Indiana Indiana Household Employment Taxes

Indiana Household Employment Taxes
Form IN-H
Schedule IN-H
State Form 48684
(R17 / 9-23)

Indiana Household Employment Taxes
Attach to Form IT-40 or Form IT-40PNR.

2023

Enclosure
Sequence No. 12

This schedule should be filed by an individual who:
	•	withholds state and county (if applicable) tax on household employees, AND
	•	pays those withholding taxes with the filing of his/her individual income tax return.
Name of employer (as shown on individual income tax return)	

	
A	 Did you file federal Schedule H for the tax year shown above?
	

Yes.	 Go to question B.

	

No.	Stop. Do not file this schedule.

Employer Social Security Number

Federal Employer Identification Number

B	 Did you withhold state and/or county income tax for any household employee?
	

Yes.	 Complete Part II on the back of this schedule.

	

No.	Stop. Do not file this schedule.

C	 Make sure you enclose the state copy of your employee's W-2 forms.

Complete Part II (on page 2) first. Carry those totals to the Part I Summary below.
Part 1:	

Summary of Household Employment Taxes

1.	 Enter the total State Tax withheld from Part II, line 2 ___________________________ 	1	.00
2.	 Enter the total County Tax withheld from Part II, line 3 _________________________ 	2	

.00

3.	 Add lines 1 and 2. Enter the total here ______________________________________ 	3	
	
Enter this amount on your Indiana individual income tax return on the following lines:
•	 Form IT-40 Schedule 4, line 2,
•	 Form IT-40PNR Schedule E, line 2.

.00

Under penalties of perjury, I declare that I have examined this schedule, including accompanying statements and W-2 forms,
and to the best of my knowledge and belief it is true, correct and complete.

___________________________________ 	
Employer's signature	

_______________________ 	
Daytime telephone number	

*24100000000*
24100000000

____________
Date

	

Part II: State and County Tax Withholding

Enter below the employee's name and Social Security number
as it appears on his/her W-2 form. Attach additional pages if
withholding for more than three household employees.
Line 1 - Enter the amount on which you are withholding federal
income tax (also enter on W-2 boxes 16 and 18.)
Line 2 - Enter the amount of Indiana state tax withheld (also
enter on W-2 box 17. Also, enter "IN" on W-2 box 15.)
Line 3 - Enter the amount of county tax withheld (also enter
on W-2 box 19).

Line 4 - Enter the 2-digit county code from Indiana
Departmental Notice #1 for which the line 3 county tax was
withheld.
Summary ♦	 Add all line 2 amounts and enter on Part I, line 1.
♦	 Add all line 3 amounts and enter on Part I, line 2.
Note: Get Form WH-4 and Departmental Notice #1 for detailed
information on how to calculate state and county withholding
amounts and to get the county code numbers. This information
is available on our web site at https://forms.in.gov/Download.
aspx?id=2702 and www.in.gov/dor/files/reference/dn01.pdf

Employee Name (First, M.I., Last)	

Employee Social Security Number

	
Income ___________________________________________________________________________ 	1	.00
State Tax Withheld _________________________________________________________________ 	 2	.00
County Tax Withheld _______________________________________________________________ 	3	.00
County Code Number (2-digit)__________________________________________________________ 	 4

Employee Name (First, M.I., Last)	

Employee Social Security Number

Income ___________________________________________________________________________ 	1	.00
State Tax Withheld _________________________________________________________________ 	 2	.00
County Tax Withheld _______________________________________________________________ 	3	.00
County Code Number (2-digit)__________________________________________________________ 	 4

Employee Name (First, M.I., Last)	

Employee Social Security Number

	
Income ___________________________________________________________________________ 	1	.00
State Tax Withheld _________________________________________________________________ 	 2	

.00

County Tax Withheld _______________________________________________________________ 	3	.00
County Code Number (2-digit)__________________________________________________________ 	 4

*24100000000*
24100000000