14581-C

Medicare Coverage Compliance Self-Assessment For State and Local Government Employers

Agency
IRS
Revision
June 2017
Fillable fields
21
Pages
3
Official source
IRS form page
Checked
October 21, 2026
Fill 14581-C online
Page 1 of form 14581-C

Form 14581-C: Medicare Coverage Compliance Self-Assessment

Form 14581-C, Medicare Coverage Compliance Self-Assessment For State and Local Government Employers, is a checklist for government employers. The form says the Form 14581 series consists of seven topical employment tax Compliance Self-Assessment tools for voluntary use by government entities, and lists Form 14581-C among the tools for use by State and Local Government Entities Only.

This form covers Medicare coverage of employees. It asks whether any employees are exempt from Medicare under the continuing employment exception, whether Medicare is withheld from all other employees, and whether Social Security and Medicare tax are withheld and paid on rehired annuitants. Each question has Yes, No and Follow Up boxes, a note on the rules and a Comments field.

The form says the tools are provided for general information only and don't constitute legal advice or determinations by the IRS. You can fill out the PDF free in your browser on this page and download it without an account.

What's on Form 14581-C

Introduction and the 14581 series

Explains the seven tools: Forms 14581-A, B, D and G for federal, state and local government entities, and Forms 14581-C, E and F for state and local government entities only.

Common errors

Errors the form says were identified during IRS audits of public employers, including failure to pay and withhold Medicare-only tax on rehired annuitants.

Question 1: continuing employment exception

Whether any employees are exempt from Medicare under this exception. The note lists the conditions for employees hired before April 1, 1986, under IRC Section 3121(u).

Exempt services note

A list of services the IRC also exempts from mandatory Social Security and Medicare taxes, such as temporary emergency workers and some students and election workers.

Question 2: Medicare withholding

Whether there are any employees from whom Medicare is not withheld, other than those who meet the exceptions identified above.

Questions 3, 3a and 3b: rehired annuitants

Whether the entity employs rehired annuitants, and whether Social Security tax and Medicare tax are withheld and paid on them.

How to fill out Form 14581-C

  1. 1

    Choose who completes it

    The form says the tools are intended for those responsible for withholding and paying employment taxes and filing required information returns.

  2. 2

    Fill it on screen or on paper

    The form says it has fillable check box and text fields so it can be completed electronically or printed and completed manually.

  3. 3

    Read the notes

    The notes summarize the continuing employment exception, exempt services and rehired annuitant rules, under the heading Medicare Coverage, Publication 963.

  4. 4

    Check Yes, No or Follow Up

    Mark one of the three boxes for questions 1, 2 and 3, and for 3a and 3b when the entity has rehired annuitants.

  5. 5

    Add comments

    Use the Comments field under each question to record details, and list open items in Notes/Follow-up at the end.

  6. 6

    Ask about exemptions

    The form says to contact the State Social Security Administrator with any questions about the exemptions listed under question 1.

Why fill Form 14581-C on indox

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  • Works on a phone, tablet or computer

What happens with it

No filing address or deadline

The form prints no filing address, deadline or signature line. It describes itself as a self-assessment tool for voluntary use by government entities.

Not legal advice

The form says the tools are provided for general information only. They don't constitute legal advice or determinations by the IRS regarding particular tax situations, and they don't cover every question.

Rehired annuitants

The form says that when an employee retires, employment has ended for the continuing employment exception, so a rehired former employee will be subject to Medicare tax even if previously exempt.

Other topics in the series

Fringe benefits, international issues, other tax issues and worker status have their own forms, as do retirement plan and Social Security coverage for state and local government entities.

IRS resources

Page 1 lists Publications 15, 15-A, 15-B, 515, 963, 1281, 1779, 5137 and 5138, the Government Retirement Plans Toolkit and Tools for Federal, State and Local Governments.

Related forms

Who completes Form 14581-C?

  • State and local government entities

    The form lists Form 14581-C for use by State and Local Government Entities Only, not for federal entities.

  • Payroll and employment tax staff

    The people responsible for withholding and paying employment taxes, including Medicare tax, for the entity's employees.

  • Employers of rehired annuitants

    Questions 3a and 3b apply when the entity employs rehired annuitants, retired individuals rehired by an employer in the same retirement system.

  • Voluntary use

    The form describes the series as tools for voluntary use by government entities to conduct self-assessments of their compliance.

The form says the self-assessment tools are intended to be completed by those responsible for withholding and paying employment taxes and filing required information returns at a public employer.

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Questions about Form 14581-C

Is Form 14581-C filed with the IRS?

The form prints no filing address or deadline. It describes the Form 14581 series as tools for voluntary use by government entities to assess their own compliance.

Can a federal agency use Form 14581-C?

The form lists it for use by State and Local Government Entities Only. Forms 14581-A, B, D and G are listed for federal, state and local government entities.

What is the continuing employment exception?

The form describes it as applying to an employee hired or rehired before April 1, 1986, who is a member of a public retirement system and meets all of the listed conditions, including continuous employment since March 31, 1986.

Are rehired annuitants subject to Medicare tax?

The form says a retired employee who is rehired will be subject to Medicare tax, even if the employee was previously exempt because of the continuing employment exception.

Does completing it give an IRS ruling?

No. The form says the tools don't constitute legal advice or determinations by the IRS regarding particular tax situations.