Household Employee

A household employee is a person who performs non-business services for a taxpayer in or around a taxpayer’s home. This includes child care and other dependent care, housecleaning, cooking and yardwork. If you made less than $2,300 per household and you did not have any expenses, you are considered a household worker and not self-employed.

If any person you worked for paid you $2,400 or more for the entire year, you must provide tax preparer with a W-2, but if you worked for mutiple employers and were paid less than $2,400 each, please provide the total amount you were paid from all employers for the year combined.

Total amount received from Employer(s) for the year*

Round to nearest whole number

Ledger of Payments from Employer(s)/Employment Verification*

	Employer Full Name	Employer Address	Amount Received	Service Performed
Employer 1
Employer 2
Employer 3
Employer 4
Employer 5
Employer 6
Employer 7
Employer 8

By signing this form, I agree that the information provided is true and correct to the best of my ability. I understand that I am responsible for keeping a record of payment for services provided for 3 years. I have been advised by my tax preparer that the IRS may require additional verification as proof of income at a later date and it is my responsibility to provide it if requested.

Date*

Date

Signature*

Updated January 2023