This form contains 26 fields organized into 6 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Additional Information
topmostSubform[0].Page1[0].f1_26[0 Text
Enter any other relevant information or amounts required for the completion of Form 8959.
Income Information
Form W-2, enter the total of the amounts from box 5 1 Text
Enter the total amount from box 5 of all your Form W-2s. This represents your Medicare wages.
2 2 · Unreported tips from Form 4137, line 6 Text
Enter the unreported tips from Form 4137, line 6. This includes tips you received but did not report to your employer.
3 3 Wages from Form 8919, line 6 Text
Enter the wages from Form 8919, line 6. This includes wages for which you were not subject to social security and Medicare tax.
6 Text
Enter the total of lines 1 through 5. This is the sum of your Medicare wages and other relevant income.
8 Self-employment income from Schedule SE (Form 1040), Part I, line 6. If you had a loss, enter -0--8 Text
Enter your self-employment income from Schedule SE (Form 1040), Part I, line 6. If you had a loss, enter -0-.
Income Reporting
topmostSubform[0].Page1[0].f1_16[0 Text
Enter the total amount of Medicare wages from your W-2 forms.
topmostSubform[0].Page1[0].f1_17[0 Text
Enter the total amount of self-employment income subject to Medicare tax.
16 Text
Enter the total amount of railroad retirement (RRTA) compensation.
W-2, enter the total of the amounts from box 6 19 Text
Enter the total of the amounts from box 6 of your W-2 forms.
20 Text
Enter the total amount of Medicare wages subject to regular Medicare tax.
23 Text
Enter any other amounts that need to be reported for the calculation of Additional Medicare Tax.
Miscellaneous
topmostSubform[0].Page1[0].f1_6[0 Text
This field appears to be a placeholder or an unused field. Please leave it blank.
topmostSubform[0].Page1[0].f1_7[0 Text
This field appears to be a placeholder or an unused field. Please leave it blank.
topmostSubform[0].Page1[0].f1_11[0 Text
This field appears to be a placeholder or an unused field. Please leave it blank.
topmostSubform[0].Page1[0].f1_12[0 Text
This field appears to be a placeholder or an unused field. Please leave it blank.
12 Text
This field appears to be a placeholder or an unused field. Please leave it blank.
13 Text
This field appears to be a placeholder or an unused field. Please leave it blank.
Personal Information
Name(s) shown on return Text
Enter the name(s) exactly as shown on your federal income tax return (Form 1040, 1040-SR, 1040-NR, or 1040-SS).
Your social security number Text
Enter your social security number. This should be a 9-digit number formatted as XXX-XX-XXXX.
Max length: 11 characters
Tax Calculation
7 7 Additional Medicare Tax on Medicare wages. Multiply line 6 by 0.9% (0.009). Enter here and go to Part II Text
Calculate the Additional Medicare Tax on your Medicare wages by multiplying the amount on line 6 by 0.9% (0.009). Enter the result here and proceed to Part II.
11 Subtract line 10 from line 9. If zero or less, enter -0--11 Text
Subtract the amount on line 10 from the amount on line 9. If the result is zero or less, enter -0-.
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 Text
Calculate the Additional Medicare Tax on railroad retirement (RRTA) compensation by multiplying the amount on line 16 by 0.9% (0.009). Enter the result here.
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 Text
Add the amounts from lines 7, 13, and 17. Enter the total here and also include this amount on Schedule 2 (Form 1040), line 11. For Form 1040-SS filers, see instructions.
21 Multiply line 20 by 1.45% (0.0145). This is your regular Medicare tax withholding on Medicare wages 21 Text
Multiply the amount on line 20 by 1.45% (0.0145) to calculate your regular Medicare tax withholding on Medicare wages. Enter the result here.
22 22 22 Text
Enter the total amount of Additional Medicare Tax calculated.