Instructions: 

[L1] Enter your Medicare wages and tips from box 5 of your Form W-2. If you have more 
than one Form W-2, enter the total of the amounts from box 5 of all Forms W-2. If you are filing a 
joint return, also include your spouse’s wages and tips. 

[L2] Enter unreported tips from line 6 of 
Form 4137, Social Security and Medicare Tax on Unreported Tip Income. If you are filing a joint 
return, also include the amount from line 6 of your spouse's Form 4137. There may be a Penalty for 
not reporting tips.- See Instructions 

[L3] Enter wages from line 6 of Form 8919, Uncollected Social 
Security and Medicare Tax on Wages. If you are filing a joint return, also include the amount from 
line 6 of your spouse's Form 8919. 

[L8] Enter your self-employment income from Schedule SE (Form 
1040), Part I, line 6. Combine amounts from this line if you have multiple Schedules SE. 

[L14] Enter the total of your RRTA compensation and tips. The amount of RRTA compensation for a 
railroad employee is reported on Form W-2, box 14. If you have more than one Form W-2, enter the 
total of the RRTA compensation amounts from box 14 of all Forms W-2. If you are filing a joint 
return, also include your spouse’s RRTA compensation. An employee representative subject to RRTA 
taxes should include the total compensation subject to Tier 1 Medicare tax as reported on line 2 of 
Form CT-2 (include the total of the compensation amounts from line 2 of all Forms CT-2 filed for 
2024). 

[L19] Enter the amount of Medicare tax withheld, if any, reported on Form W-2, box 6. If you have 
more than one Form W-2, add the amounts in box 6 of all your Forms W-2 and enter the total here. If 
you are filing a joint return, include your spouse’s Medicare tax withheld. Also include any 
uncollected Medicare tax on tips from Form W-2, box 12, code B, and any uncollected Medicare tax on 
the taxable cost of group-term life insurance over $50,000 (for former employees) from Form W-2, 
box 12, code N. If you have more than one Form W-2, add the amounts in box 12, codes B and N, of 
all your Forms W-2 and enter the total here. If you are filing a joint return, also include these 
amounts, if any, from your spouse's Form(s) W-2. However, don't include any amounts reported on 
Form W-2, box 12, codes B and N, for uncollected RRTA Medicare tax. Note. Both Medicare tax and 
Additional Medicare Tax withholding are reported together on Form W-2, box 6. 

[L23] Enter the amount of Additional Medicare Tax withheld, if any, reported on Form W-2, box 14. 
If you have more than one Form W-2, add the amounts in box 14 of all your Forms W-2 and enter the 
total here. If you are filing a joint return, include your spouse’s Additional Medicare Tax 
withheld. An employee representative subject to RRTA taxes should include the total Additional 
Medicare Tax paid as reported on line 3 of Form CT-2 (include the total Additional Medicare Tax 
paid from line 3 of all Forms CT-2 filed for 2024). 
