941 Form

Email*

Employer Information

Tax Year

Report for this Quarter

Employer Identification Number

Name (not your trade name)

Trade Name (if any)

Country

Home Address (Number and Street)

Apt/Ste No.

City

State

Zip Code

Foreign Province, State, County

Foreign Postal Code

Part 1: Answer these questions for this quarter.

Line 1: Number of employees who received wages, tips, or other compensation for the pay period including: June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4)

Line 2: Wages, tips, and other compensation

Line 3: Federal income tax withheld from wages, tips, and other compensation

Line 4: Check if there's no wages

Line 4: Check if there's no wages, tips, and other compensation are subject to social security or Medicare tax.

Line 5a: Taxable social security wages

Line 5a(i) : Qualified Sick Leave Wages

Line 5a(ii) : Qualified family leave wages

Line 5b : Taxable social security tips

Line 5c : Taxable Medicare wages & tips

Line 5d : Taxable wages & tips subject to Additional Medicare Tax withholding

Line 5f: Section 3121(q) Notice and Demand—Tax due on unreported tips

Line 7: Current quarter’s adjustment for fractions of cents

Line 8: Current quarter’s adjustment for sick pay

Line 9: Current quarter’s adjustments for tips and group-term life insurance

Line 11: Qualified small business payroll tax credit for increasing research activities.

Line 11a: Qualified small business payroll tax credit for increasing research activities

Line 11b: Nonrefundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021

Line 11b: Nonrefundable portion of credit for qualified sick and family leave wages from Worksheet 1

Line 11c: Nonrefundable portion of employee retention credit from Worksheet 1

Line 11d: Nonrefundable portion of credit for qualified sick and family leave wages for leave taken after March 31, 2021, and before October 1, 2021 .

Line 13a: Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter

Line 13: Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter

Line 13c: Refundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021

Line 13c: Refundable portion of credit for qualified sick and family leave wages from Worksheet 1

Line 13d: Refundable portion of employee retention credit from Worksheet 1

Line 13e: Refundable portion of credit for qualified sick and family leave wages for leave taken after March 31, 2021, and before October 1, 2021

Line 13f: Total advances received from filing Form(s) 7200 for the quarter

Check one refund option:

Apply to next return
Send a refund

Part 2: Tell us about your deposit schedule and tax liability for this quarter

Line 16: Check one:

Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500, and you didn’t incur a $100,000 next-day deposit obligation during the current quarter.
You were a monthly schedule depositor for the entire quarter
You were a semiweekly schedule depositor for any part of this quarter.

Tax Liability

Month 1

Month 2

Month 3

Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank.

Line 17: Check if your business has closed or you stopped paying wages

Line 17: Check if your business has closed or you stopped paying wages

Final date of last paid wages

Line 18: Check if you’re a seasonal employer and you don’t have to file a return for every quarter of the year

Line 18: Check if you’re a seasonal employer and you don’t have to file a return for every quarter of the year

Line 19: Qualified health plan expenses allocable to qualified sick leave wages for leave taken before April 1, 2021

Line 19: Qualified health plan expenses allocable to qualified sick leave wages

Line 20: Qualified health plan expenses allocable to qualified family leave wages for leave taken before April 1, 2021

Line 20: Qualified health plan expenses allocable to qualified family leave wages

Line 21: Qualified wages for the employee retention credit

Line 22: Qualified health plan expenses allocable to wages reported on line 21

Line 23: Qualified sick leave wages for leave taken after March 31, 2021, and before October 1, 2021

Line 23: Credit from Form 5884-C, line 11, for this quarter

Line 24: Qualified health plan expenses allocable to qualified sick leave wages reported on line 23

Line 25: Amounts under certain collectively bargained agreements allocable to qualified sickleave wages reported on line 23

Line 26: Qualified family leave wages for leave taken after March 31, 2021, and before October 1, 2021

Line 27: Qualified health plan expenses allocable to qualified family leave wages reported on line 26

Line 28: Amounts under certain collectively bargained agreements allocable to qualified family leave wages reported on line 26

Part 4: May we speak with your third-party designee?

Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS?

Yes
No

Designee Full Name

Phone Number

Select a 5-digit personal identification number (PIN) to use when talking to the IRS

Part 5: Sign here. You MUST complete all three pages of Form 941 and SIGN it

Date

Print your First Name here

Print your Last Name here:

Print your title here:

Best daytime phone

Are you a paid preparer?

Yes
No

Preparer's Full Name

Date

PTIN

Firm's Name

Firm's Address

Apt/Ste No.

City

State

Zip Code

Firm's EIN

Firm's Phone

Untitled

Check if self-employed

941-V: Payment Voucher

Do you want to fill-up 941-V Payment Voucher

Do you want to fill-up 941-V Payment Voucher?

Tax Year

Report for this Quarter

Employer Identification Number

Enter your business name

Enter the amount of your payment

Country

Foreign Province, State, County

Foreign Postal Code

Home Address (Number and Street)

Apt/Ste No.

City

State

Zip Code

Hidden

941

Step 1 of 2

Employer Information

Part 1: Answer these questions for this quarter.

Part 2: Tell us about your deposit schedule and tax liability for this quarter

Tax Liability

Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank.

Part 4: May we speak with your third-party designee?

Part 5: Sign here. You MUST complete all three pages of Form 941 and SIGN it

941-V: Payment Voucher

Section Break

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