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IRS.gov Website
Instructions for Schedule H (Form 1040)
taxmap/instr/i1040sh-004.htm#en_us_publink21451xd0e2919

Completed Examples of Schedule H, Form W-2, and Form W-3(p9)

For Use in Tax Year 2013
rule
On February 12, 2013, Susan Green hired Helen Maple to clean her house every Wednesday. Susan did not have a household employee in 2012 and had no household employees other than Helen during 2013.
Susan paid Helen $50 every Wednesday for her day's work. Susan decided not to withhold Helen's share of the social security and Medicare taxes from the wages she paid Helen. Instead, she will pay Helen's share of these taxes from her own funds. Susan did not withhold federal income tax because Helen did not give her a Form W-4 to request withholding and no withholding is otherwise required.
Helen was employed by Susan for the rest of the year (a total of 46 weeks). The following is some of the information Susan will need to complete Schedule H, Form W-2, and Form W-3.
Helen's total cash wages$2,300.00
  ($50 x 46 weeks)
Helen's share of the: 
 Social security tax$142.60
  ($2,300 x 6.2% (.062))
 Medicare tax$33.35 
  ($2,300 x 1.45% (.0145))
Helen's total cash wages each quarter:
  1st quarter$350.00 ($50 x 7weeks)
  2nd quarter $650.00 ($50 x 13 weeks)
  3rd quarter$650.00 ($50 x 13 weeks)
  4th quarter$650.00 ($50 x 13 weeks)
Amount included in box 1 of Form W-2 and Form W-3:
 Cash wages$2,300.00
 Helen's share of social security tax paid by Susan 142.60
 Helen's share of Medicare tax paid by Susan33.35
 Total$2,475.95
Because Susan paid less than $1,000 per quarter to household employees during 2012 (no employees) and 2013 (see above), she is not liable for FUTA tax.
taxtip
See Pub. 926 for an example showing how to complete Forms W-2 and W-3 if the employer withheld social security and Medicare taxes from the employee's wages.