SCHEDULE H                                   Household Employment Taxes                                                 OMB No. 1545-0074
(Form 1040)                 (For Social Security, Medicare, Withheld Income, and Federal Unemployment (FUTA) Taxes)
Department of the Treasury              Attach to Form 1040, 1040-SR, 1040-NR, 1040-SS, or 1041.                        Attachment  2023
Internal Revenue Service       Go to www.irs.gov/ScheduleH for instructions and the latest information.                 Sequence No. 44 
Name of employer                                                                                            Social security number 

                                                                                                            Employer identification number

Calendar year taxpayers having no household employees in 2023 don’t have to complete this form for 2023.
A   Did you pay any one household employee cash wages of $2,600 or more in 2023? (If any household employee was your spouse, 
    your child under age 21, your parent, or anyone under age 18, see the line A instructions before you answer this question.) 
           Yes. Skip lines B and C and go to line 1a.
           No. Go to line B.
B   Did you withhold federal income tax during 2023 for any household employee? 
           Yes. Skip line C and go to line 7.
           No. Go to line C.
C   Did you pay total cash wages of $1,000 or more in any calendar quarter of 2022 or 2023 to all household employees?   
    (Don’t count cash wages paid in 2022 or 2023 to your spouse, your child under age 21, or your parent.) 
           No. Stop.Don’t file this schedule. 
           Yes. Skip lines 1a–9 and go to line 10. 
Part I        Social Security, Medicare, and Federal Income Taxes 
1 a Total cash wages subject to social security tax      .  .    .  . .    . . . . .         1a
b   Qualified sick and family leave wages paid in 2023 for leave taken after March
    31, 2020, and before April 1, 2021, included on line 1a  .      . .    . . . . .         1b
2a  Social security tax. Multiply line 1a by 12.4% (0.124)       .  . .    . . . . .       . .  . .     . . .  .    2a
b   Employer share of social security tax on qualified sick and family leave wages paid in 2023 for leave 
    taken after March 31, 2020, and before April 1, 2021. Multiply line 1b by 6.2% (0.062)        .     . . .  .    2b
c   Total social security tax. Subtract line 2b from line 2a     .  . .    . . . . .       . .  . .     . . .  .    2c
3   Total cash wages subject to Medicare tax  .        . .  .    .  . .    . . . . .         3 
4   Medicare tax. Multiply line 3 by 2.9% (0.029) .      .  .    .  . .    . . . . .       . .  . .     . . .  .    4 
5   Total cash wages subject to Additional Medicare Tax withholding  .         . . .         5
6   Additional Medicare Tax withholding. Multiply line 5 by 0.9% (0.009)  .      . .       . .  . .     . . .  .    6
7   Federal income tax withheld, if any      .  .  .   . .  .    .  . .    . . . . .       . .  . .     . . .  .    7
8a  Total social security, Medicare, and federal income taxes. Add lines 2c, 4, 6, and 7.       . .     . . .  .    8a
b   Nonrefundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021  8b
c   Nonrefundable portion of credit for qualified sick and family leave wages for leave taken after March
    31, 2021, and before October 1, 2021        .  .   . .  .    .  . .    . . . . .       . .  . .     . . .  .    8c
d   Total social security, Medicare, and federal income taxes after nonrefundable credits. Add lines 8b 
    and 8c and then subtract that total from line 8a  .     .    .  . .    . . . . .       . .  . .     . . .  .    8d
e   Refundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021     8e
f   Refundable portion of credit for qualified sick and family leave wages for leave taken after March 31, 
    2021, and before October 1, 2021 .       .  .  .   . .  .    .  . .    . . . . .       . .  . .     . . .  .    8f
g   Qualified sick leave wages for leave taken before April 1, 2021  .       . . . .       . .  . .     . . .  .    8g
h   Qualified health plan expenses allocable to qualified sick leave wages reported on line 8g  .         . .  .    8h
i   Qualified family leave wages for leave taken before April 1, 2021        . . . .       . .  . .     . . .  .    8i
j   Qualified health plan expenses allocable to qualified family leave wages reported on line 8i  .       . .  .    8j
k   Qualified sick leave wages for leave taken after March 31, 2021, and before October 1, 2021  .          .  .    8k
l   Qualified health plan expenses allocable to qualified sick leave wages reported on line 8k  .         . .  .    8l
m   Qualified family leave wages for leave taken after March 31, 2021, and before October 1, 2021           .  .    8m
n   Qualified health plan expenses allocable to qualified family leave wages reported on line 8m  .         .  .    8n
9   Did you pay total cash wages of $1,000 or more in any calendar quarter of 2022 or 2023 to all household employees?   
    (Don’t count cash wages paid in 2022 or 2023 to your spouse, your child under age 21, or your parent.) 
           No. Stop. Include the amount from line 8d above on Schedule 2 (Form 1040), line 9. Include the amounts, if any, from lines  
                  8e and 8f on Schedule 3 (Form 1040), line 13z. If you’re not required to file Form 1040, see the line 9 instructions. 
           Yes. Go to line 10.
For Privacy Act and Paperwork Reduction Act Notice, see the instructions.               Cat. No. 12187K             Schedule H (Form 1040) 2023

Schedule H (Form 1040) 2023                                                                                                                                     Page  2 
Part II      Federal Unemployment (FUTA) Tax 
                                                                                                                                                      Yes  No 
10    Did you pay unemployment contributions to only one state? If you paid contributions to a credit reduction
      state, see instructions and check “No”  .             .     . . .           . . . . .     . .      . . .  .      .    . .  .    .   .    .  10
11    Did you pay all state unemployment contributions for 2023 by April 15, 2024? Fiscal year filers, see instructions                           11
12    Were all wages that are taxable for FUTA tax also taxable for your state’s unemployment tax?  .                            .    .   .    .  12
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    Contributions paid to your state unemployment fund   .                        . . . .     . .      .   14
15    Total cash wages subject to FUTA tax  .               .     . . .           . . . . .     . .      . . .  .      .    . .  .    .        15
16    FUTA tax. Multiply line 15 by 0.6% (0.006). Enter the result here, skip Section B, and go to line 25  .                                  16
                                                                        Section B 
17    Complete all columns below that apply (if you need more space, see instructions): 
         (a)                   (b)                    (c)             (d)                 (e)                (f)                   (g)                (h)   
   Name of state         Taxable wages           State experience     State           Multiply col. (b)  Multiply col. (b)    Subtract col. (f)   Contributions  
                            (as defined in         rate period      experience          by 0.054           by col. (d)        from col. (e).      paid to state  
                            state act)                                rate                                                    If zero or less,    unemployment fund 
                                                 From       To                                                                   enter    -0-.                  

18    Totals  .      . . .   . .     .         . . .  . .   .     . . .           . . . . .     . .      . . .     18
19    Add columns (g) and (h) of line 18  .           . .   .     . . .           . . . . .     . .      .   19
20    Total cash wages subject to FUTA tax (see the line 15 instructions)  .                    . .      . . .  .      .    . .  .    .        20
21    Multiply line 20 by 6.0% (0.06)  .           .  . .   .     . . .           . . . . .     . .      . . .  .      .    . .  .    .        21
22    Multiply line 20 by 5.4% (0.054)             .  . .   .     . . .           . . . . .     . .      .   22
23    Enter the smaller of line 19 or line 22.
      (If you paid state unemployment contributions late or you’re in a credit reduction state, see instructions 
      and check here) .      . .     .         . . .  . .   .     . . .           . . . . .     . .      . . .  .      .    . .  .             23
24    FUTA tax. Subtract line 23 from line 21. Enter the result here and go to line 25  .                    .  .      .    . .  .    .        24
Part III     Total Household Employment Taxes 
25    Enter the amount from line 8d. If you checked the “Yes” box on line C of page 1, enter -0-  .                           .  .    .        25
26    Add line 16 (or line 24) and line 25            . .   .     . . .           . . . . .     . .      . . .  .      .    . .  .    .        26
27    Are you required to file Form 1040? 
         Yes. Stop. Include the amount from line 26 above on Schedule 2 (Form 1040), line 9. Include the amounts, if any, from lines 
             8e and 8f on Schedule 3 (Form 1040), line 13z. Don’t complete Part IV below.
         No. You may have to complete Part IV. See instructions for details.
Part IV      Address and Signature   — Complete this part only if required. See the line 27 instructions.
Address (number and street) or P.O. box if mail isn’t delivered to street address                                                  Apt., room, or suite no. 

City, town or post office, state, and ZIP code 

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. Declaration of 
preparer (other than taxpayer) is based on all information of which preparer has any knowledge. 

Employer’s signature                                                                                       Date 
             Print/Type preparer’s name                     Preparer’s signature                             Date                Check         if PTIN
Paid                                                                                                                             self-employed
Preparer 
             Firm’s name                                                                                                    Firm’s EIN  
Use Only
             Firm’s address                                                                                                 Phone no.
                                                                                                                                          Schedule H (Form 1040) 2023