Household Employee Form

HOUSEHOLD EMPLOYEE FORM
TaxPayer’s Name

First NameLast Name
Household employee definition: If you work for someone at their home and he/she controls what work is done, how you did the work, you made less than $2800 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 more than $1000 in any quarter or $2800 or more for the entire year, the employer must provide a w2, but if you worked for multiple people and they paid you less than $2800, please give us the total amount you were paid from all employers that year combined.

Household Employee Questions
How do you keep track of the income generated from the employers?
You may choose more than one answer
Who is responsible for purchasing supplies and/or expenses?
Who controls the work and how it is performed for the employer?
Initial that the information provided is correct

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

Rows	Employer’s First & Last Name (Person Who Paid You)	Services Provided to the Employer	The Entire Amount Received from the Employer During the Tax Year	Method of Payment Received
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Provide One of Your Employer’s Information from the previous question as part of our verification process

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
By signing this form, you agree that all the information provided is true and correct to the best of your abilities regarding your work as a household employee. You understand the difference between self-employed and household employee. You understand that you are responsible for keeping a record of payment for services provided for at least 3 years. You have been advised by your tax preparer that the IRS may require additional verification as proof of income at a later date and it is your responsibility to provide it is requested Taxpayer's Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

HOUSEHOLD EMPLOYEE FORM