HOUSEHOLD EMPLOYEE INCOME VERIFICATION WORKSHEET

Household employee definition: If you work for someone at their home and he/she controls what work is done, how you performed the work, you made less than $2200 per household, and you did not have to purchase any expenses, you are considered a household worker and not self-employed.

*Some examples of workers who do household work are: Babysitters, Caretaker, Cleaning people, Domestic workers, Drivers, Health Aides, Housekeepers, Groundkeepers, Maids, Nannies, Private Nurses, Yard Workers, etc.

If any person you worked for paid you $2200 or more for the entire year, you must provide the tax preparer with a w2, but if you worked for multiple employers in their home and they paid you less than $2200, please give us the total amount you were paid from all employers that year combined.

You must list all your employers that you worked for in their homes.

Ledger of Payments from Employer / Employment Verification for Service Provided during

Employer's Name (Person Who Paid You)

Service(s) Provided to the Employer

The Entire Amount Received from the

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.