File Form 941 — Employer's QUARTERLY Federal Tax Return

Report wages, tips, federal income tax withheld, and Social Security and Medicare taxes for the quarter. Figures are computed by your payroll system; this form records and files them.

$200 flat per filing (a person reviews and files every return, which keeps out spam and fraudulent returns). Currently in preview — data collection is live and e-file is in progress.

Employer (filer)

EIN

Name control (optional)

Legal business name

Business name line 2

Trade name / DBA

In care of

Street address

Street address line 2

City

State

ZIP

Return

Tax year

Quarter

Third-party payer

Spanish-language form (Formulario 941 (sp))Seasonal employer — I don't have to file every quarter (Line 18)Business has closed or stopped paying wages (Line 17)

Part 1 — Taxes and wages

1. Number of employees who received wages, tips, or other compensation

2. Wages, tips, and other compensation

3. Federal income tax withheld

4. No wages, tips, and other compensation are subject to Social Security or Medicare tax

5a. Taxable Social Security wages

Wages

× 0.124 tax

5b. Taxable Social Security tips

Tips

× 0.124 tax

5c. Taxable Medicare wages & tips

Wages & tips

× 0.029 tax

5d. Wages & tips subject to Additional Medicare Tax

Wages & tips

× 0.009 tax

5e. Total Social Security and Medicare taxes

5f. Section 3121(q) Notice and Demand — tax on unreported tips

6. Total taxes before adjustments

7. Current quarter's adjustment for fractions of cents

8. Current quarter's adjustment for sick pay

9. Current quarter's adjustments for tips and group-term life insurance

10. Total taxes after adjustments

11. Qualified small business payroll tax credit (Form 8974)

12. Total taxes after adjustments and credits (required)

13. Total deposits for this quarter

14/15. Balance due or overpayment

Part 2 — Deposit schedule (Line 16)

Line 12 is less than $2,500 — no deposit schedule requiredMonthly schedule depositorSemiweekly schedule depositor (complete Schedule B)

Signature

Practitioner PIN (an ERO signs with the taxpayer — Form 8879-EMP)94x Online Signature PIN (the business self-files)

Signer name

Signer title

Taxpayer PIN (5 digits)

Practitioner PIN (5 digits)

PIN entered by

Allow a third-party designee to discuss this return with the IRS

A paid preparer completed this return