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Caregiver Pay Stub Template

For private home health aides and elder caregivers hired directly by a family. IRS Publication 926 lists health aides and private nurses as household workers.

Make a pay stub, $3.99Use this template, $3.99

Sample preview

StubzProSample Employer
Caregiver payday sampleIllustrative example only
EmployerSample Employer
EmployeeSample Employee
Hours × rate30 × $18.00
Pay periodIllustrative period
YTDSample total
Gross pay$540.00
Social Security-$33.48
Medicare-$7.83
Net pay$498.69
Use this template, $3.99

What this template includes

  • Family employer and caregiver identity details.
  • Pay period, pay date, hours, rate and gross pay.
  • Social Security, Medicare, net pay and year-to-date totals.

When to use it

Use this format when a family directly hires a caregiver as a household employee. If an agency employs the caregiver and controls the work, the agency is the employer and issues the stub.

Related links

Sources

FAQ

Is a directly hired caregiver a household worker?

IRS Publication 926 lists health aides and private nurses as household workers.

Who issues the stub when an agency employs the caregiver?

If an agency employs the caregiver and controls the work, the agency is the employer and issues the stub.

How much does a pay stub cost on StubzPro?

$3.99 per stub. Preview free, no account needed.

Document wages you actually paid.

Preview your pay stub before you decide to buy.

Make a pay stub, $3.99Use this template, $3.99

For real wages only. Use StubzPro to record pay you actually paid. Never make a stub to show income that wasn't earned; doing so can be illegal. This page is general information, not legal or tax advice. Figures are for 2026 and can change.