age 21, your parent, or anyone under age 18, see the line A instructions on page H-3 before you
answer this question.)
B Did you withhold federal income tax during 2005 for any household employee?
C Did you pay total cash wages of $1,000 or more in any calendar quarter of 2004 or 2005 to all household employees?
(Do not count cash wages paid in 2004 or 2005 to your spouse, your child under age 21, or your parent.)
1 Total cash wages subject to social security taxes (see page H-4) 1
6 Total social security, Medicare, and income taxes (add lines 2, 4, and 5) 6
9 Did you pay total cash wages of $1,000 or more in any calendar quarter of 2004 or 2005 to household employees?
(Do not count cash wages paid in 2004 or 2005 to your spouse, your child under age 21, or your parent.)
No. Stop. Enter the amount from line 8 above on Form 1040, line 62. If you are not required to file Form 1040, see the
line 9 instructions on page H-4.
For Privacy Act and Paperwork Reduction Act Notice, see page 7 of the separate instructions. Cat. No. 12187K Schedule H (Form 1040) 2005
VERSION A 3
I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
SCHEDULE H (FORM 1040), PAGE 2 of 2
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD to HEAD
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: NONE 203 mm (8") 279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Next: If you checked the “Yes” box on all the lines above, complete Section A.
If you checked the “No” box on any of the lines above, skip Section A and complete Section B.
Section A
13 Name of the state where you paid unemployment contributions
14 State reporting number as shown on state unemployment tax return
17 FUTA tax. Multiply line 16 by .008. Enter the result here, skip Section B, and go to line 26 17
Section B
18 Complete all columns below that apply (if you need more space, see page H-5):
(b) (d) (h) (i)
(a) (e)
State reporting number (c) State experience rate (f) (g) Subtract col. (g) Contributions
Name State
as shown on state Taxable wages (as period Multiply col. (c) Multiply col. (c) from col. (f). If paid to state
of experience
unemployment tax defined in state act) by .054 by col. (e) zero or less, unemployment
state rate
return From To enter -0-. fund
19 Totals 19
25 FUTA tax. Subtract line 24 from line 22. Enter the result here and go to line 26 25
Part III Total Household Employment Taxes
Under penalties of perjury, I declare that I have examined this schedule, including accompanying statements, and to the best of my knowledge and belief, it is true,
correct, and complete. No part of any payment made to a state unemployment fund claimed as a credit was, or is to be, deducted from the payments to employees.
Employer’s signature
Date