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.                                Attachment  2023
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 (2023)