OMB No. 1545-0074
                                             Additional Medicare Tax
Form 8959                         If any line does not apply to you, leave it blank. See separate instructions.
Department of the Treasury              Attach to Form 1040, 1040-SR, 1040-NR, or 1040-SS.                               2024
                                                                                                                         Attachment   
Internal Revenue Service          Go to www.irs.gov/Form8959 for instructions and the latest information.                Sequence No. 71
Name(s) shown on return                                                                                        Your social security number

Part I   Additional Medicare Tax on Medicare Wages
1    Medicare wages and tips from Form W-2, box 5. If you have more than one
     Form W-2, enter the total of the amounts from box 5         . .  . . . . . .            1
2    Unreported tips from Form 4137, line 6  .     . . . .       . .  . . . . . .            2
3    Wages from Form 8919, line 6  .    .  . .     . . . .       . .  . . . . . .            3 
4    Add lines 1 through 3 .      . . . .  . .     . . . .       . .  . . . . . .            4 
5    Enter the following amount for your filing status:
     Married filing jointly     . . . . .  . .     . . . .       . .  . . $250,000
     Married filing separately .    . . .  . .     . . . .       . .  . . $125,000
     Single, Head of household, or Qualifying surviving spouse .      . . $200,000           5 
6    Subtract line 5 from line 4. If zero or less, enter -0-  .  . .  . . . . . .  .         .  . .   . .      . .    6 
7    Additional Medicare Tax on Medicare wages. Multiply line 6 by 0.9% (0.009). Enter here and go to 
     Part II  . .        .  . . . . . . .  . .     . . . .       . .  . . . . . .  .         .  . .   . .      . .    7 
Part II  Additional Medicare Tax on Self-Employment Income
8    Self-employment  income  from  Schedule  SE  (Form  1040),  Part  I,  line  6.  If  you 
     had a loss, enter -0-      . . . . .  . .     . . . .       . .  . . . . . .            8 
9    Enter the following amount for your filing status:
     Married filing jointly.    . . . . .  . .     . . . .       . .  . . $250,000
     Married filing separately .    . . .  . .     . . . .       . .  . . $125,000
     Single, Head of household, or Qualifying surviving spouse .      . . $200,000           9
10   Enter the amount from line 4     . .  . .     . . . .       . .  . . . . . .            10 
11   Subtract line 10 from line 9. If zero or less, enter -0-  . . .  . . . . . .            11 
12   Subtract line 11 from line 8. If zero or less, enter -0-  . . .  . . . . . .  .         .  . .   . .      . .    12 
13   Additional Medicare Tax on self-employment income. Multiply line 12 by 0.9% (0.009). Enter here and 
     go to Part III  .      . . . . . . .  . .     . . . .       . .  . . . . . .  .         .  . .   . .      . .    13 
Part III Additional Medicare Tax on Railroad Retirement Tax Act (RRTA) Compensation
14   Railroad retirement (RRTA) compensation and tips from Form(s) W-2, box 14 
     (see instructions)       . . . . . .  . .     . . . .       . .  . . . . . .            14 
15   Enter the following amount for your filing status:
     Married filing jointly     . . . . .  . .     . . . .       . .  . . $250,000
     Married filing separately .    . . .  . .     . . . .       . .  . . $125,000
     Single, Head of household, or Qualifying surviving spouse .      . . $200,000           15
16   Subtract line 15 from line 14. If zero or less, enter -0-  .  .  . . . . . .  .         .  . .   . .      . .    16 
17   Additional Medicare Tax on railroad retirement (RRTA) compensation. Multiply line 16 by 0.9% (0.009). 
     Enter here and go to Part IV .   . .  . .     . . . .       . .  . . . . . .  .         .  . .   . .      . .    17 
Part IV  Total Additional Medicare Tax
18   Add lines 7, 13, and 17. Also include this amount on Schedule 2 (Form 1040 line),       11 (Form 1040-SS 
     filers, see instructions), and go to Part V . . . . .       . .  . . . . . .  .         .  . .   . .      . .    18 
Part V   Withholding Reconciliation
19   Medicare tax withheld from Form W-2, box 6. If you have more than one Form
     W-2, enter the total of the amounts from box 6    . .       . .  . . . . . .            19
20   Enter the amount from line 1     . .  . .     . . . .       . .  . . . . . .            20
21   Multiply  line  20  by  1.45%  (0.0145).  This  is  your  regular  Medicare  tax 
     withholding on Medicare wages      .  . .     . . . .       . .  . . . . . .            21
22   Subtract  line  21  from  line  19.  If  zero  or  less,  enter  -0-.  This  is  your  Additional  Medicare  Tax 
     withholding on Medicare wages      .  . .     . . . .       . .  . . . . . .  .         .  . .   . .      . .    22
23   Additional Medicare Tax withholding on railroad retirement (RRTA) compensation from Form W-2, box 
     14  (see instructions) .     . . . .  . .     . . . .       . .  . . . . . .  .         .  . .   . .      . .    23
24   Total  Additional  Medicare  Tax  withholding.    Add  lines  22  and  23.  Also  include  this  amount  with
     federal income tax withholding on Form 1040, 1040-SR, or 1040-NR, line 25c (Form 1040-SS filers, 
     see instructions)        . . . . . .  . .     . . . .       . .  . . . . . .  .         .  . .   . .      . .    24
For Paperwork Reduction Act Notice, see your tax return instructions.              Cat. No. 59475X                       Form 8959 (2024)